Young women’s reproductive health conversations: Roles of maternal figures and clinical practices

Autoři: Nicole K. Richards aff001;  Elizabeth Crockett aff004;  Christopher P. Morley aff001;  Brooke A. Levandowski aff001
Působiště autorů: Department of Family Medicine, State University of New York Upstate Medical University, Syracuse, New York, United States of America aff001;  Department of Public Health and Preventive Medicine, State University of New York Upstate Medical University, Syracuse, New York, United States of America aff002;  School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada aff003;  REACH CNY, Incorporated, Syracuse, New York, United States of America aff004;  Department of Psychiatry, Upstate University Hospital, Syracuse, New York, United States of America aff005;  Department of Obstetrics and Gynecology, University of Rochester, Rochester, New York, United States of America aff006
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article



To explore the role of clinical providers and mothers on young women’s ability to have confidential, candid reproductive health conversations with their providers.


We conducted 14 focus groups with 48 women aged 15–28 years (n = 9), and 32 reproductive healthcare workers (n = 5). Focus groups were audio recorded and transcribed. Data were analyzed using inductive coding and thematic analyses. We examined findings through the lens of paternalism, a theory that illustrates adults’ role in children’s autonomy and wellbeing.


Mothers have a substantial impact on young women’s health values, knowledge, and empowerment. Young women reported bringing information from their mothers into patient-provider health discussions. Clinical best practices included intermingled components of office policies, state laws, and clinical guidelines, which supported health workers’ actions to have confidential conversations. There were variations in how health workers engaged young women in a confidential conversation within the exam room.


Both young women and health workers benefit from situations in which health workers firmly ask the parent to leave the exam room for a private conversation with the patient. Young women reported this improves their comfort in asking the questions they need to make the best decision for themselves. Clinic leadership needs to ensure that confidentiality surrounding young women’s reproductive health is uniform throughout their practice and integrated into patient flow.

Klíčová slova:

Adolescents – Behavioral and social aspects of health – Decision making – Female contraception – Child health – Nurses – Parenting behavior – State law


1. Ford C, English A, Sigman G. Confidential health care for adolescents: Position paper of the society for adolescent medicine. J Adolesc Heal 2004.

2. Committee Opinion No. 710: Counseling Adolescents About Contraception. Obstet Gynecol 2017;130:e74–80. doi: 10.1097/AOG.0000000000002234 28742675

3. American Academy of Family Physicians. Adolescent Health Care, Confidentiality. 2018.

4. American Medical Association. Code of Medical Ethics Opinion 2.2.2. n.d.

5. Standards for privacy of individually identifiable health information. Final rule. Fed Regist 2002.

6. Committee on Adolescence. Contraception for Adolescents. Pediatrics 2014.

7. Burstein GR, Blythe MJ, Santelli JS, et al. Confidentiality Protections for Adolescents and Young Adults in the Health Care Billing and Insurance Claims Process. J Adolesc Heal 2016.

8. Ford CA, Thomsen SL, Compton B. Adolescents’ interpretations of conditional confidentiality assurances. J Adolesc Heal 2001.

9. Guttmacher Institute. An Overview of Minors’ Consent Law. 2018.

10. New York Civil Liberties Union. Teenagers, Health Care and the Law: A Guide to Minors’ Rights in New York State. 3rd ed. 2018.

11. Klein JD, Wilson KM, Mcnulty M, et al. Access to medical care for adolescents: Results from the 1997 Commonwealth Fund Survey of the Health of Adolescent Girls. J Adolesc Heal 1999.

12. Thrall JS, McCloskey L, Ettner SL, et al. Confidentiality and adolescents’ use of providers for health information and for pelvic examinations. Arch Pediatr Adolesc Med 2000.

13. Brubaker SJ. Denied, embracing, and resisting medicalization: African American teen mothers’ perceptions of formal pregnancy and childbirth care. Gend Soc 2007.

14. Martin KA. Giving birth like a girl. Gend Soc 2003.

15. Commendador KA. Parental influences on adolescent decision making and contraceptive use. Pediatr Nurs 2010.

16. Diiorio C, Pluhar E, Belcher L. Parent-child communication about sexuality: A review of the literature from 1980–2002. J HIVAIDS Prev Educ Adolesc Child 2003;5:7–32.

17. Santa Maria D, Markham C, Bluethmann S, et al. Parent-Based Adolescent Sexual Health Interventions And Effect on Communication Outcomes: A Systematic Review and Meta-Analyses. Perspect Sex Reprod Health 2015.

18. O'Rourke-Suchoff DK, Arora KS, Hildebrand VM, et al. Exploring maternal attitudes towards adolescent contraception: implications for use of LARC. Int J Adolesc Med Health 2017.

19. Rubin SE, Felsher M, Korich F, et al. Urban adolescents and young adults’ decision-making process around selecting intrauterine contraception. J Pediatr Adolesc Gynecol 2015.

20. Donenberg GR, Emerson E, Mackesy-Amiti ME. Sexual Risk Among African American Girls: Psychopathology and Mother-Daughter Relationships. J Consult Clin Psychol 2011.

21. Akers AY, Gold MA, Bost JE, et al. Variation in sexual behaviors in a cohort of adolescent females: The role of personal, perceived peer, and perceived family attitudes. J Adolesc Heal 2011.

22. Kienzler SE. Social referent influences on hormonal contraceptive decisions [Order No. 10124494]. ProQuest Diss Publ 2016.

23. Ferrer HB, Trotter C, Hickman M, et al. Barriers and facilitators to HPV vaccination of young women in high-income countries: A qualitative systematic review and evidence synthesis. BMC Public Health 2014.

24. Cohen EF. Neither seen nor heard: Children’s citizenship in contemporary democracies. Citizensh Stud 2005.

25. Cohen EF, Morley CP. Children, ADHD, and citizenship. J Med Philos 2009.

26. Chang J, Ipp LS, de Roche AM, et al. Adolescent-Parent Dyad Descriptions of the Decision to Start the HPV Vaccine Series. J Pediatr Adolesc Gynecol 2018.

27. Shaw DM, Busch J. Rawls and religious paternalism. J Med Philos (United Kingdom) 2012.

28. Pérez JC, Cumsille P, Martínez ML. Brief report: Agreement between parent and adolescent autonomy expectations and its relationship to adolescent adjustment. J Adolesc 2016.

29. Raidoo S, Kaneshiro B. Contraception counseling for adolescents. Curr Opin Obstet Gynecol 2017.

30. Sandman L, Munthe C. Shared decision making, paternalism and patient choice. Heal Care Anal 2010.

31. Navin MC, Wasserman JA. Reasons to Amplify the Role of Parental Permission in Pediatric Treatment. Am J Bioeth 2017.

32. Pizarro D, Richards NK, Coots S, et al. Community-Based Participatory Research: Incorporating the Integral Voice of Community in Study Design. Patient 2019.

33. Shultz R, Lenkiewicz B, Gupta I. Onondaga County Community Health Assessment and Improvement Plan 2016–2018. 2017.

34. Barbour RS. Checklists for improving rigour in qualitative research: A case of the tail wagging the dog? Br Med J 2001.

35. Aronson J. A pragmatic view of thematic analysis. Qual Rep 1994.

36. Bernard AW, Malone M, Kman NE, et al. Medical student professionalism narratives: A thematic analysis and interdisciplinary comparative investigation. BMC Emerg Med 2011.

37. Confidentiality A, Health E. ACOG Committee Opinion no. 599: Committee on Adoscent Health Care: Adolescent confidentiality and electronic health records. Obstet Gynecol 2014.

38. George AE, Abatemarco DJ, Terry MA, et al. A qualitative exploration of the role of social networks in educating urban African American adolescents about sex. Ethn Heal 2013.

39. Lindau ST, Basu A, Leitsch SA. Health literacy as a predictor of follow-up after an abnormal pap smear: A prospective study. J Gen Intern Med 2006.

40. Ali MM, Amialchuk A, Dwyer DS. Social Network Effects in Contraceptive Behavior Among Adolescents. J Dev Behav Pediatr 2011.

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