Preserving the Reproductive Rights of Girls and Women in the Era of COVID-19: The Need for a Least Restrictive Solution

Fairchild and colleagues assert that while “equal” on the surface, the rapidly implemented, society-wide public health restrictions enacted in response to the COVID-19 pandemic veil harsh inequities (Fairchild et al. 2020). These inequities are particularly apparent in the deep erosion of sexual and reproductive health rights for women and girls

Contraception Options and Provision to Adolescents

Adolescent pregnancy is a significant cause of global morbidity and mortality. Adolescents who become pregnancy have lower educational attainment, are more likely to live in poverty, and have lower wellbeing. Increasing access to hormonal contraceptives and long acting reversible contraception is highly effective in reducing adolescent pregnancies. This narrative review covers key aspects of the provision of contraception to adolescents, including confidentiality, counseling, and data supporting expanded access to adolescents. We provide information for pediatric providers to start adolescent patients on contraceptives, including a detailed description of each method, including effectiveness, use, starting, side effects and benefits. Tools for counseling and prescribing are provided

Fertility Preservation after a Cancer Diagnosis: A Systematic Review of Adolescents', Parents', and Providers’ Perspectives, Experiences, and Preferences

Study Objective Survival into adulthood is now a reality for many adolescents facing cancer. Fertility preservation (FP) is rapidly advancing, but oncology providers and health systems struggle to incorporate the newest FP technologies into the clinical care of adolescents. Our objective was to systematically review and synthesize the available data regarding the perspectives, experiences, and preferences of adolescents, parents, and oncology providers about FP to inform clinical implementation of FP technologies. Design, Setting, Participants, Interventions, and Main Outcome Measures Five electronic databases (PubMed, Embase, Web of Knowledge, Cumulative Index to Nursing and Allied Health Literature, PsychInfo) were systematically searched for studies published between January 1999 and May 2014. Adolescents were defined as 12-18 years at the time of diagnosis or designated as pubertal/postpubertal and younger than 18 years of age. Studies were assessed for methodological quality, data were extracted using a standardized form, and results were synthesized using guidelines for a narrative syntheses of quantitative and qualitative data. Results In total, 1237 records were identified, with 22 articles, representing 17 unique studies that met the inclusion criteria. The following topics were consistently observed across studies and populations: (1) fertility in trust; (2) decision-making challenges; (3) provider knowledge and practices; and (4) discrepancies between desired and actual experiences. Conclusion Despite the challenges associated with a new cancer diagnosis, adolescents and parents value the opportunity to discuss fertility concerns and preservation options. Providers play an important role in addressing these topics for families and efforts should be made to incorporate FP discussions into routine cancer care for all adolescents, with attention paid to the unique needs of adolescents and their parents

Abstinence and abstinence-only education

PURPOSE OF REVIEW: To review recent literature on medical accuracy, program effectiveness, and ethical concerns related to abstinence-only policies for adolescent sexuality education. RECENT FINDINGS: The federal government invests over 175 million dollars annually in 'abstinence-only-until-marriage' programs. These programs are required to withhold information on contraception and condom use, except for information on failure rates. Abstinence-only curricula have been found to contain scientifically inaccurate information, distorting data on topics such as condom efficacy, and promote gender stereotypes. An independent evaluation of the federal program, several systematic reviews, and cohort data from population-based surveys find little evidence of efficacy and evidence of possible harm. In contrast, comprehensive sexuality education programs have been found to help teens delay initiation of intercourse and reduce sexual risk behaviors. Abstinence-only policies violate the human rights of adolescents because they withhold potentially life-saving information on HIV and other sexually transmitted infections. SUMMARY: Federal support of abstinence-only as an approach to adolescent sexuality education is of much concern due to medical inaccuracies, lack of effectiveness, and the withholding and distorting of health information

The Influence of Age, Health Literacy, and Affluence on Adolescents’ Capacity to Consent to Research

While adults are assumed to have the capacity to consent to medical research, and young children to have no capacity, adolescents’ capacity to consent is not well described. Adapting the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR), we describe adolescents’ capacity to consent to medical research and factors influencing that capacity. Our pilot study included a community-based sample of 30 adolescents, 14 to 21 years of age, who completed the MacCAT-CR after undergoing a simulated informed consent process. We found that adolescents’ capacity to consent to research was associated with age, health literacy, and family affluence. These findings suggest that investigators and institutional review boards should be aware that factors other than age may influence capacity to consent, and, for modifiable factors, such as health literacy, consent processes for medical research with adolescents can be modified