Quality of counselling of young clients in Zimbabwe.

Researchers observed 418 consultations with clients aged 12-24 years at 38 health facilities throughout Zimbabwe and interviewed both the clients and providers. Less than one per cent of clients at these facilities were aged 12-14 years; between 5% and 20% were aged 15-19 years. Compared with older clients, those aged 12-16 years came more often for antenatal care and medical problems and less often for family planning. In sessions with 12-16 years, the most common topics were STDs (48%) and school (46%), while sessions with older clients focused more on family planning (56-68%). Providers rarely discussed adolescence or non-sexual problems such as alcohol and drugs. Younger clients were less likely than older clients to ask questions without prompting (16%), expressed their concerns (27%), and they were more likely to appear embarrassed (58%) and shy (64%). Most service providers believed that the parents should be notified if a young, unmarried client was pregnant (89%), had HIV/AIDS (74%), or engaged in sex at "an early" age (73%). The findings suggest that young people may be reluctant to seek advice at health facilities because of legitimate concerns about privacy, providers' attitudes, and narrow focus on reproductive health.