Fonseka, Ruvani W.

Maldonado, Vivian

Silverman, Jay

English

SJSU ScholarWorks

San Jose State University SJSU ScholarWorks Faculty Research, Scholarly, and Creative Activity 4-2020 “This Is Something I’m Doing for Me:” The Influence of Mexican and U.S. Culture on the Reproductive Health Decisions of Female Adolescents Living in the San Diego/Tijuana Border Region Vivian Maldonado UC San Diego Ruvani W. Fonseka UC San Diego, ruvani.fonseka@sjsu.edu Jay Silverman UC San Diego Follow this and additional works at: https://scholarworks.sjsu.edu/faculty_rsca  Part of the Clinical and Medical Social Work Commons, and the Public Health Commons Recommended Citation Vivian Maldonado, Ruvani W. Fonseka, and Jay Silverman. "“This Is Something I’m Doing for Me:” The Influence of Mexican and U.S. Culture on the Reproductive Health Decisions of Female Adolescents Living in the San Diego/Tijuana Border Region" UC Global Health Day (2020). This Presentation is brought to you for free and open access by SJSU ScholarWorks. It has been accepted for inclusion in Faculty Research, Scholarly, and Creative Activity by an authorized administrator of SJSU ScholarWorks. For more information, please contact scholarworks@sjsu.edu. “This Is Something I’m Doing for Me.” The Influence of Mexican and U.S. Culture on the Reproductive Health Decisions of Female Adolescents Living in the San Diego/Tijuana Border RegionUC Global Health Day 2020Vivian Maldonado; Ruvani W. Fonseka, MPH, MSW; Jay Silverman, PhDUniversity of California, San DiegoAbstractBackground: Latinas in the U.S. are at highest risk for adolescent pregnancy (46.3 births per 1000) with those of Mexican origin at highest risk relative to other Latinas. San Ysidro Health (SYH) has a critical need to address reproductive coercion (behaviors that directly interfere with female attempts to use contraception) to reduce the large numbers of unintended pregnancies seen among the primarily Latina female adolescents they serve. Aim: This study aims to assess whether Latina female adolescents living in the San Diego/Mexico border region consider their competing American nationality and Mexican cultural background, characterized by their conservative Mexican parents, as a barrier to family planning (FP) services and contraceptives access. Methods: Qualitative data for the main project, ARCHES (Addressing Reproductive Coercion in Health Settings) Jóvenes, was collected through focus group discussions (n=2) and interviews with SYH providers (n=9) and adolescent patients (n=10). Data analysis was performed to answer this study’s research question. Results: Latina adolescents expressed that strict, Mexican parents are a barrier to accessing FP services because of their conservative, religious beliefs about contraceptives. Some of these Latina adolescents were able to reject their parents’ cultural beliefs and found strategies to access necessary services, such as getting birth control, because of their empowering beliefs about their rights to their body.Conclusion: Some adolescents interviewed have been successful in advocating for their reproductive health rights, while others struggled with navigating conflicting cultural messages and expressing body empowerment. The findings from this study can contribute to our understanding of how culture permeates borders and influences the health outcomes of vulnerable populations. San Ysidro Health (SYH) Teen Clinic webpage headerARCHES Kenya booklet pageData Collection for ARCHES Jóvenes study• Structured interviews with SYH family planning providers (n=9)• Focus group discussions (n=2) and in-depth interviews (n=10) with female reproductive health patients (ages 15-24) Data Analysis for this study• Data analysis was performed on interviews with providers, patients who self-identified as “Hispanic,” “Latina” or “Mexican” • Transcripts were analyzed using the constant comparative method to understand the intersection between culture and reproductive health decision making factorsMethodsFemale Adolescent Participant Characteristics (n=17)Acculturation• Latina teens’ varying level of assimilation to U.S. culture and connection to Mexican culture impacts their ability to get contraceptivesAutonomy/Empowerment• Teens who believe in body autonomy and empowerment are more likely to overcome barriers to getting contraceptivesClinic Services• SYH Clinic is an outlet for teens to be exposed to U.S. cultural beliefs about contraceptives that they may not get from their Mexican parentsConservative/Religion• Latina/Mexican culture is closely linked to Catholic religion; they share conservative ideals about contraceptives and FP servicesFamilismo• Latina/Mexican culture involves putting family considerations, needs and beliefs before your own and not going against the familyFuture Plans• Teens who have future plans and goals don't want to get pregnant yet• Teens without other plans or goals may start a family youngGenerational Differences• Older generations (parents, grandparents) are more "Mexican" than teens in their conservative, strict beliefs that teens try to rejectSelf-efficacy• Teens who know where and how to get contraceptive services without parental help believe in their right to making their own health decisionsIdentified Themes42525Male CondomImplantPillWithdrawalNoneBirth Control Methods 1482 215 16 17 18 19AgeResults“One of the main focuses of the work that we do in Teen Clinic is assessing someone's life prospective plans. A lot of our engagement with the patients isn't just directly medical related. It's making sure that they have a life plan that allows them to succeed and the goals that they have met. For a lot of them, they do end up talking about what their life as a bi-national resident looks like.”SYH Provider“In this area, because we’re so close [to the border] and Hispanics, I want to say Mexicans have a tie to religion. Not all of them, but you know the majority does, and the way they have been raised, it’s something for the students that really stopped them from getting the services. It’s my daily basis saying, ‘hey you need to advocate for yourself, come on, you need to do this, step up.’”SYH School Clinic Provider“For a lot of young people who are growing up in Tijuana, or on the Mexico side of the border… for them it’s trying to assess, ‘these are the ideas that I’ve heard this whole time, but, in order to deconstruct them, am I able to…am I… do I follow the cultural norms that I’ve grown up with? Or is it something that I need to make individual choices for myself?’”SYH Provider“Even though I have my mentalities, my parents don’t, and I know that they’ve always pulled that ‘my house my rules, if you’re under my roof, you do what I say.’ You can’t really have your own decisions yet with that. So, I feel like getting birth control is my way of saying this is my choice, this is my independence, this is my life. I can do this. I think it was more for me to prove something to myself, more than actually taking precaution. It was more for myself but I just kind of wanted to be like well, this is for me. This is something I’m doing for me.”  SYH patient“One of my friends, she comes from a very Catholic home… she made hints about [getting birth control,] and her family had shut it down right away. She tried to sign up for the internship with San Ysidro Health, and her parents said no, because they thought it was because she wanted more liberty to gain the resources. She’s very obedient to her parents, so she just dropped it. She just stopped trying to get it. She doesn’t even talk about it anymore.”SYH PatientConservative/Religion Values• Catholic religion is closely associated with Mexican culture and norms, which are very conservative when it comes to sexual and reproductive healthAcculturation• These beliefs are imposed upon adolescents by their Mexican parents and are an important barrier to acknowledge because they affect teens differentlyAcculturation, Familismo and Body Autonomy/Empowerment• Teen girls are aware of the impact conservative Mexican culture plays on their reproductive health rights• Some still hold onto familismo ideals of putting their parents’ needs before their own• Other teens reject those parts of their culture in favor of empowering body autonomy idealsBody Autonomy/Empowerment• Maintaining body rights and reproductive health independence as a Mexican teenager is a critical part of acculturation to the U.S.Role of Clinic Services• Some SYH Teen Clinic providers are informally expanding health discussions to incorporate future planning, such as discussing college and career goalsConclusion“At Teen Clinic, there’s so many empowering women here… I know personally when I first came here, I was not even close to being as extroverted about sexual health, about reproductive rights and all that. I wasn’t that informed in the first place. They made it casual and normal, and they really de-stigmatized everything that I had learned.”  SYH Patient• Clinics and government programs have already decreased structural barriers such as transportation, access, and cost, but there are also underlying cultural barriers that need to be addressed• Studies have been discordant about whether Latina teens reject one culture completely for the other, or if they pick and choose elements of each to follow• This study suggests that acculturation is a spectrum; not all teens are affected the same, and this influences their ability to seek clinic services and take control of their reproductive health • SYH providers are already informally discussing body autonomy and life-planning with patients, which impacts whether they are being safe and protecting against unintended pregnancies• While understanding the Latina teens’ perspectives on culture is crucial, it is also helpful to understand the critical role providers have in bridging the information and access gap to contraceptive services, especially with vulnerable teens living close to the Mexican border• Future studies could explore discussions about culture and body autonomy/empowerment to inform helpful guidelines for vulnerable teens who have cultural barriers to FP services that are not formally addressed by traditional health programsReferencesAcknowledgementsFunding for the main project was provided by ACTRI. Funding for this project was provided by the UCSD Triton Research and Experiential Learning Scholarship. Special thanks to my mentors at the Center on Gender Equity and Health. 1. Hernandez ND, Chandler R, Nava N, et al. Young adult US-born Latina women’s thoughts, feelings and beliefs about unintended pregnancy. Culture, Health & Sexuality. 2019;0(0):1-17. doi:10.1080/13691058.2019.16425172. Roncancio AM, Ward KK, Berenson AB. The Use of Effective Contraception among Young Hispanic Women: The Role of Acculturation. Journal of Pediatric and Adolescent Gynecology. 2012;25(1):35-38. doi:10.1016/j.jpag.2011.08.0083. Killoren SE, Zeiders KH, Updegraff KA, Umaña-Taylor AJ. The Sociocultural Context of Mexican-origin Pregnant Adolescents’ Attitudes toward Teen Pregnancy and Links to Future Outcomes. J Youth Adolesc. 2016;45(5):887-899. doi:10.1007/s10964-015-0387-94. Alzate MM, Villegas S, Salihu HM. The power of culture and context on Hispanic/Latina teen pregnancy and birth in Oklahoma: provider and parental perspectives. Social Work in Health Care. 2018;57(10):890-905. doi:10.1080/00981389.2018.15143515. San Ysidro Health Teen Clinic. San Ysidro Health Teen Clinic. https://www.syhteenclinic.org/. 6. Wilkinson TA, Miller C, Rafie S, Landau SC, Rafie S. Older teen attitudes toward birth control access in pharmacies: a qualitative study. Contraception. 2018;97(3):249-255. doi:10.1016/j.contraception.2017.11.0087. Campo S, Kohler C, Askelson NM, Ortiz C, Losch M. It Isn’t All About Language: Communication Barriers for Latinas Using Contraceptives. J Transcult Nurs. 2015;26(5):466-472. doi:10.1177/10436596145247848. Hietanen A-E, Pick S. Gender Stereotypes, Sexuality, and Culture in Mexico. In: Safdar S, Kosakowska-Berezecka N, eds. Psychology of Gender Through the Lens of Culture: Theories and Applications. Cham: Springer International Publishing; 2015:285-305. doi:10.1007/978-3-319-14005-6_149. Lara D, Decker MJ, Brindis CD. Exploring how residential mobility and migration influences teenage pregnancy in five rural communities in California: youth and adult perceptions. Culture, Health & Sexuality. 2016;18(9):980-995. doi:10.1080/13691058.2016.115051410. Valdez ES, Andrade R, Palafox MM. Developing a Binational Community-Based Participatory Research Partnership to Address Reproductive Health on the U.S.–Mexico Border. Progress in Community Health Partnerships. 2019;13(3):265-271. doi:10.1353/cpr.2019.005411. Sterling SP, Sadler LS. Contraceptive Use Among Adolescent Latinas Living in the United States: The Impact of Culture and Acculturation. Journal of Pediatric Health Care. 2009;23(1):19-28. doi:10.1016/j.pedhc.2008.02.00412. Condoms, Culture, and Conviction: The Effect of Acculturation and Religiosity on Latina Condom Use during First Sex with New Partners: Social Work in Public Health: Vol 32, No 3. https://www.tandfonline.com/doi/full/10.1080/19371918.2016.1215278. Accessed November 25, 2019.

“This Is Something I’m Doing for Me:” The Influence of Mexican and U.S. Culture on the Reproductive Health Decisions of Female Adolescents Living in the San Diego/Tijuana Border Region

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“This Is Something I’m Doing for Me:” The Influence of Mexican and U.S. Culture on the Reproductive Health Decisions of Female Adolescents Living in the San Diego/Tijuana Border Region

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