Factors associated with pregnant adolescents' access to sexual and reproductive health services in New York City.

OBJECTIVE: This longitudinal study examined access to, and factors associated with, receipt of sexual and reproductive health services deemed essential by the World Health Organization among pregnant adolescents in New York City.

METHODS: Participants included 649 pregnant adolescents, ages 14-21 who were enrolled in a clustered randomized controlled trial from 2008 to 2012. Data were collected via medical record abstraction and structured surveys during the second and third trimesters of pregnancy and 12-months postpartum. We used multivariable logistic regression to test associations between measures of social and economic vulnerability (age, race/ethnicity, immigration status, food and housing security, relationship status, perceived discrimination) and access to core sexual and reproductive health services (perinatal care, contraception, HIV testing, sexual health knowledge).

RESULTS: Only 4% of participants received all four core aspects of sexual and reproductive health assessed. Adolescents <18 years old had lower odds of contraception use (OR = 0.46, CI 0.27-0.78), having had an HIV test (OR = 0.35, CI 0.16-0.78), and high sexual health knowledge (OR = 0. 59, CI 0.37-0.95), compared to those ≥18 years. Black women were significantly more likely to have high sexual health knowledge compared to other women (OR = 1.84, CI 1.05, 3.22). Immigrants had higher odds of adequate perinatal care (OR = 1.60, CI 1.09-2.36) and contraception use (OR = 1.64, CI 1.07-2.53), but lower likelihood of high sexual health knowledge (OR = 0.52, CI 0.34-0.81), compared to US-born counterparts. Food insecurity was associated with lower likelihood of comprehensive perinatal care (OR = 0.63, CI 0.45-0.90).

CONCLUSIONS: Access to sexual and reproductive health services in New York City is poor among vulnerable adolescents. Health practice and policy should assure access to fundamental sexual and reproductive health services among vulnerable populations in the United States.