Research Article|Articles in Press

Parent Perspectives about Initiating Contraception Conversations with Adolescent Daughters

  • Julia C. Durante
    Corresponding author: Julia C. Durante, 2350 N Stemmons Fwy, Ste F5200, Dallas, TX, 75207, Phone: 214-456-8783, Fax: 214-456-2230
    Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX

    Children's Health System of Texas, Dallas, TX
    Search for articles by this author
  • Robin T. Higashi
    Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX

    Harold C. Simmons Comprehensive Cancer Center, Dallas, TX
    Search for articles by this author
  • May Lau
    Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX

    Children's Health System of Texas, Dallas, TX
    Search for articles by this author
  • Jasmin A. Tiro
    Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX

    Harold C. Simmons Comprehensive Cancer Center, Dallas, TX
    Search for articles by this author
  • Jenny K.R. Francis
    Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX

    Children's Health System of Texas, Dallas, TX

    Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX
    Search for articles by this author
Published:March 06, 2023DOI:



      Parent-youth Sexual and Reproductive Health (SRH) conversations are critical to reducing adolescent pregnancy, yet many parents do not discuss contraception before youth become sexually active. We aim to describe parental perspectives about when and how to initiate contraception discussions, characterize motivators to discuss contraception, and explore the role of healthcare providers in supporting contraception communication with youth.


      We conducted semi-structured interviews with 20 parents of female youth ages 9-20 recruited from areas of Dallas, TX, with high rates of racial and ethnic disparities in adolescent pregnancy. We analyzed interview transcripts with a combined deductive and inductive approach, with discrepancies resolved by consensus.


      Parents were 60% Hispanic, 40% non-Hispanic Black, and 45% were interviewed in Spanish. Most identified as female (90%). Many initiated contraception discussions based on age, physical development, emotional maturity, or perceived likelihood of sexual activity. Some expected daughters to initiate SRH discussions. Cultural avoidance of SRH discussion often motivates parents to improve communication. Other motivators included reducing pregnancy risk and managing anticipated youth sexual autonomy. Some feared that discussing contraception could encourage sex. Parents trusted and wanted pediatricians to serve as a bridge to discuss contraception with youth before sexual debut through confidential, comfortable communication.


      Tension between the desire to prevent adolescent pregnancy, cultural avoidance, and fear of encouraging sexual behaviors causes many parents to delay contraception discussions prior to sexual debut. Healthcare providers can serve as a bridge between sexually naïve adolescents and parents by proactively discussing contraception using confidential and individually-tailored communication.



      SRH (Sexual and Reproductive Health), LARC (Long-Acting Reversible Contraception)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric and Adolescent Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Widman L
        • Choukas-Bradley S
        • Noar SM
        • Nesi J
        • Garrett K.
        Parent-Adolescent Sexual Communication and Adolescent Safer Sex Behavior: A Meta-Analysis.
        JAMA Pediatr. Jan 2016; 170: 52-61
        • Lindberg LD
        • Santelli J
        • Desai S.
        Understanding the Decline in Adolescent Fertility in the United States, 2007–2012.
        J Adolesc Health. Nov 2016 2016; 59: 577-583
        • Abma JC
        • Martinez GM.
        Sexual Activity and Contraceptive Use Among Teenagers in the United States, 2011-2015.
        Natl Health Stat Report. Jun 2017; : 1-23
        • Finer LB
        • Philbin JM.
        Sexual initiation, contraceptive use, and pregnancy among young adolescents.
        Pediatrics. May 2013; 131: 886-891
      1. Centers for Disease Control and Prevention. Reproductive Health: Teen Pregnancy - Birth Rates for Females Aged 15 to 19 Years, by Race and Hispanic Origin of Mother: United States, 2018 and 2019. Accessed December 10, 2022.

      2. Akers AY, Schwarz EB, Borrero S, Corbie-Smith G. Family Discussions About Contraception And Family Planning: A Qualitative Exploration Of Black Parent and Adolescent Perspectives. Perspectives on Sexual and Reproductive Health. Sept 2010;42(3):160-167. doi:10.1363/4216010

        • Szucs LE
        • Harper CR
        • Andrzejewski J
        • Barrios LC
        • Robin L
        • Hunt P.
        Overwhelming Support for Sexual Health Education in U.S. Schools: A Meta-Analysis of 23 Surveys Conducted Between 2000 and 2016.
        Journal of Adolescent Health. 2022; 70: 598-606
        • Eisenberg ME
        • Bernat DH
        • Bearinger LH
        • Resnick MD.
        Support for Comprehensive Sexuality Education: Perspectives from Parents of School-Age Youth.
        Journal of Adolescent Health. Apr 2008 2008; 42: 352-359
        • Ramchandani K
        • Morrison P
        • Gold MA
        • Akers AY.
        Messages About Abstinence, Delaying Sexual Debut and Sexual Decision-Making in Conversations Between Mothers and Young Adolescents.
        J Pediatr Adolesc Gynecol. Apr 2018; 31: 107-115
        • Swain CR
        • Ackerman LK
        • Ackerman MA.
        The influence of individual characteristics and contraceptive beliefs on parent-teen sexual communications: a structural model.
        J Adolesc Health. Jun 2006; 38 (753.e9-18)
      3. Pluhar EI, DiIorio CK, McCarty F. Correlates of sexuality communication among mothers and 6-12-year-old children. Child Care Health Dev. May 2008;34(3):283-90. doi:10.1111/j.1365-2214.2007.00807.x

        • Lantos H
        • Manlove J
        • Wildsmith E
        • Faccio B
        • Guzman L
        • Moore KA.
        Parent-Teen Communication about Sexual and Reproductive Health: Cohort Differences by Race/Ethnicity and Nativity.
        Int J Environ Res Public Health. Mar 7 2019; 16
        • Flores D
        • Barroso J.
        21st Century Parent-Child Sex Communication in the United States: A Process Review.
        J Sex Res. May-Jun 2017; 54: 532-548
        • Santelli JS
        • Klein JD
        • Song X
        • et al.
        Discussion of Potentially Sensitive Topics With Young People.
        Pediatrics. Feb 2019; 143
        • Sieving RE
        • Mehus C
        • Catallozzi M
        • et al.
        Understanding Primary Care Providers' Perceptions and Practices in Implementing Confidential Adolescent Sexual and Reproductive Health Services.
        J Adolesc Health. Oct 2020; 67: 569-575
        • Boekeloo BO
        Will you ask? Will they tell you? Are you ready to hear and respond?: barriers to physician-adolescent discussion about sexuality.
        JAMA Pediatr. 2014; 168 (Feb): 111-113
        • Lopez LM
        • Grey TW
        • Chen M
        • Tolley EE
        • Stockton LL.
        Theory-based interventions for contraception.
        Cochrane Database Syst Rev. Nov 2016; 11 (Cd007249)
      4. Bandura A. Health promotion by social cognitive means. Health Educ Behav. Apr 2004;31(2):143-64. doi:10.1177/1090198104263660

        • Ford CA
        • Cheek C
        • Culhane J
        • et al.
        Parent and Adolescent Interest in Receiving Adolescent Health Communication Information From Primary Care Clinicians.
        J Adolesc Health. Aug 2016; 59: 154-161
        • Alexander SC
        • Fortenberry JD
        • Pollak KI
        • et al.
        Sexuality talk during adolescent health maintenance visits.
        JAMA Pediatr. 2014; 168 (Feb): 163-169
        • Alexander SC
        • Christ SL
        • Fortenberry JD
        • et al.
        Identifying types of sex conversations in adolescent health maintenance visits.
        Sex Health. 2016; 13 (Feb): 22-28
      5. American Academy of Pediatrics. Bright Futures: Guidelines for Health Supervision Of Infants, Children, and Adolescents. 4th ed ed. Elk Grove Village, IL:; 2017.

      6. Centers for Disease Control and Prevention. Youth Risk Behavior Survey Questionnaire. Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Accessed April 1, 2022.

        • Sieving RE
        • McRee A-L
        • Mehus C
        • et al.
        Sexual and Reproductive Health Discussions During Preventive Visits.
        Pediatrics. 2021; 148
      7. United States Census Bureau. Dallas City, Texas, Quick Facts. Accessed March 27, 2022.

      8. Centers for Disease Control and Prevention. CDC Natality Request 2007-2020. Updated August 11, 2022.

      9. The Texas Campaign to Prevent Teen Pregnancy. Teen Birth in Texas, Teen Birth Rate by County, 1991 - 2020. Accessed August 11, 2022.

      10. Healthy North Texas TDoSHS. Teen Births, Dallas: 2017. Accessed 4/4/22,

        • Bradley EH
        • Curry LA
        • Devers KJ.
        Qualitative data analysis for health services research: developing taxonomy, themes, and theory.
        Health Serv Res. Aug 2007; 42: 1758-1772
        • Dennis AC
        • Wood JT.
        We're Not Going to Have This Conversation, But You Get It”: Black Mother–Daughter Communication About Sexual Relations.
        Women's Studies in Communication. 2012; 35 (Jan 2012): 204-223
        • Eisenberg ME
        • Sieving RE
        • Bearinger LH
        • Swain C
        • Resnick MD.
        Parents' communication with adolescents about sexual behavior: A missed opportunity for prevention?.
        Journal of Youth and Adolescence. 2006; 35 (Dec): 893-902
        • Santa Maria D
        • Markham C
        • Bluethmann S
        • Mullen PD
        Parent-based adolescent sexual health interventions and effect on communication outcomes: a systematic review and meta-analyses.
        Perspect Sex Reprod Health. 2015; 47 (Mar): 37-50
        • Romo LF
        • Bravo M
        • Cruz ME
        • Rios RM
        • Kouyoumdjian C.
        El Sexo no es Malo": Maternal Values Accompanying Contraceptive Use Advice to Young Latina Adolescent Daughters.
        Sex Res Social Policy. Jun 2010; 7: 118-127
        • Kenny MC
        • Wurtele SK.
        Latino Parents' Plans to Communicate About Sexuality With their Children.
        Journal of Health Communication. Aug 2013; 18: 931-942
        • Guilamo-Ramos V
        • Bowman AS
        • Benzekri A
        • Ruiz Y
        • Beltran O.
        Misalignment of sexual and reproductive health priorities among older Latino adolescents and their mothers.
        Contraception. 2019; 99 (Mar): 179-183
        • Galloway CT
        • Duffy JL
        • Dixon RP
        • Fuller TR.
        Exploring African-American and Latino Teens' Perceptions of Contraception and Access to Reproductive Health Care Services.
        J Adolesc Health. 2017; 60 (Mar): S57-s62
        • Bryson AE
        • Hassan A
        • Goldberg J
        • Moayedi G
        • Koyama A.
        Call to Action: Healthcare Providers Must Speak Up for Adolescent Abortion Access.
        Journal of Adolescent Health. 2022; 70: 189-191