PDF(Pubmed)
Abstract：
BACKGROUND: Access and use of contraception services by adolescent girls and young women (AGYW) remains suboptimal, exposing AGYW to early and often unexpected pregnancy. Unexpected pregnancies are a public health concern, associated with poor neonatal and maternal health outcomes, as well as school dropout, which may result in economic hardships. This study aimed to explore (a) AGYW perceptions and experiences of receiving contraception services from health care providers and (b) health care providers\' perceptions and experiences of providing contraception services to AGYW.
METHODS: Data were collected through semi-structured individual interviews with AGYW aged 15-24 years old and health care providers working in eight health care facilities around the Cape Town metropolitan area, in South Africa\'s Western Cape Province. Thematic analysis was used to analyse the data.
RESULTS: AGYW and health care providers voiced varying, and often contrasting, perceptions of some of the barriers that hinder AGYW\'s access to contraception services. AGYW indicated that provider-imposed rules about when to access contraceptive services hindered access, while health care providers felt that these rules were necessary for coordinating their work. In addition, AGYW highlighted health care providers\' hostile attitudes towards them as an important factor discouraging access. On the contrary, health care providers did not think that their attitudes hampered AGYW\'s access to and use of contraception services, instead they emphasised that challenges at the health system level were a major issue, which they feel they have little control over. Such challenges made health care providers\' work unpleasant and frustrating, impacting on their work approach and how they receive and offer services to AGYW.
CONCLUSIONS: The expectation of negative attitudes from health care providers continues to be at the centre of AGYW discouragement towards accessing contraception services. System challenges are among some of the key drivers of health care provider\'s hostile attitudes, posing challenges to the efficient provision of services. In order to improve AGYW\'s access to and use of contraception services, and subsequently achieve the country\'s SDGs, conscious efforts need to be directed towards improving the workload and working conditions of health care providers.
METHODS: Data were collected through semi-structured individual interviews with AGYW aged 15-24 years old and health care providers working in eight health care facilities around the Cape Town metropolitan area, in South Africa\'s Western Cape Province. Thematic analysis was used to analyse the data.
RESULTS: AGYW and health care providers voiced varying, and often contrasting, perceptions of some of the barriers that hinder AGYW\'s access to contraception services. AGYW indicated that provider-imposed rules about when to access contraceptive services hindered access, while health care providers felt that these rules were necessary for coordinating their work. In addition, AGYW highlighted health care providers\' hostile attitudes towards them as an important factor discouraging access. On the contrary, health care providers did not think that their attitudes hampered AGYW\'s access to and use of contraception services, instead they emphasised that challenges at the health system level were a major issue, which they feel they have little control over. Such challenges made health care providers\' work unpleasant and frustrating, impacting on their work approach and how they receive and offer services to AGYW.
CONCLUSIONS: The expectation of negative attitudes from health care providers continues to be at the centre of AGYW discouragement towards accessing contraception services. System challenges are among some of the key drivers of health care provider\'s hostile attitudes, posing challenges to the efficient provision of services. In order to improve AGYW\'s access to and use of contraception services, and subsequently achieve the country\'s SDGs, conscious efforts need to be directed towards improving the workload and working conditions of health care providers.
摘要：
背景：青春期女孩和年轻妇女（AGYW）获得和使用避孕服务的情况仍然欠佳，将AGYW暴露于早期且经常意外的怀孕。意外怀孕是一个公共卫生问题，与不良的新生儿和产妇健康结果相关，以及辍学，这可能会导致经济困难。这项研究旨在探索（a）AGYW从医疗保健提供者那里获得避孕服务的看法和经验，以及（b）医疗保健提供者向AGYW提供避孕服务的看法和经验。
方法：通过对年龄在15-24岁的AGYW和在开普敦都会区的八个医疗机构工作的医疗保健提供者的半结构化个人访谈收集数据，在南非的西开普省。采用专题分析法对数据进行分析。
结果：AGYW和医疗保健提供者表达了不同的观点，经常形成对比，对阻碍AGYW获得避孕服务的一些障碍的看法。AGYW指出，提供者强加的关于何时获得避孕服务的规则阻碍了获得，而医疗保健提供者认为这些规则对于协调他们的工作是必要的。此外,AGYW强调了医疗保健提供者对他们的敌对态度，这是阻碍获取服务的重要因素。相反,卫生保健提供者不认为他们的态度阻碍了AGYW获得和使用避孕服务，相反，他们强调卫生系统层面的挑战是一个主要问题，他们觉得自己无法控制。这些挑战使医疗保健提供者的工作不愉快和令人沮丧，影响他们的工作方法以及他们如何接受和提供服务AGYW。
结论：医疗保健提供者对消极态度的期望仍然是AGYW对获得避孕服务的劝阻的中心。系统挑战是医疗保健提供者敌对态度的一些关键驱动因素之一，对有效提供服务构成挑战。为了提高AGYW获得和使用避孕服务的能力，并随后实现该国的可持续发展目标，需要有意识地努力改善医疗保健提供者的工作量和工作条件。
方法：通过对年龄在15-24岁的AGYW和在开普敦都会区的八个医疗机构工作的医疗保健提供者的半结构化个人访谈收集数据，在南非的西开普省。采用专题分析法对数据进行分析。
结果：AGYW和医疗保健提供者表达了不同的观点，经常形成对比，对阻碍AGYW获得避孕服务的一些障碍的看法。AGYW指出，提供者强加的关于何时获得避孕服务的规则阻碍了获得，而医疗保健提供者认为这些规则对于协调他们的工作是必要的。此外,AGYW强调了医疗保健提供者对他们的敌对态度，这是阻碍获取服务的重要因素。相反,卫生保健提供者不认为他们的态度阻碍了AGYW获得和使用避孕服务，相反，他们强调卫生系统层面的挑战是一个主要问题，他们觉得自己无法控制。这些挑战使医疗保健提供者的工作不愉快和令人沮丧，影响他们的工作方法以及他们如何接受和提供服务AGYW。
结论：医疗保健提供者对消极态度的期望仍然是AGYW对获得避孕服务的劝阻的中心。系统挑战是医疗保健提供者敌对态度的一些关键驱动因素之一，对有效提供服务构成挑战。为了提高AGYW获得和使用避孕服务的能力，并随后实现该国的可持续发展目标，需要有意识地努力改善医疗保健提供者的工作量和工作条件。
