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

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

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

Values, quality, and evaluation in ethics consultation

Background: The American Society for Bioethics and Humanities has recommended regular evaluation of the quality of health care ethics consultation. This article discusses the impact of ethics consultation on clinicians' perceptions of a patient's plan of care and on the personal values of clinicians who participated in an ethics consultation. Methods: Following institutional review board (IRB) approval, select data points were abstracted from case file report forms for ethics consultations over a 12-month period. Clinicians involved in the care of a patient who was the focus of an ethics consultation were invited to participate in an anonymous online survey. Clinicians who initiated an ethics consultation, were interviewed during the course of an ethics consultation, or were present at a patient care conference attended by an ethics consultant were invited to participate. A purposive sampling approach was used to invite clinicians to participate in an in-person interview. Results: The survey response rate was 44.4% (123 respondents from 277 invited). More than 60% of participants felt the consultation helped clarify the values of the patient and/or patient's family and helped them clarify their own values. Only 32% of participants indicated the patient's plan of care changed as a result of the ethics consultation, yet 75% indicated their confidence in the plan of care increased as a result of the ethics consultation. Preliminary findings from the qualitative interviews support the overall positive assessments reported by survey respondents. Conclusions: Ethics consultation can help clinicians clarify their own values and helps them clarify the values of patients and patients' families. Ethics consultation offers meaningful support when clinicians face ethically challenging cases, provides an opportunity to address moral distress, and is viewed favorably by those who experience the resource

Factors influencing abstinence, anticipation, and delay of sex among adolescent boys in high-STI prevalence communities

Purpose Abstinence is a core pregnancy and STI prevention strategy. We explore the attitudinal, behavioral, and family contexts relating to abstinence and the decision to delay sex among adolescent boys. Methods Adolescent boys ages 14–17 were recruited from community sites using a venue-based sampling method. All eligible boys at venues were invited to participate in an electronic survey. Question items included sexual behaviors, attitudes related to sex, relationships, masculine values, and family contextual items. Results We enrolled 667 participants, age 15.7 years, of diverse ethnicity. 252 (38%) were abstinent. Abstinent participants were younger, less likely to report non-coital behaviors, and reported lower conventional masculine values. Among abstinent participants, 62% planned to delay sex, while 38% anticipated sex in the next year. Participants with lower conventional masculine values, and more religious or moral motivations for abstinence were more likely to plan to delay sex. Discussion Abstinence among boys is common, even in high STI risk communities. For these boys, abstinence appears to be a complex behavioral decision, influenced by demographic, behavioral, attitudinal and contextual factors such as age, race, non-coital sexual behaviors and masculine values. Understanding the attitudes and contexts of abstinence, including plans to delay sex, can inform the development of public health programs for early fatherhood and STI prevention

Masculinity in Adolescent Males’ Early Romantic and Sexual Heterosexual Relationships

There is a need to understand better the complex interrelationship between the adoption of masculinity during adolescence and the development of early romantic and sexual relationships. The purpose of this study was to describe features of adolescent masculinity and how it is expressed in the contexts of early to middle adolescent males’ romantic and sexual relationships. Thirty-three 14- to 16-year-old males were recruited from an adolescent clinic serving a community with high sexually transmitted infection rates and were asked open-ended questions about their relationships—how they developed, progressed, and ended. Participants described a high degree of relationally oriented beliefs and behaviors related to romantic and sexual relationships, such as a desire for intimacy and trust. The males also described a more limited degree of conventionally masculine beliefs and behaviors. These beliefs and behaviors often coexisted or overlapped. Implications for the clinical care of similar groups of adolescents are described