Intersectoral strategies between health and education for preventing adolescent pregnancy in Chile: Findings from a qualitative study

Abstract

Background In Chile, despite its steady decrease overall, adolescent pregnancy is concentrated in the most vulnerable population. Efforts in intersectoral collaboration between health and education to address the problem are being developed, but they have not been assessed. Objective To describe intersectoral strategies between health and education to address adolescent sexual and reproductive health, prevent adolescent pregnancy, and to explore adolescents’ and health professionals’ perceptions regarding those strategies. Design A qualitative ethnographic study was carried out in five municipalities in the Metropolitan Region of Chile. A sample of five key informants, 23 health professionals and 50 adolescents participated in a total of 38 semi‐structured interviews and five discussion groups. Results Two intersectoral strategies to respond to adolescents’ sexual and reproductive health needs were identified: (a) the “in‐and‐out” strategy, where health professionals provide health care mostly in health centres and carry out specific actions in schools and (b) the school‐based strategy in which health professionals carry out continuous actions in schools as part of the curriculum. The second is perceived as responding better to adolescents’ needs in sexual and reproductive health issues and in preventing adolescent pregnancy. Discussion The school‐based strategy, with the constant presence of health professionals and lack of bureaucratic procedures, facilitates adolescents to access sexual and reproductive health care. This strategy enables sexual and reproductive health to be understood as an integral dimension of adolescents’ lives, and it reinforces a holistic idea of health in which it is approached as a whole.

Intersectoral actions in decreasing social inequities faced by children and adolescents

“…Ribeirão Preto, SP, Brazil, 2019 As for the year of publication, the papers included were published from 2008 to 2019, though most papers were published between 2014 and 2019 (26) , with only one Appleby, et al (27) 2019 Ethiopia -----------5/**** Appleby, et al (28) 2019 New Zealand Qualitative 1/***** Barrett, et al (29) 2016 USA -----------3/***** Chandra-Mouli, et al (30) 2018 India Qualitative and quantitative 5/**** Fabbiani, et al (31) 2016 Uruguay Experience report -Qualitative 1/***** Fabelo-Roche, et al (32) 2016 Cuba Qualitative 1/***** Ferrugem, et al (17) 2015 Brazil Experience report -Qualitative 1/***** Gimenez, et al (33) 2014 Brazil Qualitative 1/***** Jones, et al (34) 2019 Australia Descriptive 1/***** Laurin, et al (35) 2015 Canada Multiple cases study -interpretative 1/***** Leite, et al (36) 2015 Brazil Experience report -Qualitative 1/***** Melo, et al (37) 2016 Brazil Case study -Qualitative 1/***** Milman, et al (38) 2018 Chile Case study 1/***** Mongiovi, et al (39) 2018 Brazil Experience report -Qualitative 1/***** Monteiro, et al (40) 2015 Brazil Action research with a qualitative approach 1/***** Moyano, et al (41) 2018 Argentina Action research with a qualitative approach 1/***** Nunes, et al (42) 2016 Brazil Exploratory descriptive study with qualitative approach 1/***** O'Malley, et al (43) 2017 USA Case study 1/***** Obach, et al (44) 2019 Chile Qualitative ethnographic 1/***** Obach, et al (45) 2017 Chile Qualitative ethnographic 1/***** Pappas, et al (46) 2008 Pakistan -----------5/***** Reader, et al (47) 2017 United States -----------1/***** Shan, et al (48) 2014 Canada Mixed 5/**** Tãno, et al (49) 2019 Brazil Exploratory survey, with triangulation of methods 5/***** Tkac, et al (50) 2017 Brazil Longitudinal, experimental 3/**** Torricelli, et al (51) 2014 Argentina Cross-sectional, descriptive, qualitative and quantitative 5/***** Woodland, et al (52) 2016 Australia Mixed methods 5/***** According to the geographical distribution, the studies were published in different regions: South America, North America, Central America, Africa, Asia, and Oceania. Brazil was the countr...…”

Health System Strategies and Adolescent Sexual Health: Systematic review using Rodgers Concept Analysis Framework

“…Different HSSs are implemented to address ASH issues in response to the ever changing environments [26][27][28][29]. It is presented that strategies to address sexual health issues have evolved in line with the ever changing environmental and contextual factors leading to utilisation of different technological platforms so as to ensure relevance of the strategies in addressing ASH issues [14,21,22,27,29].…”

“…Due to differences in adolescents age groups, social status , ethnic beliefs and expectations; designed HSSs are never comprehensive enough [14,21]. It is therefore noted that most HSSs have their strengths and weaknesses, therefore putting some adolescent populations at risk whilst on the other hand giving advantages to other adolescent populations [25,26,[36][37][38].…”

“…Strategies that clash with specific societal beliefs are bound not to work. Adolescents from poor settings such as those that are from rural areas are more at risk of suffering negative sexual health outcomes as compared to those in urban areas that have easy access to information and health facilities [26,36]. Adolescents utilising Indigenous Health Systems (IHSs) often have poor health outcomes as compared to utilising Modernised Health Systems (MHSs) [43].…”

“…All the authors read and approved the final manuscript. [ 14,21,37,38,40] Need for Integrated ASH Systems [ 5,11,40,42] Available Resources [ 37,38] Type of society [ 14,25,26,36,37,43] Weak adolescent programs constrained by different factors [ 2,5] Parallel or Fragmented ASH Systems resulting in low impact [ 11] Vulnerability and heightened risks for poor health outcomes [ 3,5,[27][28][29]42] Challenges in interacting with different ethnic groups and gender [ 23,24,37,38] CF of HSSs and ASH as informed by findings.…”