Family discussions about contraception and family planning: a qualitative exploration of black parent and adolescent perspectives.

Approximately 750,000 adolescents become pregnant in the United States each year,1 and most of these pregnancies are unintended.2 Consistent contraceptive use is the critical factor mediating adolescent pregnancy risk,3 but multiple barriers prevent adolescents from using contraceptives; chief among these are lack of access to services and adolescents’ concerns about parental attitudes toward contraceptive use.4 However, parents do not only impede adolescents’ contraceptive use; they also may exert a positive influence.5,6 Thus, improving parent-adolescent communication about contraception and family planning is one way to encourage young people’s consistent, effective use of contraceptives. Several studies have documented a positive relationship between parent-adolescent communication and adolescent contraceptive use. Jaccard et al.7 and Tucker8 found that maternal communication about contraception was associated with increased use among adolescent males. Newcomer et al.9 found that adolescent females whose mothers discussed contraception were twice as likely to use contraceptives as those whose mothers did not. Other work has shown that parent-adolescent communication is linked to adolescents’ sexual behavior and capacity to negotiate sexual situations with partners. For example, DiClemente et al.10 noted that family communication was positively associated with adolescent females’ condom use and communication with partners about protection. Previous studies assessing the association between parental communication and adolescent contraceptive use had several major limitations. First, most focused on mother-adolescent, particularly mother-daughter, communication. Few examined how communication with sons is related to male contraceptive use7 or how parents of each gender discuss these issues with their children.8 Second, most studies used cross-sectional questionnaire designs and therefore could not assess the causal nature of these associations. Third, questionnaire designs limit exploration of the broad processes by which parents teach their children about contraceptive use and adolescent pregnancy. Fourth, most existing studies used either parents or adolescents as informants, rather than collecting and comparing data from both to obtain a more robust picture of communication within families. To develop effective parent education and communication skills-building programs, health care providers and sexual health educators need to understand how parents cultivate their children’s contraceptive knowledge, attitudes and behaviors; the role fathers and mothers play in this process; and the challenges parents face. Despite the sizable literature on parent-adolescent communication, important questions have been inadequately explored, including when discussions begin; what factors spark conversations; the content of discussions; how discussions evolve over time; what affects children’s receptivity to these discussions; how discussions affect adolescents’ contraceptive behaviors; and how discussions with mothers differ, in content and effect, from those with fathers. In this analysis, we explored some of these questions from the perspectives of black parents and adolescents of both genders. Understanding family communication about contraception and family planning among black adolescents is particularly important because this population initiates sex at an early age,11 has one of the lowest rates of adolescent contraceptive use in the United States11 and is disproportionately affected by adolescent pregnancy.12