Perspectives on Confidential Care for Adolescent Girls

M. Diane McKee; Lucia F. O’Sullivan; Catherine M. Weber

doi:10.1370/afm.601

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Table 1.

Study Recruitment and Refusal Rates

Recruitment Characteristics	Total Mothers No. (%)	Total Daughters No.
Dyads presumed eligible	228	–
Returned opt-out card	13 (6)	–
Attempted to reach	180	–
Reached by telephone (after repeated efforts)	79 (44)	–
Found to be ineligible after contact	20	–
Refused participation	19 (32)	0
Intended to attend a group	40	20
Actually attended a scheduled group	21	18

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Table 2.

Demographic Information of Black (n = 8) and Latina (n = 14) Mothers

Demographic Characteristics	Black No.	Latina No.
* Participants could check more than 1 option.
Age, years
30–40	6	3
41–50	2	8
50+	0	1
Born in United States	6	9
Employment status*
In school part-time	0	1
In school full-time	1	0
Employed part-time	1	3
Employed full-time	3	6
Homemaker	4	3
Currently receiving public assistance	3	4
Estimated family Income
$0–$20,000	4	8
$21,000–$40,000	3	4
$41,000–$60,000	0	1
$61,000+	1	0
No. of children, mean (range)	3.5 (2–8)	3.5 (2–9)
No. of people living on income, mean (range)	4.4 (2–7)	4.1 (2–9)

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Table 3.

Sexual Behavior and Reproductive Care Histories of Black (n = 6) and Latina (n = 12) Daughters

History Characteristics	Black No.	Latina No.
* Participants could check more than 1 option.
Relationship history
Boyfriend in past	6	10
Boyfriend at time of study	2	7
Sexual history
Sexual activity (ever)	4	8
Sexual activity (prior 2 months)	2	7
Sexual intercourse (ever)	4	7
Sexual intercourse (prior 2 months)	2	7
Number of intercourse partners	1 (3 missing)	1.8 (mean)  1–3 (range)
Reproductive care history
Past gynecologic examination	2	5
Past pregnancy	1	2
Past pregnancy concern	2	5
Past birth	0	2
Type of contraceptives/prophylactic use at last intercourse*
Condoms	4	4
Withdrawal	1	–
Birth control pills	–	–
Rhythm	–	–
Vaginal sponge	–	–
Foam, jelly, cream, or suppositories	–	–
Diaphragm	–	–
Intrauterine device (IUD)	–	1
Depo-Provera (the shot)	–	2
Norplant	–	–
Contraceptive film	–	–
Other	–	–
Don’t know	–	–
None of the above	–	1
No response	–	1
Mothers’ awareness of girls’ sexual experience
Mother knows of sexual experience	3	5
Told mother about sexual experience	2	4

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The Article in Brief

Perspectives on Confidential Care for Adolescent Girls

By M. Diane McKee, MD, MS, and colleagues

Background Adolescent girls who live in poor urban areas are at much higher risk for health problems related to sexual activity than girls in other areas, yet they don't often seek confidential reproductive health care on their own. This study looked at the role that mothers play in encouraging appropriate and timely gynecologic care for adolescent girls.

What This Study Found Mothers want to protect their daughters against early sexual activity, pregnancy, and sexually transmitted infection, and believe they will be responsible for dealing with the results of such problems. Many mothers believe that a daughter's private visit to the doctor would promote risky behavior and challenge the mother-daughter bond. Mothers are willing to help their daughters receive gynecologic care, but only after the girls become sexually active. Mothers' awareness of sexual activity is low, and girls in this study worked hard to keep their sexual status private.

Implications

Lack of trust in doctors and a mother's role as protector can be barriers to reproductive health care for adolescent girls.
New approaches are needed to help prepare mothers and daughters for the adolescent's transition to independent health care. Doctors could try setting aside a portion of visits as confidential when girls are in early adolescence as a way to encourage this transition.
Doctors need to build skills to communicate about confidential care, while respecting the mothers' role as champion of her family's health care and protector of her adolescent's well being.