Abortion request during adolescence and management of confidentiality. A challenging issue
Danielle Wyss, J.-C. Suris, S.-C. Renteria (Switzerland)
Mutidisciplinary Unity for Adolescent Health (UMSA) and Family Planning Clinic, Psycho-social Unit, Department for Obstetrics and Gynecology, Centre Hospitalier Universitaire CHUV, 1012 Lausanne, Switzerland
Introduction. The right for adolescents to access to confidential health services, including requests for abortion, is broadly recognized by the United Nations Convention on the Rights of the Child. It is widely approved and applied by reproductive health professionals, provided that the capacity to discern of the young person is deemed sufficient. This study focuses on the challenges due to the request for confidentiality towards the holders of parental authority in this context, and on the consequences of the different ways of taking care of it.
Objectives.To determine whether the situation of minor consultants asking for confidentiality differs from the others and to assess the risks of assuming confidentiality regarding the continuity of follow-up, the contraceptive compliance and the risk of a new unplanned pregnancy.
Material and methods.Retrospective study of 174 female aged less than 18 years who consulted a specialized unit for adolescents or a family planning center with an abortion request between 2003 and 2006. The sample was divided into two groups depending on whether confidentiality was requested or not. For the groups «without» (N=104) and « with »(N=70) a request for confidentiality, we compared the socio-demographic, relational and medical factors related to the decision and the medical and psycho-social follow-up post abortion.
Results.Adolescents «with» a request for confidentiality are more likely than those « without» to be of foreign nationality, especially from Africa or South America (59.4% versus 37.1%). They are more likely to be studying (80% versus 62.1%) and they more often live with both parents (47.1% versus 33.7%); they have more frequently a partner of about the same age (72.1% versus 57.3%) and are less ambivalent before the decision to abort (94.3% versus 83.7%). There was no difference between the two groups regarding the relationship with the parents, the age of the pregnancy, the experience with hormonal contraceptives before the pregnancy, the follow-up post abortion or the occurrence of a new unexpected pregnancy in the following year.
Conclusions. It seems to be more difficult for adolescents living in “intact” families or integrated in an educational or professional track to talk to their parents about their unexpected pregnancy. If the request for confidentiality is made in the setting of a specialized unit for adolescents with an explicit therapeutic agreement and closely scheduled follow-ups, it does not appear to have negative consequences on the compliance with follow-up or the risk of a subsequent unplanned pregnancy. In these circumstances, the assumption that recommends the ability to guarantee the care of adolescents in sexual and reproductive health matters in respect of confidentiality is compatible with the responsibility of caregivers vis-à-vis these underage patients, on the short and medium-term.