Former Foster Youth's Perceptions of Their Acquisition of Sexual and Reproductive Health Information While in Foster Care

Background:Foster youth and former foster youth have disproportionately high rates of pregnancy, sexually transmitted infections, and engagement in sexual risk behaviors, possibly due to systemic barriers to acquiring sexual health information. Seeking to understand these barriers, this pilot study explored what factors influenced former foster youth’s acquisition of sexual and reporductivehealth information while they were in the child welfare system (CWS).

Methods:Eight young adults between 18 and 26 formerly involved with the foster care system but no longer wards of a Midwestern state were recruited from an independent living facility for former foster youth. Participants completed semi-structured interviews focused on their experiences learning about sexuality and sexual health information while in care.

Findings:Three main themes specific to the child welfare system (Power, Relationships, and Context) and one theme related to the overall societal environment (Social Culture) were identified, each with several subthemes. “Power” related to the ability of participants to make sexual and reproductive health decisions. A subtheme of “Power Removed” related to participants having decisions forced upon them, while the less prevalent subtheme of “Power Exercised” was demonstrated by the ability of some to make their own decisions.

Relationships played a significant role in the acquisition of sexual health information, as participants discussed how their interactions with foster parents influenced their obtainment of knowledge. Subthemes of “intimacy,” “trust,” and “positive modeling” were identified, with a lack of each hampering their ability to obtain necessary information. The participants stated that without a trusting and intimate relationship with foster parents, they were not inclined to engage in such personal conversations. Positive relationship modeling was also often not present in the participant’s lives, limiting their ability to recognize healthy relationships.

The specific context of the CWS was also recognized as impactful. Participants identified systemic “competing concerns” in their lives that limited their ability to work on other matters. On a more interpersonal level, participants suggested that some foster parents focused more on “outcome management” (i.e., not having a youth in their care become pregnant) than on engaging the youth in sexual discussions. A third subtheme, “dispersion of responsibility,” related to the young adults’ perceptions that despite multiple professionals in their lives, none took responsibility for this aspect of their care.

Within the larger culture, participants identified a “sex-negative” social environment that discourages sexual discussion, especially outside of the immediate family. A final subtheme related to a “lack of relevant content,” as several youth noted the information received was heteronormative and not necessarily relevant to youth in the CWS.

Conclusions and implications: This study identified several barriers to the acquisition of sexual and reproductive health information for youth in the CWS. In order to improve the sexual and reproductive health outcomes for this vulnerable population, there must be a focus on strengthening the youths’ relationships with caregivers, on addressing systemic barriers imposed by the CWS, and on provided content that focuses on the youths’ unique needs. Further work in this area will need to address how to achieve these goals.