Perspectives on confidential care for adolescent girls

PURPOSE: We wanted to obtain perspectives of mothers and daughters on facilitators of and barriers to with adolescent girls' timely access to risk-appropriate reproductive care. METHODS: We conducted 5 separate focus groups with Latina and black mothers and their adolescent daughters. All participants resided in impoverished neighborhoods of New York City. Participants addressed mothers' roles in helping girls initiate gynecologic care, perceived role of physicians in daughters' sexual health, including the provision of confidential care, and perceived need for girls' gynecologic care. Data were analyzed using qualitative data analysis methods. RESULTS: Mothers see themselves as their daughters' primary protectors against daughters' poor reproductive outcomes. Many believe that confidential care promotes risky behavior and undermines mothers' efforts to protect girls. Mothers endorse facilitating gynecologic care and entering alliances with physicians but see the need for care as arising only after girls' sexual debut. Unfortunately, maternal awareness of sexual activity is low. Adolescent girls express considerable discomfort around reproductive health care and negotiating maternal involvement, and they fear breaches in confidentiality. CONCLUSIONS: A lack of trust in health care clinicians and the mother's gatekeeper role are key barriers to girls' transition to reproductive care. Consistently including a confidential component to health care visits in early adolescence, with preparation for both mothers and daughters, may reduce the distrust and discomfort.