One in ten (9%) young adults aged 18–25 on their parents’ health insurance and nearly one in five (18%) of all adolescents aged 15–17 reported that they would not seek sexual and reproductive health care services because of concerns that their parents might find out, according to a new analysis by Guttmacher researchers Liza Fuentes, Meghan Ingerick, Rachel Jones and Laura Lindberg.
Despite recent improvements in health insurance coverage and contraceptive use in the United States, confidentiality remains a concern for many young people. The authors analyzed data from the 2013–2015 National Survey of Family Growth to gain a better understanding of the barriers adolescents and young adults face when attempting to access confidential sexual and reproductive health services. For some young people, confidentiality concerns are a tangible barrier to accessing contraceptive care.
Among females aged 15–25 who had ever had sex, those who had confidentiality concerns were less likely to have received any contraceptive services in the previous year than those who did not have concerns. Of those who had confidentiality concerns, just 22% of 15–17-year-olds and 47% of 18–25-year-olds had received a contraceptive service in the previous year, compared with 67% and 75%, respectively, of those without such concerns.
"It is problematic that some young people may not obtain needed sexual and reproductive health services because they are concerned about protecting their confidentiality," says Liza Fuentes, lead author of the analysis. "All adolescents and young adults should be supported in obtaining confidential care and ensuring their health and well-being."
Billing practices pose a barrier to confidential care for young people who rely on their parents’ private health insurance. Under many plans, the policyholder (in this case, the parent) receives an explanation of benefits, which is a detailed statement of services provided at health care visits to anyone covered under the plan. Only two states—New York and Wisconsin—have implemented policies specifically to protect the confidentiality of young people who are affected by this practice.
For young people who rely on publicly funded programs such as Medicaid and Title X, confidential care for sexual and reproductive health services is explicitly guaranteed. However, the policy landscape may be changing. Texas has requested permission to reverse this long-standing practice by using federal Medicaid funds to support a state policy that requires parental consent for sexual and reproductive health services for minors. If approved, the Texas plan would negatively impact the most vulnerable young people, including many who may choose not to receive needed services because of concerns about confidentiality.
Leading U.S. medical associations endorse confidential health care for adolescents and specifically recommend that adolescent patients spend time alone with their health care provider. The authors found that 45% of adolescents reported that they had spent time alone with a provider at their last health care visit. Females aged 15–17 who had discussed several sexual and reproductive health topics with their parents were more likely to have spent time alone with a provider than those who had not discussed these topics.
Adolescents aged 15–17 with characteristics typically linked to socioeconomic disadvantage were less likely to have concerns about confidential sexual and reproductive health care than their peers. Young people with these characteristics were also less likely than their peers to have spent time alone with a provider at their last health care visit. It is possible that parents of these young people are more supportive of their children’s use of sexual and reproductive health care services, or they may have less time to monitor their children’s use of such services.
"Too many young people face barriers to confidential care, and as a result, many do not receive needed services," says Jesseca Boyer, Guttmacher policy expert. "Rather than imposing additional barriers, policymakers, providers and caregivers must work to guarantee access to confidential sexual and reproductive health services for young people."
"Adolescents’ and Young Adults’ Reports of Barriers to Confidential Health Care and Receipt of Contraceptive Services," by Liza Fuentes, Meghan Ingerick, Rachel Jones and Laura Lindberg, is currently available online and will appear in a forthcoming issue of the Journal of Adolescent Health.