Hispanics constitute the biggest minority ethnic or racial group in the United States. Recent immigration trends have contributed to the doubling in size of the Hispanic population in the last two decades. Hispanics constitute 17% of the US population totaling over 54 million people. The dramatic growth of US Latino population, in both numbers and diversity, generates challenges for enhancing public health interventions and minimizing medical care disparities. Research shows that Hispanics are far more likely, compared to other ethnic and racial groups to lack access care. This fact underlines the necessity for effective interventions geared towards diminishing teen pregnancy. The lack of insurance coverage, coupled with other factors such as low income and cultural and linguistic barriers, aggravates the scale of unmet health care needs within this population. This paper explores the existing evidence base on effective contraceptive use and interventions for Latino adolescents who constitute my selected cultural group. Roncancio, Ward, and Berenson’s article on the role of acculturation in directing the use of contraception among Hispanic adolescents forms the basis of this review.
The Health Care Needs of Hispanic Youth
Family planning remains one of the greatest public health achievements of the last century, and global acceptance has grown tremendously among exposed populations (Tsui, McDonald-Mosley, & Burke, 2010). Nevertheless, sometimes the uptake of contraception is undermined by limited access and poor service delivery, which in turn translate to a high burden of unintended pregnancy. Young Hispanic women have been shown to be half as likely to utilize contraception compared to non-Hispanic white women of the same age. As such, it is unsurprising that 76% of pregnancies reported in this population are unintended (CDC, 2015). According to Roncancio, Ward, and Berenson, the alarming rate of unplanned pregnancies stems from the level of unmet needs for contraception, cases of contraceptive failure or unsuitable utilization of contraceptives (2012). Nursing intervention is needed to expand health insurance rates among Latinos while simultaneously addressing the larger socioeconomic, political, and cultural issues that place obstacles in the path of Latinos accessing health services (Kaakinen et al., 2015). The paper contends that the health care needs of the Latino youth are overlooked, a situation that has been exacerbated by the “cycle of disempowerment” occasioned by factors such as shifting cultural norms, poverty, and cultural insensitivity in the delivery of health care.
Cultural groups comprise of individuals who share a common trait such as language, ethnicity or religion. The generic terms “Latinos” or “Latinas” or “Hispanics” describe persons of Latin American origin whose origin is Puerto Rico, Cuban, Mexico and other Spanish-speaking countries and regions within the Western Hemisphere. Today, Latinos constitute the biggest and fastest growing minority group in the US (Lescano, Brown, Raffaelli, & Lima, 2009). Analysts approximate that, by the year 2050, Hispanic population will hit 128.8 million people surpassing the 30% mark of the total US population (CDC, 2015). According to the CDC, the birth rate for Hispanic women aged 15-19 years is nearly five times the rate for Asian Americans, two times the rate of non-Hispanic whites, and comparatively higher compared to the rates for non-Hispanic black and Alaska/Indian Native adolescents (2015).
Unplanned or unwanted teen pregnancies remain a serious public health care challenge. On average, Hispanic adolescents have an earlier onset of sexual activity and face an elevated risk for HIV and other sexually transmitted infections (Roncancio, Ward, & Berenson, 2012). Latino adolescent females report the highest incidence of childbearing among the major racial and ethnic groups in the US. Unplanned pregnancies may stem from the failure to utilize contraceptive methods or the failure of the selected contraceptive methods used. Apart from growing rates of unintended pregnancies among the Hispanic youth, the Latino community also faces mounting cases of obesity and its related health risks (Roncancio, Ward, & Berenson, 2012).
Factors Causing Low Uptake of Contraceptives among Hispanic Adolescents
There exist considerable economic and racial/ethnic disparities in rates of unintended pregnancies (Tsui, McDonald-Mosley, & Burke, 2010; Roncancio, Ward, & Berenson, 2012). These inequalities propel the cycle of disadvantage faced by certain demographic groups robbing women the tools to control their fertility as desired. Although, Hispanic youth face mounting risks occasioned by unprotected sexual activity, Hispanic youth receives minimal information on contraception and family planning (Kaakinen et al., 2015). Several potential explanations exist to elucidate on disparities in family planning outcomes and the high rates of unintended pregnancies among Latinos in the US. Some of the factors, including poverty, cultural emphasis on motherhood, and skewed gender relations and machismo, fuel women’s reluctance to make use of contraceptives or demand that their partners do so (Roncancio, Ward, & Berenson, 2012).
On average, Hispanics are disproportionately affected by poverty (Roncancio, Ward, & Berenson, 2012). Living in poverty heightens health risks, stress, and unhealthy behaviors. Moreover, due to poverty, a sizeable number of Latino families are forced to live in low-incomes areas typified by limited opportunities (educational and employment), and high rates of crime and violence (Kaakinen et al., 2015). Most importantly, the lack of health insurance hampers Latinos’ access to health care yielding to an increase of unmet medical needs. In 2010, 29.1% of Hispanics lacked health insurance with Hispanic adults aged 18-64 being the most affected (CDC, 2015). The uninsured Latino youth report mounting unmet health care needs, and usually go without physician contact compared to those with insurance. A language divide also exists between Hispanics who speak English and those who principally speak Spanish, which creates hindrances to public health campaigns and medical care (Lescano, Brown, Raffaelli, & Lima, 2009).
Acculturation and Biculturalism
The scale of acculturation and biculturalism may also account for the differences in contraceptive use among young Hispanic women (Roncancio, Ward, & Berenson, 2012). Acculturation represents the level to which an individual from a non-dominant ethnic group (in this case Latino) embraces different elements of the culture of the dominant ethnic group (Caucasian). In their study, Lescano, Brown, Raffaelli, and Lima (2009) observes that Latinas who are more acculturated enjoy greater life choices and options and engage in high-risk sexual behavior such as having multiple partners compared to less acculturated Latinas. A lowly acculturated and bicultural Hispanic typically does not have sufficient information on their body, available health care resources, and contraceptive options (Lescano, Brown, Raffaelli, & Lima, 2009).
Family and Gender Roles
Latino families are renowned for providing supervision and social-emotional support for Latino youth. The social linkages and familial ties are culturally significant in directing the reproductive health needs of Latina teens. In their report, the CDC recognizes that Puerto Rican and Mexican mothers intimately monitor their daughters’ behavior with the support of extended family members in an attempt to safeguard them from unintended pregnancy (2015). Nevertheless, the value placed on motherhood in Latino culture can be blamed for luring young Latinas into motherhood during teenage years. Machismo also considerably influences notions of culturally acceptable, gender-based sexual behavior (Roncancio, Ward, & Berenson, 2012). In the face of sexual pressure, young Latina women typically lack the power and the negotiation skills and assertiveness required to arrive at safe and healthy decisions. The imbalanced power dynamic may undermine the capacity of young Latinas in making sexual and reproductive health decisions, especially if men view such suggestions as questioning their personal power and self-esteem.
The other factors limiting Latina youths’ access to health care include lack of cultural sensitivity among health care providers and the level of religiosity. Roman Catholicism, which is the prominent religion among Latinos, adversely influences the sexual health behaviors of young Latinas since it disallows contraception. The outlined factors limit the provision of consistent, preventive and readily accessible health services and predispose young Latina women to the risk of unintended pregnancy and sexually transmitted infections such as HIV/AIDS (Roncancio, Ward, & Berenson, 2012). Overall, Hispanic youth suffers from the “cycle of disempowerment” including societal factors that contribute to heightened risk of STIs.
In their study, Tsui, McDonald-Mosley, and Burke, notes that enhancing access to contraception and providing comprehensive sex education lead to fewer unwanted pregnancies (2010). Advocacy for adolescence reproductive health education is needed to foster the uptake of the available contraceptive services (Lescano, Brown, Raffaelli, & Lima, 2009). Tackling the rate of unintended pregnancies and the spread of sexually transmitted infections (STIs) necessitates confronting the multiple factors that heighten the risk for this population. The grim situation is aggravated by the lack of knowledge on the available contraception options, and barriers to health care access occasioned by language or cultural differences.
The nursing interventions at home or community level may encompass health education to youth geared towards improving awareness on benefits of family planning, safe sex and birth spacing. Such an intervention should allow adolescents to access diverse reproductive health services via integrated and linked services. The intervention should also involve counseling, and cultivate awareness of domestic and sexual violence (Kaakinen et al., 2015).
According to Lescano, Brown, Raffaelli, and Lima, there is a great need to take culture into account when implementing sexuality interventions with Latino adolescents (2009). The recruitment of Latino staff for family planning awareness programs is likely to attract greater numbers of Hispanic youth. The Latino cultural traditions may impede on young women’s capacity to openly communicate with their partners (Lescano, Brown, Raffaelli, & Lima, 2009). Hence, programs tailored for young Latinas should enhance their assertiveness, negotiation and communication skills. Family-based culturally tailored programs qualify as the most promising approach for STI prevention. The interventions should mirror cultural realities and avert mismatches drawing from language preference and use, and contextual characteristics including delivery approach. Latinos are under-served by the US health care system (Lescano, Brown, Raffaelli, & Lima, 2009). Hence, it is necessary to provide culturally and linguistically sensitive programs that best convey the health messages meant for Hispanic adolescents. More outreach is required to enhance teenager and parental access to information regarding family planning.
Contraceptive use to prevent unwanted pregnancies, especially among Latino adolescents who register the highest incidence of unwanted pregnancies among American youth, is far from being fully utilized, which has led to poor reproductive health outcomes among Hispanic youth. There is a need to enhance Latino adolescents’ access to health care services, including family planning or reproductive health care services. Outreach and prevention education programs can aid to inform Latino youths’ health services and programs available to them. The nursing interventions should feature adolescent-based STI testing, as well as contraceptive counseling. Furthermore, the family planning intervention should be cognizant of the strategies that tackle barriers to health care stemming from cost, stigma, and embarrassment. The medical practitioners leading the advocacy ought to be culturally competent, ready to respect confidentiality.
Young Hispanics require support in building their negotiation and communication skills and developing shared responsibility for sexual decisions and behavior. To some extent, Hispanics’ health care needs are overlooked because it is easier to disregard the needs of politically and economically weak people. The absence of political and economic power renders it difficult to lodge demands for health care or even draw public attention to their needs. Hence, there is a need to work to gain the backing of local and state political leaders, especially those coming from Latinos and other minorities, by making them aware of the pressing health care needs of Hispanic youth.