Given Dr. Fonkwo’s medical background, she stressed that this question must be raised and raised again. She stated that if a doctor doesn’t receive sufficient medical training to provide health services to adolescents, they will not be equipped to deliver the services. Medical training must to be structured to address the needs of adolescents. Lastly, Dr. Fonkwo suggested several elements that can contribute to better outcomes: system-level approaches, attention to training and coursework, continuous medical education, feedback mechanisms, and national indicators.
Dr. Muriuki, who also has a clinical background, remarked that when the provider fails, the client will remember. Various issues—such as long workdays—can influence how they treat their patients. Dr. Muriuki noted that providers are members of a community, and have their own values and issues. The health system expects that, in walking into a clinic, providers will set aside their own beliefs and biases—but the system does little to support providers in navigating the potential conflict between who they are and what they do, to ensure that clients are provided with unbiased services. Provider bias has to be addressed within the system so that we are not just targeting the end result of a system failure.
Ms. Streifel added that provider bias can lead to women using contraceptive methods other than their own choice (non-preferred methods), which can result in them abandoning that method (contraceptive discontinuation). Ms. Streifel noted that, according to a PRB analysis on policies in 22 countries, only 4 countries out of 22 support youth access to family planning services without consent from both parents and spouses; only 10 support a full range of family planning options to meet young people’s needs. Policies that remove requirements for third party consent and restrictions are necessary to promote contraceptive use among youth. She expressed that provider training should include values clarification and knowledge of youth cognitive development. Ms. Streifel emphasized that providers need to take a case history, provide information on how to manage side effects, and dispel myths about contraceptive methods. She also stated that training should be given to all who work in the health system, as anybody can have an impact on an adolescent’s visit. Ms. Streifel closed this section with a comment that since unmarried youth have a preference for obtaining contraception from the private and informal sector, pharmacy and drug shop staff should also receive training to better serve youth.