Opportunities to Improve Sexual and Reproductive Care Among Hospitalized Adolescents

Sexual Health Discussion Among Hospitalized Adolescents: Opportunities To Improve Confidentiality and Care Coordination in Primary Care Follow-up

Improved access to sexual and reproductive care (SRC) improves adverse outcomes among adolescents, yet barriers continue to exist. Although the continued declining rate of adolescent pregnancy over the past decades is encouraging, adolescents in the United States still experience disproportionately high rates of unplanned pregnancy and sexually transmitted infections (STIs) compared with adolescents in other industrialized countries.^1–3 Nearly 90% of adolescent pregnancies are unplanned, leading to increased risk for preventable outcomes, including preterm delivery, low birth weight, and neonatal mortality.^4,5 In addition, unintended teen-aged pregnancy is associated with reduced education attainment and career earning potential.⁶ Rates of STIs among adolescents remain high, with nearly 1 in 4 girls testing positive for an STI annually.⁷ In addition, only half of adolescents are fully vaccinated against the human papillomavirus (HPV), leaving those who are unvaccinated at risk for developing HPV-associated cancers.⁸ Despite multiple national organizations advocating for provision of comprehensive care for adolescents at every clinical encounter, adolescent reproductive and sexual health needs often go unmet.^9,10 In light of recent events, including the COVID-19 pandemic as well as the current administration’s health care reform policies, access to evidence-based SRC is even further decreased, particularly among vulnerable populations, including adolescents; thus, efforts to address these needs are now more critical than ever.^11,12

Many adolescents, particularly those at highest risk for unintended pregnancy and STIs, have limited access to SRC because of numerous barriers, including poor access and confidentiality concerns.^13–15 Open parent-teenager communication regarding sexual and reproductive health promotes reduced risk behaviors, but most teenagers do not receive these discussions with their parents, guardians, or health care providers.¹⁶ Among …