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Electronic letters published:
![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
Hispanic Adolescents' Pregnancy Prevention
Accessing Quality Information Regarding Reproductive Health
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Maria Rosa Solorio, Los Angeles, CA Assistant Professor, UCLA Dept. of Family Medicine
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I was pleased to read the article by Diane McKee, Health Care Seeking Among Urban Minority Adolescent Girls: The Crisis at Sexual Debut (Nov/Dec 2004). Up until now, qualitative studies that explore Hispanics girls’ health seeking for reproductive health concerns have been lacking in the literature. Yet, for many decades we have known that these young girls are at high risk for unplanned adolescent pregnancy and its associated negative health and socioeconomic outcomes for both mother and child. In California Hispanic adolescent have birthrates that are three times that of white adolescent girls: 85 vs. 25 births per 1,000 adolescents [1]. While the overall adolescent pregnancy rates have been decreasing over the past 10 years in California, the rate of decrease has not been as high for Hispanic girls. Because the proportion of California’s adolescent population who are Hispanic is projected to be 50% by 2020 [2], it is imperative to understand the unique factors underlying this group’s health, including reproductive health needs, and to provide them with culturally appropriate services [3]. Future research, especially more qualitative studies that explore the facilitators and barriers to Hispanic adolescents use of family planning services before a first pregnancy are needed. In California, a Family Pact Program exists that facilitates use of family planning services, regardless of ability to pay. However, as described in one of our recent studies, while family planning service utilization was similar in Hispanic and white adolescent girls in California, Hispanics girls were more likely than white girls to use family planning services after a first pregnancy [3]. We suspect that because of cultural norms within Hispanic families, that often forbid adolescents from having sexual intercourse before marriage, that Hispanic adolescents are uncomfortable inquiring about family planning services with their families because they may not want to disclose their sexual activity, especially to their mothers. In our study, parental knowledge of adolescent sexual activity did not vary by race/ethnicity. However, we did not measure parental attitudes towards adolescent’s sexual behavior and we suspect that Hispanic parental attitudes towards adolescent sexual activity are likely to be more negative than white parents. Therefore, messages that Hispanics adolescents receive about sexuality from their parents, especially their mothers, may focus only on abstinence rather then on how to prevent pregnancy, if sexually active. These messages may deter non-pregnant Hispanic adolescents from seeking family planning services, because this would imply that they are sexually active. Therefore, it appears that main problem to be addressed in increasing levels of use of reproductive health care services among Hispanics adolescents is how to encourage this group to use such services as a preventive measure, before a first pregnancy. Our paper suggests that implementing campaigns at schools or community-based organizations may be one way of doing this. Also, as suggested by our paper and Diane McKee’s paper, a need exists for clinic providers to provide culturally appropriate anticipatory guidance on sexual and reproductive health. References 1. Department of Health and Human Services, 1999 Natality Data Set, 2001, Series 21, No. 12. 2. California State Department of Finance, County Population Projections with Age, Sex and Race/Ethnic Detail, 1990-2040 in 10-year Increments, 1998. http://www.dof.ca.gov/htm./demograp/proj_age.htm, accessed June 7, 2004. 3. Solorio MR, Yu H, Brown ER, Becerra L, Gelberg L. A Comparison of Hispanic and White Adolescent Females’ Use of Family Planning Services in California. Perspectives on Sexual and Reproductive Health 2004; 36 (4):157-161. Competing interests: None declared |
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Nancy J. Baker, Minneapolis, Minnesota Department of Family Medicine and Community Health
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McKee, Karasz and Weber have undertaken an important qualitative study in an effort to identify barriers to reproductive health services for a small group of African American and Latina girls attending two New York public high schools. It?s not surprising that initial health seeking for non-reproductive health problems uniformly took place in the girls families- almost exclusively from mother or mother-surrogates. For most US families, mothers are the primary caretakers of children and adolescents in the home. An important developmental stage for all teens is separation from parent(s), characterized by independence and self-determination. Co- incidentally, this stage is paralleled by sexual maturation for all, and the onset of sexual activity for some. The fact that the teens described by the authors did not seek counsel on reproductive health issues from their mothers may reflect this desire for independence, as well as their fear of disappointing their parent. Peer relationships and peer pressure continue to be of keen importance to teens and can have both beneficial and deleterious effects. Peers, though often supportive, are least likely to provide reliable, age appropriate information and counsel in the same way as a qualified adult. It was reassuring that at least 6 of the 15 girls who were sexually active admitted having a close, trusting relationship with a health care provider. What additional strategies can benefit vulnerable teens? Markam found that high school students perception of family connectedness is a protective factor related to sexual risk-taking, even among high risk youth attending alternative high schools in North Carolina (Markam CM et. al. Family Connectedness and Sexual Risk-Taking Among Urban Youth Attending Alternative High Schools. Persp On Sex and Rep Hlth. 35(4):174-9. 2003 August). Family Physicians should urge mothers (and fathers) to stay connected with their daughters (and sons) and initiate ongoing discussion(s) regarding reproductive health issues. In addition, all Family Physicians should be encouraged to form personal and confidential relationships with their adolescent patients in order to address unmet reproductive health needs. Family Physicians can also discuss mentorship with teens and their parents. Beier reported that adolescents with an adult mentor reported a statistically significant decrease in several high risk behaviors, including having had sex with more than one partner in the last six months (OR, .056) (Beier SR et. al. The Potential Role of an Adult Mentor in Influencing High-Risk Behaviors in Adolescents. Arch Ped Adol Med. 154(4): 327-31. 2000 April). Finally, school based health centers (SBHC) are another valuable resource where qualified health care professionals can provide accurate and age appropriate reproductive health information. Coyne-Beasley found from a survey of 949 sexually experienced adolescents in North Carolina, 58% said they wouldd use SBHC for information to prevent pregnancy and to learn about STIs(Coyne-Beasley T et. al. Sexually Active Students Willingness to Use School-Based Health Centers for Reproductive Health Care Services in North Carolina. Amb Peds. 3(4):196-202. 2003 July-August). Competing interests: None declared |
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