Exploring and Monitoring Privacy, Confidentiality, and Provider Bias in Sexual and Reproductive Health Service Provision to Young People: A Narrative Review

Abstract

Purpose: Poor privacy and confidentiality practices and provider bias are believed to compromise adolescent and young adult sexual and reproductive health service quality. The results of focus group discussions with global youth leaders and sexual and reproductive health implementing organizations indicated that poor privacy and confidentiality practices and provider bias serve as key barriers to care access for the youth. Methods: A narrative review was conducted to describe how poor privacy and confidentiality practices and provider bias impose barriers on young people seeking sexual and reproductive health services and to examine how point of service evaluations have assessed these factors. Results: 4544 peer-reviewed publications were screened, of which 95 met the inclusion criteria. To these articles, another 16 grey literature documents were included, resulting in a total of 111 documents included in the review. Conclusion: Poor privacy and confidentiality practices and provider bias represent significant barriers for young people seeking sexual and reproductive health services across diverse geographic and sociocultural contexts. The authors found that present evaluation methods do not appropriately account for the importance of these factors and that new performance improvement indicators are needed.

“You could find a good or a bad provider, I would say you just have to go and see”: A qualitative study of the influence of perceptions of service quality on family planning service use in Burkina Faso

“…For young and unmarried women in Burkina Faso and elsewhere, provider interactions have been documented as being particularly key to determining client appraisals of service quality and the intention to revisit facilities [21][22][23]. The fear of stigmatization of young unmarried sexually active women by providers in cultural contexts where premarital relations are taboo, and childbearing is valued, has been widely documented as leading to the non-use of services [23,24] and confirmed by the new evidence presented here.…”

“…Bobo Dioulasso, unmarried users ages [20][21][22][23][24] Many respondents sought to use the calendar method if they did not want to go to the health facility because of expectations of negative treatment as reported by their friends or family. However, the calculations needed to use such 'natural' methods effectively were sometimes perceived to be too complex for uneducated women.…”

“…Typically, the quality of FP services is defined in relation to services and commodities available at a facility as well as in relation to perceived provider competence, the existence of follow-up mechanisms (for example for LARC removal), and client-provider relations [19,20]. For young and unmarried women in Burkina Faso and elsewhere, provider interactions have been documented as being particularly key to determining client appraisals of service quality and the intention to revisit facilities [21][22][23]. The fear of stigmatization of young unmarried sexually active women by providers in cultural contexts where premarital relations are taboo, and childbearing is valued, has been widely documented as leading to the non-use of services [23,24] and confirmed by the new evidence presented here.…”

Exploring the Complexity of Telehealth Privacy Through a Lens of Adolescent Development

“…Despite its recognized importance, ensuring privacy has presented a number of challenges for both HCPs and adolescent patients. Health care providers, for example, report difficulties such as maintaining adolescents’ privacy through the process of billing and reimbursement (Ford et al, 2004), while adolescents express concerns about family or friends overhearing their healthcare conversations and endorse doubts about the privacy of electronic medical records (Allison et al, 2022; Beeson et al, 2016; Cheng et al, 1993; Corley et al, 2022; Daley et al, 2019; Diaz et al, 2022; Ford et al, 1997; Ginsburg et al, 1995; Mikesell et al, 2022; Rea et al, 2022; Reddy et al, 2002; Sharko et al, 2018). Such privacy concerns may serve as obstacles to building trust between adolescent patients and their HCPs, especially when discussing sensitive topics such as sexual and reproductive health, substance use, and mental health, which are essential components of comprehensive care for adolescents (Copen et al, 2016; Ford et al, 1997; Thrall et al, 2000).…”

An Interpretative Study of LARCs Discontinuation in Ethiopia: The Experiences of Women Accessing Contraceptives in Selected Public Health Facilities

“…43 Though health promotion programs advocate LARCs for their efficacy with little demand for strict user compliance, studies reported the tendency among health providers to force LARCs on users has been criticized to contradict the right based family planning approach. 44 , 45 Family planning service providers should focus on the fertility intention of women and LARC side effects when counseling women for choice of contraceptives. 46 , 47 Health promotion programs and agents should target the promotion of gender equality and improving women’s autonomy in sexual and reproductive health decision making, which arguably increase their access to proper and effective contraceptives and other health services thereby increasing their social, economic, and political roles, and personal development.…”