Girls in custody: A qualitative study of experiences, preferences and opportunities surrounding family planning

Awarded 2016
Complex Family Planning Fellowship Research
Angeline Ti, MD, MPH
University of California, San Francisco

Background: There are a growing number of adolescent girls involved in the juvenile justice system, including those detained in juvenile detention centers. These girls tend to have higher rates of sexual activity, sexually transmitted infections, and unintended pregnancy, and less access to routine health care. 
Study purpose: We used principles of patient-centered care to explore the experiences and preferences for family planning care of incarcerated girls.
Methodology: We conducted detailed interviews with girls incarcerated in a facility in Nothern California, and analyzed the interviews to look for new themes, and themes related to patient-centered care. 
Important findings: Overarching themes of stigma and autonomy were influential in girls’ experiences and preferences for family planning care. Girls described stigma related to incarceration, sexual activity, and lack of contraception use. Their desire for autonomy contributed to concerns around family planning care. Despite this, the vast majority desired access to family planning care while incarcerated. Many valued relationships they had with facility providers, reporting more trust and familiarity with facility providers than those in the community. Constraints of incarceration decreased availability of emotional supports and decreased involvement of family in health-related decision-making, which both worsened girls’ experiences with family planning care and enhanced their sense of autonomy. Difficulties with care coordination and transitions between the facility and community often resulted in fragmented care.
Conclusions:  Providing patient-centered family planning care in juvenile facilities is desirable but complex, and requires prioritizing patient preferences while recognizing the strengths and limitations of providing FP care within JDCs.