Reports show that Hispanic young adults are less likely to access sexual and reproductive health services compared with their white counterparts, and this may make them vulnerable to sexually transmitted diseases (STDs) and unintended pregnancies. Access to sexual and reproductive health services provide women with practical information about reproductive choices, and can offer access to contraception. Thus, the question becomes, why do young adult Latinos shy away from receiving sexual and reproductive health services?
At Child Trends, we conducted focus groups with 95 young adult Latina women ages 18-24 and 24 health care providers to shed some light on this question. These focus groups showed, like other studies, that lack of insurance, transportation, and child care shaped young Latinas access to reproductive health services. To my surprise, however, despite having entered adulthood and being legally independent, young women’s perceptions of parental support appeared to shape their reproductive health-seeking behaviors. While some young women perceived parental support for accessing these services, the majority did not. Those who perceived a lack of support took steps to hide their receipt of services from their parents, if they sought such services. In contrast, those who perceived support accessed services freely and without fear, and appeared to appreciate their ability to turn to their parents for advice and support.
To explain why parental support may be so important in young adult Latinas’ access to reproductive health services, I revisited the cultural principle of familismo, which emphasizes that loyalty to family takes precedence over individual needs. It seemed that the young women continued to see their parents as authority figures into their young adulthood and that, consequently, led many to take parental approval into account in the reproductive health choices they made. Those who did not perceive parental support thought their parents held traditional values and placed an emphasis on the young women’s virginity. For these young women, their parents’ finding out that they accessed reproductive health care meant admitting to them that they engaged in premarital sex (84 percent were unmarried). Women who perceived parental support, on the other hand, described parents who understood and accepted their sexual activity.
Our study findings remind us that research needs to be interpreted in the proximal cultural context of the individual or groups. Young women in our study still carried the cultural values of their upbringing and this shaped their reproductive health-seeking behaviors. Having said that, this study also reaffirms that the lives of young Latina women in the U.S. are embedded in the larger American cultural context, as well. This larger context seems to conflict with the Latino culture in that it encourages individualism, is more accepting of premarital sex, and is more open to young and unmarried women using reproductive health. These clashing cultural expectations appeared to be a source of confusion and stress for those who did not obtain parental support for their reproductive health needs. As the focus group moderator, I could see that the young women seemed to go through an internal struggle of wanting to access services, but they also were aware that this would be against the will of their parents.
These findings can generate some initial ideas to improve reproductive health service delivery for this population, for example:
• Providers can clearly explain privacy and confidentiality policies to Latina clients to help alleviate their fears or concerns of their parents’ becoming aware of their receipt of services.
• Clinics may need to consider alternative ways to follow up with women outside of personal visits (e.g., via personal email, cell phone, or text).
As in most research studies, our study had some limitations. We did not directly examine parents’ perspectives, and given the heterogeneity of the Latino population, findings in this study may not apply to all Latina young women.
A longer, peer-reviewed article describing the detailed findings of this study was recently published in the Journal of Adolescent Health.
More recommendations for providers to increase utilization of sexual and reproductive health services by young Latina women are discussed in a paper co-authored with other colleagues at Child Trends.
Selma Caal, Research Scientist