DISCUSSION RESPONSES

My subject choice is that of family planning. I live in a rural health community, with a large Native American population, and family planning is lacking in the traditional culture. According to the Arizona Department of Health, the teen pregnancy birth rate (14-19) is thirty-five percent (azdhs, 2019). This lends to the unemployment rate of greater than twenty two percent for the Navajo reservation. There is a cultural pattern where the teen mother gives the baby to the "auntie" to raise the child. Then as the mother ages, she takes on the role of "auntie" for the next generation. We have several minor patients that come into our specialty clinic and obtaining guardianship records is next to impossible. The patient customarily arrives with their "auntie" who assumes the role of the parent and they know the patient best. However, according to hospital policy, we must have court documents. Some providers will assume the risk of rendering care to the presenting guardian as they understand the risk.

According to Dehlendorf (2019), there are steps to take to establish the family planning process. These include: establish rapport, identify those appropriate to receive contraceptive counseling, assess medical history and complications, initiate the counseling process, elicit informed preferences for methods, facilitate preference concordinate decision making and lastly counsel about method initiation and use. In my clinical setting, it is on the reservation. Many providers are non Native and do not subscribe or understand the cultural process. In my observation, the cultural difference can lead to a condesending or more paternal approach to family planning with their patients who are minors. There is also lack of family planning addressed since many of the patients are minors.

Chacko (2019), explains that a young adolescent may prefer to have her mother present throughout the office visit, particularly if the mother is aware of the teenager's sexual behavior and wants the teenager to use a contraceptive method. Even if this is the case, it is important to encourage independent time with the adolescent to obtain a more detailed history about other possible high-risk behaviors. This is essentially important due to the adult present not necessarily being their true parent. Since teens are minors, according to Chacko, M "The need for parental consent also may be related to state or federal funding for hormonal contraception in local clinics. The Guttmacher Institute maintains a list of state policies regarding parental involvement and consent that are updated regularly." Providers must know their population, demographics and cultural practices as well as their own beliefs to be able to address family planning with teens in the safest and most realistic manner.

References:

Arizona Department of Health Services (2019). Data management. Retrieved from: https://www.azdhs.gov/documents/prevention/health-systems-development/data-reports-maps/reports/datadocu.pdf

Chacko, M. (2019). Contraception: Issues specific to adolescents. UptoDate. Retrieved from: https://www.uptodate.com/contents/contraception-issues-specific-to-adolescents?search=family%20planning&source=search_result&selectedTitle=8~150&usage_type=default&display_rank=8

Dehlendorf, C. (2019) Contraceptive counseling and selection for women. UptoDate. Retrieved from: https://www.uptodate.com/contents/contraceptive-counseling-and-selection-for-women?search=family%20planning&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1