Perspectives on Patient-Centered Family Planning Care from Incarcerated Girls: A Qualitative Study

Abstract

We applied a patient-centered care (PCC) framework to explore incarcerated girls' experiences of and preferences for family planning (FP) care. We conducted qualitative semistructured interviews with incarcerated girls to explore domains of PCC: access to care, patient preferences, information and education, emotional support, family and friends, physical comfort, coordination of care, and continuity and transition. A juvenile detention center (JDC) in an urban California county. Girls incarcerated during the study period. Transcripts were analyzed using directed content analysis to identify themes related to PCC and additional overarching themes. Twenty-two participants completed interviews. Overarching themes of stigma and autonomy emerged as influential in girls' experiences and preferences for FP care. Participants described stigma related to incarceration, sexual activity, and lack of contraception use. Participants' desire for autonomy contributed to concerns around FP care. Despite this, most desired access to FP care while incarcerated. Many valued relationships they had with JDC providers, reporting more trust and familiarity with JDC 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 worsened girls' experiences with FP care and enhanced their sense of autonomy. Difficulties with care coordination and transitions between the JDC and community often resulted in fragmented care. Providing patient-centered FP care in JDCs is desirable but complex, and requires prioritizing patient preferences while recognizing the strengths and limitations of providing FP care within JDCs.