UCSF

ABSTRACT

REPRODUCTIVE HEALTH CHOICES, DISPARITIES, AND SOCIAL CONTEXTS OF AFRICAN AMERICAN ADOLESCENT FEMALES WHO UTILIZE SCHOOL-BASED HEALTH CENTERS

Gina Gabrielle Robinson-Osder

African American adolescent females (AAAFs) continue to experience high rates of sexually transmitted infections, including chlamydia, gonorrhea, and HIV. African American and Hispanic adolescent females also continue to have higher birth rates compared to their White counterparts.

The risk markers of race and ethnicity correlate with fundamental determinants of health such as low socioeconomic status and limited access to health care. The prevalence of some risk factors can be addressed and even decreased through early prevention and lifestyle changes that are facilitated through services delivered at School-based Health Centers (SBHCs).

The purpose of this critical ethnography was to better understand the multifactorial contributors to AAAFs’ reproductive health disparities. Aims included critically analyzing reproductive health decisions, use of SBHCs, peer influences and contextual factors in AAAF’s lives. The study participants were 20 sexually active, self-identified AAAFs between 15-18 years old, from lower socioeconomic backgrounds as identified by their zip codes. Data collection included in-depth interviews and observations of social activities with participants. The data were iteratively coded for major themes and subcategories. Two major overarching themes regarding the sexual debut of these AAAFs were the intersection of reproductive health, sexual behaviors, and developmental vulnerability in AAAFs, and the social contexts contributing to AAAFs’ reproductive health disparities.

All of the AAAFs in this study reported being unprepared mentally, physically, and emotionally for their sexual debut. Developmental vulnerability was more apparent in the younger AAAFs. The young females, none of whom were on any form of birth control, lacked the cognitive development to negotiate their readiness to engage sexually with their older male partners, versus the older adolescents who had partners their own age, were on birth control, and better negotiated their sexual debut. Thirteen of the 20 AAAFs had mothers under the age of 18 years when they were born. Despite 17 of the 20 AAAFs being exposed to neighborhood violence, they were remarkably resilient.

All of the AAAFs in this study ultimately started on birth control methods provided through the SBHCs. The SBHCs provided access to confidential reproductive health care, health education, and counseling, and should be used to address vulnerabilities in younger AAAFs.