Adolescents' and Young Adults' Reports of Barriers to Confidential Health Care and Receipt of Contraceptive Services

Abstract

Purpose The purpose of this study was to describe adolescents’ and young adults’ concerns about confidential reproductive health care and experience with time alone with a provider, and examine the association of these confidentiality issues with receipt of contraceptive services. Methods Data from the 2013 to 2015 National Survey of Family Growth were analyzed using Poisson regression to describe 15- to 25-year-olds’ confidential reproductive health-care concerns and time alone with a provider at last health-care visit according to sociodemographic characteristics. We also assessed whether confidentiality issues were associated with obtaining contraceptive services among females. Results Concerns about confidential reproductive health care were less common among 15- to 17-year-olds who were covered by Medicaid compared to their parents’ private insurance (adjusted risk ratio [ARR] = .61, confidence interval [CI] .41–.91) and had high-school graduate mothers compared to college-graduate mothers (ARR = .68, CI .47–.99), and were more common among those who lived with neither parent compared to living with both parents (ARR = 2.0, CI 1.27–3.16). Time alone with a provider was more common among black girls than white girls (ARR = 1.57, CI 1.11–2.22) and less common among girls covered by Medicaid than those with parents’ private insurance (ARR = .72, CI .56–.92). Time alone was less common among boys living with neither parent compared to living with two parents (ARR = .48, CI .25–.91) and with high-school graduate mothers compared to college-graduate mothers (ARR = .59, CI .42–.84). Among sexually experienced girls and women, confidentiality concerns were associated with a reduced likelihood of having received a contraceptive service in the past year. Conclusions Greater efforts are needed to support young Americans in receiving confidential care.

Use of Health Insurance Among Clients Seeking Contraceptive Services at Title X–Funded Facilities in 2016

“…Prior to implementation of the ACA, a key reason for adolescents’ not using existing health insurance to cover their services was confidentiality concerns, and these concerns may have become relevant to other age‐groups following the ACA, which expanded coverage for young people on their parents’ insurance plans up to age 26. A study using data from 2013–2015 indicated that one in 10 young women aged 18–25 and one in five aged 15–17 would not seek sexual and reproductive health care because of concerns that their parents might find out, but we are aware of no comparable data on whether these concerns extend to patients seeking care at Title X–funded sites. Finally, although fluctuations in health insurance coverage, or “churn,” can disrupt and inhibit access to health care broadly, it is unclear how extensive this churn is among clients seeking care at Title X–funded sites.…”

Exploring young women’s reasons for adopting intrauterine or oral emergency contraception in the United States: a qualitative study

“…Women ages 30 and under were eligible to participate. We selected this age group because the vast majority of ECP users are within this age range and they may present distinctive counseling preferences and needs given their unique developmental stage and barriers they face accessing care [25,26].…”

The Developmental Aspects of Patients Spending Time Alone With Physicians

“…Young women with a history of ever having had sex were significantly more likely to report time alone and confidentiality discussions with providers independent of all other factors, suggesting that at least some adolescents with much to gain from private conversations are receiving it. In other words, young women with a history of sex who are seen privately and confidentially by a health-care provider are likely to be more willing to disclose sexual activity, which facilitates clinicians recognizing the need for and delivering of risk-reduction counseling, contraception, sexually transmitted disease testing, and HIV testing [11]. This report also shows that higher proportions of young people who have spent private time with a health-care provider or ever talked about confidentiality generally report more positive attitudes about the effectiveness of health-care professionals, importance of talking with health-care professionals, and higher levels of comfort discussing sensitive topics with health-care professionals.…”