Confidential Services Research Articles

What are the barriers and facilitators to seeking help for mental health in NHS doctors: a systematic review and qualitative study

BackgroundThe mental health of healthcare professionals is reaching a breaking point, and the COVID-19 pandemic has exacerbated current mental health issues to unprecedented levels. Whilst some research has been carried out on the barriers that doctors face when seeking mental health help, there is little research into factors which may facilitate seeking help. We aimed to expand the research base on factors which act as barriers to seeking help, as well as gain insight into facilitators of help-seeking behaviour for mental health in NHS doctors.MethodsWe conducted a systematic literature review which identified the barriers and facilitators to seeking help for mental health in healthcare professionals. Following this, we conducted semi-structured interviews with 31 NHS doctors about their experiences with mental health services. Finally, through thematic analysis, key themes were synthesised from the data.ResultsOur systematic literature review uncovered barriers and facilitators from pre-existing literature, of which the barriers were: preventing actions, self-stigma, perceived stigma, costs of seeking treatment, lack of awareness and availability of support, negative career implications, confidentiality concerns and a lack of time to seek help. Only two facilitators were found in the pre-existing literature, a positive work environment and availability of support services.Our qualitative study uncovered additional barriers and facilitators, of which the identified barriers include: a negative workplace culture, lack of openness, expectations of doctors and generational differences. The facilitators include positive views about mental health, external confidential service, better patient outcomes, protected time, greater awareness and accessibility, open culture and supportive supervisors.ConclusionOur study began by identifying barriers and facilitators to seeking mental health help in healthcare workers, through our systematic literature review. We contributed to these findings by identifying themes in qualitative data.. Our findings are crucial to identify factors preventing NHS doctors from seeking help for their mental health so that more can be done on a national, trust-wide and personal level to overcome these barriers. Likewise, further research into facilitators is key to encourage doctors to reach out and seek help for their mental health.

Caring for Carers: Veterinarians Struggle With MH Issues

Caring for Carers: Veterinarians Struggle With MH Issues

Federated Learning and Its Role in the Privacy Preservation of IoT Devices

Federated learning (FL) is a cutting-edge artificial intelligence approach. It is a decentralized problem-solving technique that allows users to train using massive data. Unprocessed information is stored in advanced technology by a secret confidentiality service, which incorporates machine learning (ML) training while removing data connections. As researchers in the field promote ML configurations containing a large amount of private data, systems and infrastructure must be developed to improve the effectiveness of advanced learning systems. This study examines FL in-depth, focusing on application and system platforms, mechanisms, real-world applications, and process contexts. FL creates robust classifiers without requiring information disclosure, resulting in highly secure privacy policies and access control privileges. The article begins with an overview of FL. Then, we examine technical data in FL, enabling innovation, contracts, and software. Compared with other review articles, our goal is to provide a more comprehensive explanation of the best procedure systems and authentic FL software to enable scientists to create the best privacy preservation solutions for IoT devices. We also provide an overview of similar scientific papers and a detailed analysis of the significant difficulties encountered in recent publications. Furthermore, we investigate the benefits and drawbacks of FL and highlight comprehensive distribution scenarios to demonstrate how specific FL models could be implemented to achieve the desired results.

ML-DDoSnet: IoT Intrusion Detection Based on Denial-of-Service Attacks Using Machine Learning Methods and NSL-KDD

The Internet of Things (IoT) is a complicated security feature in which datagrams are protected by integrity, confidentiality, and authentication services. The network is protected from external interruptions and intrusions. Because IoT devices run with a range of heterogeneous technologies and process data over time, standard solutions may not be practical. It is necessary to develop intelligent procedures that can be used for multiple levels of data flow in the system. This study examines metainnovations using deep learning-based IDS. Per the findings of the earlier tests, BiLSTMs are better for binary (regular/attacker) classification; however, sequential models (LSTM or BiLSTM) are better for detecting some brutal attacks in multiclass classifiers. According to experts, deep learning-based intrusion detection systems can now recognize and select the best structure for each category. However, specific difficulties will need to be solved in the future. Two topics should be studied further in future attempts. One of the researchers’ concerns is the impact of various data processing techniques, such as artificial intelligence or metamethods, on IDS. The BiLSTM approach has chosen the safest instances with the highest accuracy among the models. According to the findings, the most reliable and suitable solution for evaluating DDoS attacks in IoT is the BiLSTM design.

Adolescent Access to Federally Funded Clinics Providing Confidential Family Planning Following Changes to Title X Funding Regulations

In May 2019, new federal regulations regarding Title X funding were introduced. There has been no formal evaluation of the impact of this regulatory shift as it pertains to minors' access to services. To explore the geography of federally funded clinics providing confidential reproductive care to adolescents following changes to Title X funding regulations. This retrospective cross-sectional study used a population-based sample of US Census tracts. All clinics participating in the Title X program in August 2018 and August 2020 were included in the analysis. Data were analyzed from January to December 2021. Period, defined as before and after the 2019 Title X rule change (August 2018 and August 2020, respectively). US Census tracts were evaluated for the availability of confidential family planning care within a 30-minute drive, according to the presence of a Title X clinic or a permissive state law. Census tracts in which minors lost access to confidential care after the rule change were characterized in terms of demographic characteristics. Univariate logistic regression evaluated associations between Census tract characteristics and the odds of losing vs maintaining access to legally protected confidential minor services. The study included 72 620 Census tracts, accounting for approximately 324 697 728 US residents (99.96% of the population). After the Title X rule change, 1743 clinics in the Title X program left (39.0%) and minors living in 6299 Census tracts (8.7%) lost access to confidential family planning care, corresponding to an estimated 933 649 youth aged 15 to 17 years. Minors living in rural Census tracts (odds ratio [OR], 1.27; 95% CI, 1.18-1.36) and those in the Midwest (OR, 2.41; 95% CI, 2.24-2.60) had higher odds of losing access to care. Minors living in Census tracts with a higher Social Vulnerability Index (OR, 0.51; 95% CI, 0.47-0.55), a larger proportion of Black individuals (OR, 0.34; 95% CI, 0.31-0.37), and/or a larger proportion of Hispanic individuals (OR, 0.45; 95% CI, 0.42-0.49) were less likely to lose access to care. These findings suggest that there were losses in access to legally protected confidential reproductive health services for youth after the 2019 Title X rule change. Although evidence-based Title X guidelines have since been reinstated, state laws that ensure adolescent confidentiality in obtaining family planning services may protect youth from future alterations to the Title X program.

Indian Academy of Pediatrics Consensus Guidelines for Adolescent Friendly Health Services

JustificationAdolescent health is critical to the current and future well- being of the world. Pediatricians need country specific guidelines in accordance with international and national standards to establish comprehensive adolescent friendly health services in clinical practice.ProcessIndian Academy of Pediatrics (IAP) in association with Adolescent Health Academy formed a committee of subject experts in June, 2019 to formulate guidelines for adolescent friendly health services. After a review of current scientific literature and drafting guidelines on each topic, a national consultative meeting was organized on 16 August, 2019 for detailed discussions and deliberations. This was followed by discussions over e-mail and refining of draft recommendations. The final guidelines were approved by the IAP Executive Board in December, 2021.ObjectiveTo formulate guidelines to enable pediatricians to establish adolescent friendly health services.RecommendationsPediatricians should coordinate healthcare for adolescents and plan for transition of care to an adult physician by 18 years of age. Pediatricians should establish respectful, confidential and quality adolescent friendly health services for both out-patient and in-patient care. The healthcare facility should provide preventive, therapeutic, and health promoting services. Pediatricians should partner with the multidisciplinary speciality services, community, and adolescents to expand the scope and reach of adolescent friendly health services.Electronic Supplementary MaterialSupplementary material is available for this article at 10.1007/s13312-022-2539-9 and is accessible for authorized users.

Drassanes Exprés: a public and confidential testing service for asymptomatic STIs with same-day result notification

BackgroundSTIs are a major public health concern. Screening programmes for asymptomatic users are key components of STI control. Traditional limitations of screening programmes include low population coverage and delays in...

Слежка и цензура. Сети слежки и цензуры прессы в революционной Мексике, 1911-1923

Controlling information and keeping an eye on enemies were two fun-damental activities for the different revolutionary factions in the revolu-tionary decade (1910-1920) and in the early years of the post-revolutionary stage. The armed struggle has aspects that have been little explored and that reflected the concern to watch over and censure its en-emies. Francisco I. Madero failed in his attempts to neutralize the op-position forces; Venustiano Carranza, on his part, managed to monopo-lize information and build the foundations of intelligence networks that would make it possible for the Carrancistas to stop possible uprisings. The assassination of Carranza in May 1920, far from ending these prac-tices, led the new group in power ― headed by Generals Álvaro Obregón and Plutarco Elías Calles, as well as Adolfo de la Huerta ― to improve their confidential intelligence services and closely monitor the opposition press.

Covid-19 and Increased Risk of Physician Suicide: A Call to Detoxify the U.S. Medical System.

Suicide among physicians is a longstanding problem, with risk factors exacerbated by the coronavirus disease 2019 (COVID-19) pandemic. In this article, we explore suicidal thoughts and behaviors among physicians and risk factors created or intensified by the work environment, such as overwork and loss of autonomy. We discuss the ways in which the COVID-19 pandemic has made the medical work environment more stressful (e.g. greater exposure to traumatic experiences and employment insecurity) and, consequently, elevated physician suicide risk. We also review evidence that the medical system in the United States has not adequately protected physicians' mental health. Lack of confidentiality, stigma, cost, and time, as well as intrusive medical licensing applications, remain barriers to physicians seeking help. Work pressures imposed by insurance companies and financial incentives to increase revenue while cutting costs compound physicians' work stress. We conclude that system-wide changes to the practice of medicine and policies regarding healthcare delivery are needed to improve physicians' work environments, as is research addressing the impact of the interventions to reduce their suicidal risk. The proposed changes, and greater access to timely and confidential mental health services amid and in the aftermath of the pandemic, may prove promising approaches to reduce physicians' suicide risk.

Sorority Women's Perceptions of Survivors' Services and Justice on an Urban Campus

While researchers have attempted to estimate the prevalence of and identify risk factors for sexual assault, less is understood about the relationship among populations at high risk for sexual assault and their perceptions of survivors’ services organizations and justice. The purpose of this investigation is to contribute to existing research through exploratory qualitative analyses of 43 undergraduate sorority women’s perceptions of survivors’ services and justice on a large, urban campus in the Pacific Northwest in the United States. Results of these exploratory analyses revealed that the sorority women had preferences for informal confidants and services whom they could trust concerning matters of sexual violence. The women also discussed that they would prefer confidential and mental health competent services for fear that disclosing sexual violence might draw public attention to them. On the same note, the women expressed a preference for justice that would prioritize their reputation and minimize stigmatization and highlighted how disclosure of sexual violence could impact their social, educational, and employment opportunities. Moreover, they described a fear of being blamed or not believed about sexual violence. Lastly, participants supported relatively punitive sanctions for perpetrators. Overall, participants cited many barriers to accessing formal support services, exposing the persistent justice gap that remains for this population. Findings suggest a need for outreach regarding campus services designed to address sexual violence.

Identifying key challenges and needs in digital mental health moderation practices supporting users exhibiting risk behaviours to develop responsible AI tools: the case study of Kooth

Digital platforms for mental health and wellbeing purposes have become increasingly common to help users exhibiting risk behaviours (e.g. self-harming, eating-related disorders) across all ages, opening new frontiers in supporting vulnerable users. This study stems from a larger project, which explores how responsible AI solutions can up-scale existing manual moderation approaches and better target interventions for young people who ask for help or engage in risk behaviours online. This research aims to better understand the challenges and needs of moderators and digital counsellors, i.e. the ‘behind the scenes’. Through this case study, the authors intend to contribute to the development of responsible AI tools that are fit for purpose and better understand the challenges. The key focus lies on Kooth.com, the UK’s leading free online confidential service offering counselling and emotional wellbeing support to young people in the UK through its online web-based and pseudo-anonymous digital platform.

All pharmacists working in primary care in England can now self-refer to NHS Practitioner Health

All primary care staff, including GP and community pharmacists, can now self-refer to NHS Practitioner Health, NHS England has confirmed. Launched in 2008, NHS Practitioner Health is a free, confidential service aimed at supporting healthcare professionals with mental illness and addiction problems who are working or looking to return to clinical practice. Up until now, […]

The MI-PHOTOS Project: Understanding the Health and Wellbeing of Rural Historically Marginalized Mothers Through Photovoice.

Despite the persistent health inequities faced by rural women in the United States, few researchers have partnered with women in rural communities to co-create sustainable change. To fill this gap, Mothers Improving Pregnancy and Postpartum Health Outcomes Through stOry Sharing (MI-PHOTOS) employed a community-based participatory research (CBPR) approach by partnering with mothers, community leaders, and community-based organizations in Robeson County, North Carolina, a rural, racially diverse county. The project's aims were (a) to promote maternal health by listening to mothers' stories of having and raising children in their community and (b) to develop a shared understanding of these mothers' strengths and challenges. MI-PHOTOS utilized photovoice, an exploratory and qualitative CBPR methodology. Grounded theory guided data analysis. During photovoice discussions, conversation focused on maternal experiences and evoked strengths, facilitators, and barriers impacting maternal health. Themes focused on (a) MI-PHOTOS serving as a social support group for the community and family stressors that mothers faced and (b) the necessity of professional support programs. Three overarching findings emerged during this process: (a) MI-PHOTOS as an informal support group, (b) mental health stigmatization, and (c) the need to bridge home visiting programs with peer and confidential therapeutic services. Future work should incorporate mothers' and communities' strengths into program development by drawing on existing home visiting programs, identifying opportunities for peer-support, and creating referral networks for individual, confidential therapeutic services. Through continued community partnership, we can generate fuller understandings of mothers' experiences of having and raising children and ultimately promote health equity among rural mothers.

LGBTQ youth mental health during COVID-19: unmet needs in public health and policy

LGBTQ youth mental health during COVID-19: unmet needs in public health and policy

Adolescents\u2019 perceived barriers to accessing sexual and reproductive health services in California: a cross-sectional survey

BackgroundAdolescents may forego needed sexual and reproductive health (SRH) services due to a variety of concerns and barriers. The purpose of this study is to compare adolescents’ perceptions of these barriers by participant characteristics including race/ethnicity, gender, sexual orientation, housing situation, and sexual experience.MethodsAdolescents in a California-wide sexual health education program completed an anonymous survey at baseline (N = 10,015) about perceived barriers to using SRH services. Logistic regression analyses that accounted for the clustered data structure assessed differences by gender, age, sexual orientation, race/ethnicity, living situation, and sexual experience.ResultsThe majority of participants were Hispanic/Latino (76.4%) with an average age of 14.9 years, and 28.8% had sexual experience. Half of the youth reported concerns about test results (52.7%), cost of services (52.0%), and confidentiality of services (49.8%). When controlling for other characteristics, youth identifying as transgender/non-binary/multiple genders had the highest odds of perceiving cost (odds ratio (OR) 1.89) and confidentiality (OR 1.51) as barriers. Increasing age was associated with decreasing odds of all barriers. Sexual orientation was a consistent predictor, with LGBQ+ youth having higher odds of perceiving test results (OR 1.21), cost (OR 1.36), and confidentiality (OR 1.24) as barriers. Asian or Pacific Islander/Native Hawaiian youth had higher odds of perceiving test results (OR 1.68) and cost (OR 1.37) as barriers. In contrast, Black youth had lower odds of reporting cost (OR 0.65) and confidentiality (OR 0.77) as barriers. Younger respondents and youth who identified as female, transgender/non-binary/multiple genders, LGBQ+, and Asian or Pacific Islander/Native Hawaiian had higher odds of reporting five or more barriers compared to reference groups.ConclusionsThe majority of adolescents face barriers to accessing appropriate SRH services, with females, gender-minority youth, younger adolescents, LGBQ+ youth, and Asian and Pacific Islander/Native Hawaiian youth more likely than others to report barriers. Access to SRH services can be improved through strengthening linkages between clinics and SRH education programs, providing youth-friendly clinical services, and ensuring youth have sufficient information, skills, and support to access care.Trial registrationApproved by California Health and Human Services Agency’s Committee for the Protection of Human Subjects [12-08-0658, 11/30/2017].

An intervention to improve teacher well-being support and training to support students in UK high schools (the WISE study): A cluster randomised controlled trial.

Teachers are at heightened risk of poor mental health and well-being, which is likely to impact on the support they provide to students, and student outcomes. We conducted a cluster randomised controlled trial, to test whether an intervention to improve mental health support and training for high school teachers led to improved mental health and well-being for teachers and students, compared to usual practice. We also conducted a cost evaluation of the intervention. The intervention comprised (i) Mental Health First Aid training for teachers to support students; (ii) a mental health awareness session; and (iii) a confidential staff peer support service. In total 25 mainstream, non-fee-paying secondary schools stratified by geographical area and free school meal entitlement were randomly allocated to intervention (n = 12) or control group (n = 13) after collection of baseline measures. We analysed data using mixed-effects repeated measures models in the intention-to-treat population, adjusted for stratification variables, sex, and years of experience. The primary outcome was teacher well-being (Warwick-Edinburgh Mental Well-being Scale). Secondary outcomes were teacher depression, absence, and presenteeism, and student well-being, mental health difficulties, attendance, and attainment. Follow-up was at months 12 (T1) and 24 (T2). We collected process data to test the logic model underpinning the intervention, to aid interpretation of the findings. A total of 1,722 teachers were included in the primary analysis. Teacher well-being did not differ between groups at T2 (intervention mean well-being score 47.5, control group mean well-being score 48.4, adjusted mean difference -0.90, 95% CI -2.07 to 0.27, p = 0.130). The only effect on secondary outcomes was higher teacher-reported absence among the intervention group at T2 (intervention group median number of days absent 0, control group median number of days absent 0, ratio of geometric means 1.04, 95% CI 1.00 to 1.09, p = 0.042). Process measures indicated little change in perceived mental health support, quality of relationships, and work-related stress. The average cost of the intervention was £9,103 per school. The study's main limitations were a lack of blinding of research participants and the self-report nature of the outcome measures. In this study, we observed no improvements to teacher or student mental health following the intervention, possibly due to a lack of impact on key drivers of poor mental health within the school environment. Future research should focus on structural and cultural changes to the school environment, which may be more effective at improving teacher and student mental health and well-being. www.isrctn.com ISRCTN95909211.

Intimate Partner and Sexual Violence, Reproductive Coercion, and Reproductive Health Among American Indian and Alaska Native Women: A Narrative Interview Study.

Background: The disproportionately high prevalence of poor reproductive and sexual health outcomes among American Indian and Alaska Native (AI/AN) women is related to histories of colonization, oppression, and structural racism. Intimate partner violence (IPV) and sexual violence (SV) contribute to these health outcomes. Materials and Methods: Narrative interviews were conducted with AI/AN women from four tribal reservation communities. Interviews explored connections among sexual and reproductive health, IPV, SV, reproductive coercion (RC), and pregnancy experiences as well as women's experiences of healing and recovery. Results: Among the 56 women interviewed (aged 17-55 years, 77% were aged 40 years and younger), all described multiple exposures to violence and highlighted lack of disclosure related to sexuality, childhood abuse, SV, and historical trauma. Access to confidential reproductive health services and contraceptive education was limited. Almost half (45%) reported experiencing RC in their lifetime. Use of substances occurred in both the context of SV and for surviving after exposure to violence. Women underscored the extent to which IPV, SV, and RC are embedded in histories of colonization, racism, and ongoing oppression. Interventions that incorporate AI/AN traditions, access to culturally responsive reproductive health and advocacy services, organizations, and services that have AI/AN personnel supporting survivors, public discussion about racism, abuse, sexuality, and more accountable community responses to violence (including law enforcement) are promising pathways to healing and recovery. Conclusions: Findings may advance understanding of AI/AN women's reproductive health in the context of historical trauma and oppression. Intervention strategies that enhance resiliency of AI/AN women may promote reproductive health.

Mental health support and training to improve secondary school teachers’ well-being: the WISE cluster RCT

Background Health and Safety Executive data show that teachers are at heightened risk of mental health difficulties, yet few studies have attempted to address this. Poor teacher mental health may impact on the quality of support provided to young people, who also report increased mental health difficulties themselves. Objective To test the effectiveness of an intervention aiming to improve secondary school teachers’ well-being through mental health support and training. Design A cluster randomised controlled trial with embedded process and economic evaluations. Setting Twenty-five mainstream, non-fee-paying secondary schools in the south-west of England and South Wales, stratified by geographical area and free school meal entitlement, randomly allocated to intervention or control groups following collection of baseline measures (n = 12, intervention; n = 13, control) between May and July 2016. Participants All teachers in the study schools at any data collection. All students in year 8 (baseline) and year 10 (final follow-up). Intervention Each intervention school received three elements: (1) a 1-day mental health first aid for schools and colleges training session delivered to 8% of all teachers; (2) a 1-hour mental health session delivered to all teachers; and (3) 8% of staff trained in the 2-day standard mental health first aid training course set up a confidential peer support service for colleagues. Control schools continued with usual practice. Main outcome measures The primary outcome was teacher well-being (using the Warwick–Edinburgh Mental Wellbeing Scale). Secondary outcomes were teacher depression, absence and presenteeism, and student well-being, mental health difficulties, attendance and attainment. Follow-up was at 12 and 24 months. Data were analysed using intention-to-treat mixed-effects repeated-measures models. Economic evaluation A cost–consequence analysis to compare the incremental cost of the intervention against the outcomes measured in the main analysis. Process evaluation A mixed-methods study (i.e. qualitative focus groups and interviews, quantitative surveys, checklists and logs) to examine intervention implementation, activation of the mechanisms of change outlined in the logic model, intervention acceptability and the wider context. Results All 25 schools remained in the study. A total of 1722 teachers were included in the primary analysis. We found no difference in mean teacher well-being between study arms over the course of follow-up (adjusted mean difference –0.90, 95% confidence interval –2.07 to 0.27). There was also no difference in any of the secondary outcomes (p-values 0.203–0.964 in the fully adjusted models). The average cost of the intervention was £9103 (range £5378.97–12,026.73) per intervention school, with the average cost to Welsh schools being higher because of a different delivery model. The training components were delivered with high fidelity, although target dosage was sometimes missed. The peer support service was delivered with variable fidelity, and reported usage by teachers was low (5.9–6.1%). The intervention had high acceptability, but participants reported low support from senior leadership, and minimal impact on school culture. Limitations Participants and the study team were unblinded, self-report for the main outcome measures and inaccurate measurement of peer support service usage. Conclusions The Wellbeing in Secondary Education (WISE) intervention was not effective at improving teacher or student well-being, or reducing mental health difficulties, possibly because of contextual barriers preventing it becoming embedded in school life. Future work Identification of ways in which to achieve system-level change and sustained support from senior leaders is important for future school-based mental health interventions. Trial registration Current Controlled Trials ISRCTN95909211. Funding This project was funded by the National Institute for Health Research Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 12. See the NIHR Journals Library website for further project information. Intervention costs were met by Public Health Wales, Public Health England and Bristol City Council.

Novel Platforms for Biomedical HIV Prevention Delivery to Key Populations - Community Mobile Clinics, Peer-Supported, Pharmacy-Led PrEP Delivery, and the Use of Telemedicine.

Purpose of ReviewA gap exists between PrEP interest and PrEP uptake in key populations (KP) for HIV prevention that may be ascribed to PrEP delivery services not being acceptable. This review summarizes novel platforms for HIV prevention outside of the traditional health facilities environment.Recent FindingsMobile health clinics provide highly acceptable integrated, KP-focused services at convenient locations with the potential of high PrEP uptake. Telemedicine and health apps decongest health systems and allow for personal agency and informed decision-making on personal health. Pharmacy-led PrEP delivery provides de-medicalized, confidential PrEP services at extended hours in community locations, from trusted medical professionals. Peer-supported delivery encourages continued PrEP use.SummaryCommunity-based, differentiated and de-medicalized PrEP delivery can address uptake and continued use barriers in key populations. Future research should assess scalability, cost-effectiveness and sustainability of these PrEP delivery platforms, as well as focus on ways to simplify PrEP provision.

Should Physicians Elicit Parental Permission before Providing Termination of Pregnancy to All Adolescent Patients?

We aimed to present a review of current legal regulations worldwide and the main arguments for and against the requirement of parental consent for abortion in adolescents. While confidentiality in sexual and reproductive healthcare has been guaranteed to adolescents in many countries, many physicians disagree with the practice of providing confidential abortion to adolescents without parental consent. The main reason is that adolescents are not sufficiently mature and competent to independently make decisions and that they need parental protection. Adolescents who are willing to involve parents in their abortion decision will likely benefit from the adult experience and support. The existence of parental involvement legislation reduces the number of adolescent’s abortions. There is a consensus that adolescents should have access to confidential health services and that parental involvement, should not be a barrier to care. However, the majority of adolescents aged 14 to 17 are as competent as adults to understand the risks and benefits of abortion, make voluntary decision ns and provide consent without parents. Also, mandatory parental notification on the intent to undergo abortion may be a trigger for family violence which is dangerous for adolescents and may have long-term consequences. Conclusion − We support the thesis that involving parents in the process of pregnancy termination should not be mandatory. It should be the decision of a competent adolescent and the obligation rests on the medical professionals to assess the ability of the adolescent to make a competent decision about abortion.