Preventing, but Not Caring for, Adolescent Pregnancies? Disparities in the Quality of Reproductive Health Care in Sub-Saharan Africa

Purpose: There is concern that adolescents experience worse quality of health care than older women. We compare quality of reproductive health services (family planning and antenatal care) for adolescents (<20 years) versus adult women (≥25 years), in four sub-Saharan African countries. Methods: In total, 2,342 family planning visits and 8,600 antenatal care visits were analyzed from Democratic Republic of the Congo, Malawi, Senegal, and Tanzania. Service Provision Assessment surveys include observation of care and client exit interviews. We compare visit content and care satisfaction for adolescents versus adult women aged ≥25. All models are multilevel, weighted to reflect survey design, and include client, provider, and facility covariates (pooled models also include survey fixed effects). Results: Adolescents receive more overall family planning care activities compared to adult women (2.31 activities in adjusted generalized linear models, standard error [SE] 1.29, p <.1), and 3.76 more discussion activities (e.g., counseling) on average (SE 1.94, p <.1), but significantly fewer discussion activities during antenatal care (−3.10 activities, SE.97, p <.01). However, adolescents’ satisfaction with both care types was not significantly different than adult women. These relationships largely persist in country-stratified models, using different model specifications, and when comparing adolescents to women aged ≥20. Conclusions: Adolescents’ family planning visits are similar to, or even slightly more comprehensive than, adult women—but their antenatal visits include fewer recommended care components, with particular gaps for activities requiring provider-client dialog. This suggests opportunities for strengthening communication between providers and young women, and improving care across the reproductive health continuum.