244. Parental Involvement In Contraceptive Access And Decision-Making: Qualitative Findings From Adolescent Contraceptive Users In Atlanta, GA

Increasing use of highly and moderately effective contraception has contributed to recent declines in unintended teen pregnancies, and efforts to improve access to these methods are ongoing. Many states allow minors to self-consent for contraceptive services in order to reduce confidentiality concerns as a barrier to care. However, there is growing attention to the positive role parents can play in adolescent healthcare, particularly through partnerships within the parent-adolescent-provider triad. Limited research has examined such a triadic approach in contraceptive care, for which confidentiality is especially important. Accordingly, we explored adolescents’ perceptions of parental involvement in contraceptive access and decision-making. We analyzed qualitative data from 17-19 year old contraceptive users in Atlanta, GA (n=30), including IUD and implant (n=10), oral contraceptive (n=10), and injectable (n=10) users. The clinic- and community-recruited sample was 60% African-American and 20% Hispanic. Participants completed a semi-structured, individual interview that addressed pregnancy and STI prevention goals and strategies. Participants were specifically asked how people in their life have shaped feelings about preventing pregnancy, as well as reasons for selecting their current and past contraceptive methods. Parents emerged as a salient factor during thematic analysis of de-identified transcripts using MAXQDA. Across contraceptive types, twenty-three participants described parents’, particularly mothers’, level of involvement with access to and/or decision-making about contraception. Many indicated that their mothers supported contraceptive use. For example, one implant user said, “My mother had found out that I had become sexually active and she wanted me to be protected. She didn’t want me to have a child while I still was a child.” In fact, participants described their mother’s roles during contraceptive initiation and continuation, including scheduling/attending appointments, consulting on method selection, and/or facilitating follow-up visits. In a few cases, mothers essentially chose their daughter’s method for them. In contrast, one participant recalled her mother’s instruction to seek contraceptive services independently because she was “not a little child anymore.” Some participants who sought contraception to regulate menstrual cycles and/or alleviate cramps emphasized these reasons to parents, even if they were sexually active. Other adolescents who had concerns about parental attitudes initiated contraception independently (in some cases, waiting until age eighteen), but then subsequently informed their mothers and experienced largely positive reactions. Some participants had not involved or informed their parents given discomfort discussing sexual activity and/or concern about parental reaction; though in several of these cases, parents had previously communicated a desire to support adolescents in preventing pregnancy. Our study documents maternal support for and direct involvement in contraceptive access and decision-making, underscoring the potential for a triadic approach to adolescent contraceptive care. Providers can promote parent-adolescent communication about pregnancy prevention and educate parents about why and how to support adolescent contraceptive access. However, adolescents also expressed concerns about parental reaction to sexual activity, reinforcing the importance of confidentiality and the need to carefully navigate a triadic approach across adolescent sexual development.