Facilitators and barriers to contraception access and use for Hispanic American adolescent women: An integrative literature review

STATEMENT OF THE PROBLEM

Hispanic American adolescents experience high rates of pregnancy with profound consequences. Compared with White teens, Hispanic teens use contraception less frequently and often choose less effective forms of contraception. Access to contraception is a primary barrier to use which contributes to relatively high and disparate rates of pregnancy in Hispanic teens. This integrative review identifies facilitators and barriers of contraception access and use for Hispanic women, 13-17 years of age, living in the U.S.

METHODOLOGY

Following the Whittemore and Knafl (2005) methodology and PRISMA guidelines, peer reviewed studies were retrieved from PUBMED, CINAHL and EMBASE. The Mixed Methods Appraisal Tool was used to assess the study quality and thematic analysis was used to categorize barriers and facilitators.

FINDINGS

Of 131 studies retrieved, 16 met inclusion criteria. Individual, interpersonal and healthcare provider factors were identified as primary categories of barriers and facilitators with structural issues comprising an additional barrier category. Individual level barriers were disproportionately represented and further categorized into themes: beliefs/misconceptions, dislike of contraception, pregnancy risk perception, lack of knowledge, and lack of control. Barriers related to cultural and religious influences were identified in individual, interpersonal and structural levels. The most frequently reported facilitators were perceived parent comfort discussing sexual health and past experience of pregnancy.

DISCUSSION

Limitations in this review may stem from heterogeneity in the acculturation and geography of participants and analysis by a single reviewer. Implications include considering the range of information sources and the influence they have on risk perception and risk mitigation for this population.

CONCLUSION & SIGNIFICANCE

Adolescents describe many modifiable influences on contraception access and use. Misperceptions related to contraception, stemming from beliefs and perceptions, can be corrected through increased access to reliable sources of sex education, parental support, and direct access to nurses and healthcare providers. Awareness of these influences can inform further research and intervention development to address these health disparities.

Study protocol: Examining sexual and reproductive health literacy in Mexican American young women using a positive deviance approach

Health literacy is generally low in marginalized groups, leading to delays in accessing care, poor health outcomes, and health disparities. Yet, some individuals in these groups demonstrate higher health literacy and better health outcomes. These exceptional cases exemplify 'positive deviance' because they have found ways to be successful where others have not. Identifying the methods, practices, and resources that these individuals have used to gain health literacy and healthcare access may have generalized application to improve health literacy, access to care, and health outcomes. Using the Integrated Model of Health Literacy, the main objectives of this study are to (1) identify facilitators, barriers, and strategies to gain sexual and reproductive health literacy and healthcare access and (2) to explore each of the core domains of health literacy as they relate to successful access of sexual and reproductive healthcare services among individuals identified as positive deviants. For the purposes of this mixed methods community engaged study, positive deviants are defined as Mexican American young women aged 18-29 years old living in Rural Western New York who have accessed sexual and reproductive healthcare within the past year. A community advisory committee will be formed to provide community-engaged guidance and support for the recruitment of participants. Positive deviants will participate in a survey and semi-structured interview. Data collection and analysis will be simultaneous and iterative. Results will provide evidence of positive deviant methods, practices, and strategies to gain health literacy and access to sexual and reproductive healthcare. Findings may reveal characteristics and patterns in the relationship of health literacy and healthcare access that can inform interventions to improve health literacy and make healthcare more accessible for this demographic group and context.

Neither Accidental Nor Intended: Pregnancy as an Adolescent Identity Project Among Hispanic Teenage Mothers in Doña Ana County, New Mexico

Social scientists have dispelled teen pregnancy’s public characterization as inherently pathological and instead frequently study teen reproductive practices as the result of either socioeconomic and cultural constraints or individual processes of identity construction. Through semistructured interviews with 15 young Hispanic mothers in southern New Mexico, I consider both macro-level contexts and individual-level identification processes in understanding teens’ reproductive decision making. Highlighting narratives of sexual and reproductive passivity in the region’s impoverished colonias, I describe how young women in these communities explained their pregnancies as the result of what I have termed sterility cuentos, their boyfriends’ false stories of sterility. I go on to tease apart the contradictory narratives of girls in metropolitan Las Cruces who called their pregnancies accidents despite wanting and planning to become pregnant. Through thematic narrative analysis, I argue that teen pregnancy can be thought of as part of a larger adolescent identity project in which teens in particular social locations reproduce, negotiate, and/or reconstruct various axes of their identities through their reproductive decisions within the context of significant constraints. I conclude by considering implications for teen pregnancy prevention efforts in light of this vast diversity in how Hispanic teens become pregnant and experience motherhood.

Teenage Moms Living in Nova Scotia, Canada: An Exploration of Influences on Their Decision to Become a Mother

Currently, there is an extensive North American literature outlining the social, economic, and cultural background of women who become teen moms. However, relatively little is known about the nature of the influences on teen women's decisions to become mothers. This qualitative study sought to add to the literature on teenage motherhood by exploring, from the perspective of the young women, the social, economic, and cultural influences on their decision to become a mom. The research is based on 40 semi-structured interviews with teen moms living in Nova Scotia, Canada. The results underline the fact that there are multiple and complex reasons why some teens decide to become a mother. In addition, the findings point to the importance of examining the neighborhood and societal-level forces influencing teens' decisions to become a mother.

Cultural Factors Affecting the Negotiation of First Sexual Intercourse among Latina Adolescent Mothers

In 1995, the Latina adolescent birth rate surpassed that of African Americans for the first time. This article investigates cultural and social factors affecting the initiation of sexual intercourse among Latina adolescent mothers in Los Angeles. The data are from life history interviews with forty young mothers and their partners conducted in 1994 to 1997. Results suggest that sexual intercourse is initiated within the context of the couple's developing relationship, and that the course of relationships is highly scripted. Men pressure for sex and women resist. Women should be ignorant about sex, but control access to intercourse. Sex is never discussed. Thus, it is unexpected, and contraception other than withdrawal is not used. This script places young Latinas at enormous risk for pregnancy and STDs.

Implementation and Long-Term Outcomes of Two HIV Intervention Programs for Latinas

Despite the disproportionate effect of HIV/AIDS on Latinas in the United States, only a few studies of HIV prevention programs have focused on this priority population. In the meantime, public health practitioners have needed to develop and implement programs that contribute to the reduction of HIV sexual risk among women in Latino communities. This article reports on a joint effort of a state health department, community advocates, and researchers to develop and test the effectiveness of two 12-week interventions, an Intensive HIV Prevention Program and a Women’s Health Program. The authors present the short-term and longer term outcomes of both programs, assess their strengths and weaknesses, and finally consider the broader implications of their findings for HIV prevention programs for Latinas nationwide.

Abused women report greater male partner risk and gender-based risk for HIV: findings from a community-based study with Hispanic women

The purpose of this study was to assess the relationship between intimate partner violence (IPV) and sexual risk in terms of safer sex behaviour and intent, individual and gender-based HIV risk factors, and male partner HIV risk, among a lower-income community-based sample of Hispanic women reporting a current male sexual partner. Baseline survey data on HIV-related behaviours and risk factors gathered from participants (N=170) of an HIV intervention evaluation study for Hispanic women were used for current analyses. Participants were age 18-36 years, predominantly born outside of the continental US (88.8%) and not English fluent (68.2%). Adjusted logistic regression analyses and 95% confidence intervals were conducted to assess the relationships between male-perpetrated IPV in the past three months and sexual risk variables. One-fifth (21.2%) of the sample reported male-perpetrated IPV in the past three months. Abused women were significantly more likely than those not abused in the past three months to report high STD/HIV risk perceptions (OR=3.02, 95% CI=1.33-6.88), gender-based risk including sexual control by male partners (OR=3.09, 95% CI=1.41-6.76) and male partner risk including male infidelity (OR=4.58, 95% CI=1.57-13.32). Results support the need for emphasis on IPV prevention within HIV prevention programmes and demonstrate the need for HIV prevention efforts directed at men with a history of IPV perpetration.

Cultural Landscapes and Cultural Brokers of Sexual and Reproductive Health in U.S. Latino and Latin American Populations

A literature review synthesizing 19 recent journal articles related to sexual and reproductive health education in U.S. Latino and Latin American populations. Emphasis is on the role of culture and qualitative research methodologies and listening to the voice of communities. Part 1 deals with the cultural landscape: social influence on behavior by male partners, family, and community. Part 2 describes the roles played by lay health providers and promoters (parteras, promotoras, poetas) as cultural brokers influencing sexual and reproductive health behavior.