Skip to main content
SpringerLink
Log in

A Mixed-Methods Study Exploring Colombian Adolescents’ Access to Sexual and Reproductive Health Services: The Need for a Relational Autonomy Approach

  • Original Research
  • Published:
Journal of Bioethical Inquiry Aims and scope Submit manuscript

Abstract

This study’s objective was to understand Colombian adolescents’ experiences and preferences regarding access to sexual and reproductive health services (SRHS), either alone or accompanied. A mixed-method approach was used, involving a survey of 812 participants aged eleven to twenty-four years old and forty-five semi-structured interviews with participants aged fourteen to twenty-three. Previous research shows that adolescents prefer privacy when accessing SRHS and often do not want their parents involved. Such findings align with the longstanding tendency to frame the ethical principle of autonomy as based on independence in decision-making. However, the present study shows that such a conceptualization and application of autonomy does not adequately explain Colombian adolescent participants’ preferences regarding access to SRHS. Participants shared a variety of preferences to access SRHS, with the majority of participants attaching great importance to having their parents involved, to varying degrees. What emerges is a more complex and non-homogenous conceptualization of autonomy that is not inherently grounded in independence from parental involvement in access to care. We thus argue that when developing policies involving adolescents, policymakers and health professionals should adopt a nuanced “relational autonomy” approach to better respect the myriad of preferences that Colombian (and other) adolescents may have regarding their access to SRHS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data Availability

The data that support the findings of this study are not available due to ethical restrictions.

Notes

  1. For example, one needs to be at least eighteen years old to be sterilized in Colombia. Nonetheless, an adolescent younger than eighteen years old would be allowed to consult a doctor to obtain information about sterilization procedures without legal obligations for the doctor to inform the adolescent’s parents or legal guardians.

  2. For this research, “sexual and reproductive health services” was an inclusive concept representing all related services (e.g., contraceptives, vasectomy, abortion, HIV/STI testing).

  3. At the request of the Profamilia staff, patients who were at the clinic for STI/HIV testing were not invited to answer the survey. At Profamilia, young people receiving tests for STI/HIV need to fill out paperwork and receive counselling from a nurse on safe sex practices, which can be time consuming for the patient. To not overwhelm patients seeking such testing, they were not invited to participate in the survey.

  4. It should be noted that the expression “sexual and reproductive health” was challenging to understand for an important number of participants. As shown in the interview excerpts, the expression “family planning” (la planificación)—which is popularly used in Colombia—was instead used during some of the interviews.

References

  • Beauchamp, T., and F. Childress. 2012. Principles of biomedical ethics, 7th ed. New York: Oxford University Press.

    Google Scholar 

  • Brisson, J., V. Ravitsky, and B. Williams-Jones. 2021. “Fostering Autonomy” for adolescents to access health services: A need for clarifications. Journal of Adolescent Health 68(6): 1038–1039.

    Article  Google Scholar 

  • Candib, L.M. 2002. Truth telling and advance planning at the end of life: Problems with autonomy in a multicultural world. Families, Systems, & Health 20(3): 213.

    Article  Google Scholar 

  • Council for International Organizations of Medical Sciences. 2017. International ethical guidelines for health-related research involving humans, 4th ed. Geneva: WHO Press.

    Google Scholar 

  • Dahl, R.E., N.B. Allen, L. Wilbrecht, and A.B. Suleiman. 2018. Importance of investing in adolescence from a developmental science perspective. Nature 554(7693): 441–450.

    Article  CAS  PubMed  Google Scholar 

  • Dove, E.S., S.E. Kelly, F. Lucivero, M. Machirori, S. Dheensa, and B. Prainsack. 2017. Beyond individualism: Is there a place for relational autonomy in clinical practice and research? Clinical Ethics 12(3): 150–165.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ells, C., M.R. Hunt, and J. Chambers-Evans. 2011. Relational autonomy as an essential component of patient-centered care. IJFAB: International Journal of Feminist Approaches to Bioethics 4(2): 79–101.

    Google Scholar 

  • Espinoza, W.H.F. 2017. La autonomía progresiva del niño y su participación en el proceso judicial [The progressive autonomy of the child and their participation in the judicial process]. Vox Juris 34(2): 171–189.

    Article  Google Scholar 

  • Every Women Every Child. 2015. The global strategy for women’s, children’s and adolescents’ health (2016–2030). New York: World Health Organization.

    Google Scholar 

  • Fuentes, L., M. Ingerick, R. Jones, and L. Lindberg. 2018. Adolescents’ and young adults’ reports of barriers to confidential health care and receipt of contraceptive services. Journal of Adolescent Health 62(1): 36–43.

    Article  Google Scholar 

  • Frosch, D.L., and R.M. Kaplan. 1999. Shared decision making in clinical medicine: Past research and future directions. American Journal of Preventive Medicine 17(4): 285–294.

    Article  CAS  PubMed  Google Scholar 

  • Garside, R., R. Ayres, M. Owen, V.A. Pearson, and J. Roizen. 2002. Anonymity and confidentiality: Rural teenagers’ concerns when accessing sexual health services. BMJ Sexual & Reproductive Health 28(1): 23–26

    Google Scholar 

  • Gilbar, R., and J. Miola. 2015. One size fits all? On patient autonomy, medical decision-making, and the impact of culture. Medical Law Review 23(3): 375–399.

    Article  PubMed  Google Scholar 

  • Gómez-Vírseda, C., Y. de Maeseneer, and C. Gastmans. 2019. Relational autonomy: What does it mean and how is it used in end-of-life care? A systematic review of argument-based ethics literature. BMC Medical Ethics 20(1): 1–15.

    Article  Google Scholar 

  • Guetterman, T.C., M.D. Fetters, and J.W. Creswell. 2015. Integrating quantitative and qualitative results in health science mixed methods research through joint displays. The Annals of Family Medicine 13(6): 554–561.

    Article  PubMed  Google Scholar 

  • Guttmacher Institute. 2015. Adolescent women’s need for and use of sexual and reproductive health services in developing countries. New York: The Guttmacher Institute.

    Google Scholar 

  • Heidenreich, K., A. Bremer, L.J. Materstvedt, U. Tidefelt, and M. Svantesson. 2018. Relational autonomy in the care of the vulnerable: Health care professionals’ reasoning in moral case deliberation (MCD). Medicine, Health Care and Philosophy 21(4): 467–477.

    Article  PubMed  Google Scholar 

  • Ho, A. 2008. Relational autonomy or undue pressure? Family’s role in medical decision‐making. Scandinavian Journal of Caring Sciences 22(1): 128–135.

    Article  PubMed  Google Scholar 

  • Imbert, G. 2010. L’entretien semi-directif: à la frontière de la santé publique et de l’anthropologie [The semi-structured interview: at the frontier of public health and anthropology]. Recherche en soins infirmiers (3): 23–34.

    Article  Google Scholar 

  • Kon, A.A. 2009. The role of empirical research in bioethics. The American Journal of Bioethics 9(6–7): 59–65.

    Article  PubMed  Google Scholar 

  • Mabaso, Z., T. Erogbogbo, and K. Toure. 2016. Young people’s contribution to the Global strategy for women’s, children’s and adolescents’ health (2016–2030). Bulletin of the World Health Organization 94(5): 312–312.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mackenzie, C., and N. Stoljar. 2000. Relational autonomy: Feminist perspectives an autonomy, agency, and the social self. New York: Oxford University Press.

    Book  Google Scholar 

  • Paillé, P., and A. Mucchielli. 2008. L’analyse à l’aide des catégories conceptualisantes. L’analyse qualitative en sciences humaines et sociales [Analysis using conceptualizing categories. Qualitative analysis in the humanities and social sciences]. Paris: Armand Collin.

    Google Scholar 

  • Patton, G.C., C. Coffey, C. Cappa, et al. 2012. Health of the world’s adolescents: A synthesis of internationally comparable data. The Lancet 379(9826): 1665–1675.

    Article  Google Scholar 

  • Patton, G.C., S.M. Sawyer, J.S. Santelli, et al. 2016. Our future: A Lancet commission on adolescent health and wellbeing. The Lancet 387(10036): 2423–2478.

    Article  Google Scholar 

  • Ravez, L. 2020. Introduction à l’éthique de la santé publique [Introduction to public health ethics]. Montpellier: Sauramps Médical.

    Google Scholar 

  • Reddy, D.M., R. Fleming, and C. Swain. 2002. Effect of mandatory parental notification on adolescent girls’ use of sexual health care services. JAMA 288(6): 710–714.

    Article  PubMed  Google Scholar 

  • Sawyer, S.M., P.S. Azzopardi, D. Wickremarathne, and G.C. Patton. 2018. The age of adolescence. The Lancet Child & Adolescent Health 2(3): 223–228.

    Article  Google Scholar 

  • Soenens, B., M. Vansteenkiste, and S. Van Petegem. 2017. Autonomy in adolescent development: Towards conceptual clarity. Hove: Psychology Press.

    Book  Google Scholar 

  • Turner Saelzer, S., and J.A. Varas Braun. 2021. Adolescentes en Chile: propuesta de armonización de su condición de relativamente incapaces con el reconocimiento de su autonomía progresiva [Adolescents in Chile: a proposal to harmonize their relatively incapable condition with the recognition of their progressive autonomy]. Revista de Derecho Privado 40: 149–171.

    Google Scholar 

  • United Nations. 2015. Transforming our world: The 2030 Agenda for Sustainable Development. New York: United Nations.

    Google Scholar 

  • ———. 2011. Convention on the Rights of the Child: The right of the child to freedom from all forms of violence (General Comment No. 13). https://www.unicef.org/turkmenistan/sites/unicef.org.turkmenistan/files/2019-09/GC_13_EN.pdf. Accessed December 12, 2021.

  • World Health Organization. 2017. Global accelerated action for the health of adolescents: guidance to support country implementation (AA-HA!). Geneva: World Health Organization.

    Google Scholar 

  • Worthman, C.M., and K. Trang. 2018. Dynamics of body time, social time and life history at adolescence. Nature 554(7693): 451–457.

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This project was financed by Julien Brisson’s Canadian Doctoral Award to Honour Nelson Mandela awarded by the Canadian Institutes of Health Research (CIHR) (201610GSD-385545-283387).

Author information

Authors and Affiliations

  1. Department of Social & Preventive Medicine, School of Public Health, University of Montreal, Montreal, Canada

    J. Brisson, V. Ravitsky & B. Williams-Jones

Authors
  1. J. Brisson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. V. Ravitsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B. Williams-Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Brisson.

Ethics declarations

Conflict of Interests

My coauthors and I have no conflicts of interest to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Brisson, J., Ravitsky, V. & Williams-Jones, B. A Mixed-Methods Study Exploring Colombian Adolescents’ Access to Sexual and Reproductive Health Services: The Need for a Relational Autonomy Approach. Bioethical Inquiry 21, 193–208 (2024). https://doi.org/10.1007/s11673-024-10356-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11673-024-10356-w

Keywords

Search

Navigation