442 - Confidential Contraception Protections and Challenges for Adolescents in Foster Care in Texas

Poster Number: 442
Publication Number: 442.1

Erin M. Kovar, University of Texas at Austin Dell Medical School, Austin, TX, United States; Justin Kramer, Atrium Health, Charlotte, NC, United States; Jessica Sims, University of Texas Southwestern, Dallas, TX, United States; Jill D.. McLeigh, Children's Health, Dallas, TX, United States; Hilda Loria, University of Texas Southwestern Medical School, Dallas, TX, United States; Simon J. Craddock. Lee, University of Kansas School of Medicine, Kansas City, KS, United States; Jasmin A. Tiro, University of Chicago Division of the Biological Sciences The Pritzker School of Medicine, Chicago, IL, United States; Jenny KR. Francis, University of Texas Southwestern Medical Center, Dallas, TX, United States

Background: It is unclear how youth in foster care have systematic access to contraception.

Objective:
This mixed-methods study analyzed the policies of government agencies and medical societies with semi-structured interviews of stakeholders to understand the experience of accessing contraception confidentially for youth in care. We explore how policies may influence lived experiences.


Design/Methods:
Overall, 37 documents were analyzed: 20 from federal (n=3), state (n=8), and local (n=9) policies and 17 from foster care agencies (n=7) and medical societies (n=10). References to confidential protections were coded into four categories: teen-focused (explicit statements about confidential protections for adolescents to consent to contraception), parent-focused (requires parental permission), deferred (refers to other rules for final guidance), and missing (lacks language about contraception). We also interviewed 39 individuals involved in foster care (12 adolescents, 9 providers, and 18 caregivers) to obtain their views on accessing contraception. Thematic analysis and inductive coding identified emergent themes to triangulate how policies influence lived experience.


Results:
Only federal documents specific to Medicaid contained teen-focused language. Six state documents emphasized parental rights; two had missing language. Two local documents contained parent-focused language; seven had deferred/missing language. Two foster care documents had explicit language regarding confidential contraceptive services; five had missing positions. Nine medical ‎societies supported confidential protections, yet eight also used deferral language referring to state regulations. One medical society had missing language. Across the interviews, three main themes emerged about access to contraception. Child Protective Services, legal health departments, state agencies, and “requirements” at placements were perceived as playing a main role in access to contraption. Regulations in place to help protect confidential access to contraception were often confusing or not supportive of youths’ confidentiality. Tension between adolescent autonomy and guidance from caregivers created challenges in confidential access to contraception. A gap in guidance from policies matched lived experiences in which “legal” requirements, regulations, and caregivers were perceived as overstepping adolescent autonomy.


Conclusion(s):
A lack of teen-focused language and a struggle between federal and state language regarding confidential protection of contraceptive services for youth in care creates confusion among stakeholders and a loss of adolescent autonomy.