Health Care Seeking Among Urban Minority Adolescent Girls: The Crisis at Sexual Debut

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