145. Parent Perspectives about Initiating Contraception Discussions with Adolescent Daughters

Parent-youth sexual and reproductive health (SRH) discussions are critical to reducing risk behaviors associated with adolescent pregnancy. However, many parents do not proactively discuss contraception before youth become sexually active. The role of healthcare providers in supporting timely contraception discussions with adolescents prior to sexual debut while addressing parental concerns needs careful investigation. Thus, we aim to describe parental perspectives about when and how to initiate contraception discussions with youth, characterize motivators to discuss contraception, and explore the role of healthcare providers in supporting contraception discussions with youth prior to sexual debut. We conducted semi-structured interviews with 20 parents caring for female youth 9-20-years-old recruited from community-based sites in Dallas, TX. Recruitment occurred at sites serving primarily Hispanic and non-Hispanic Black parents due to significant racial and ethnic disparities in local adolescent pregnancy rates. We analyzed interview transcripts with a combined deductive and inductive approach. Discrepancies in coding were resolved by consensus. Parents were 60% Hispanic, 40% non-Hispanic Black and 45% preferred to be interviewed in Spanish. Most parents identified as female (90%) and 25% parented a 9-10-year-old, 20% parented an 11-15-year-old, and 55% parented a 16-20-year-old. Overall, many parents based when and how to initiate contraception discussions on the youth’s age, indicators of physical maturation such as menarche, or emotional maturity as indicated by developing romantic interests. Some delayed discussions until late adolescence, whereas others began far in advance of sexual activity. For parents who assumed the youth were not yet sexually active, many used intuition about romantic interests as a trigger to initiate contraception discussions. Some parents expected daughters to initiate the discussion independently: “when she comes to me, I'll know that it's time.” Cultural experiences of generational avoidance of SRH discussion at home motivated some parents to communicate with youth. Other motivators included communication as a means of risk reduction and health promotion to avoid unintended pregnancy and manage anticipated youth sexual autonomy. Conversely, parental fears and concerns that contraception might encourage sexual activity were common. Parents specifically wanted pediatricians to talk about contraception with post-menarchal daughters before sexual debut. Prepared, proactive, and individualized discussions built parental trust in physician-led contraception discussions. Open and comfortable physician communication boosted parent trust in confidential discussions with youth. The tension between the desire to prevent adolescent pregnancy, generational avoidance of contraception, and fear that contraception discussions could promote sexual behaviors may cause many parents to struggle and delay contraception discussions prior to sexual debut. Healthcare providers can serve as a bridge between sexually naïve adolescents and parents by proactively discussing contraception with all youth using confidential and individually-tailored communication.