Parental paternalism as an equity issue: A case study of parental influence on adolescents’ reproductive health in Medellín, Colombia

Abstract

Background

In bioethics, parental paternalism in adolescent healthcare is typically analyzed through the lens of autonomy and consent, emphasizing parents’ role and adolescents’ capacity to make independent decisions. However, this approach may overlook the role of parental self-interest in shaping healthcare decisions, particularly in the context of reproductive health, and may contribute to inequitable outcomes for adolescents. This exploratory empirical bioethics study examines these dynamics through an equity lens, offering a broader perspective on how relational and social factors can differentially constrain adolescents’ reproductive choices, such as the use of contraceptives.

Methods

In 2024, semi-structured interviews were conducted with parents of adolescents aged 10–19 in Medellín, Colombia. Participants were recruited through a sexual and reproductive health clinic and community networks. Transcripts were analyzed using the public health ethics principle of equity.

Results

Of the 28 participants, 79% were mothers, and together they had 35 adolescents with a mean age of 14. While parental paternalism is typically framed as solely altruistic, some participants described influencing adolescents’ contraceptive decisions to avoid assuming caregiving roles as young grandparents. In a context like Colombia, where adolescent pregnancy is prevalent and grandparents often provide care, such motivations raise equity concerns about how parental self-interest may unequally constrain adolescents’ reproductive choices.

Conclusions

These findings highlight an underexplored equity concern: when parental self-interest shapes adolescents’ healthcare decisions, it can create unjust disparities in their ability to make reproductive health choices. Equity-oriented approaches must address how family dynamics can reinforce structural barriers to adolescent health and well-being.