Girls’ Rights and Self-Advocacy in Health Care

An advocate, such as a parent or caregiver, can help adolescent girls navigate the complex health care system. However, there are also ways a young woman can advocate for herself when seeing a clinician.

This guide from Nursing@Georgetown is meant to empower young women, ages 10 to 19, to engage with their health care providers. Use the information below to gain an understanding of what to expect in appointments and steps to take before, during, and after you see a clinician.

Before the Appointment

Going to see a health care provider can be overwhelming. Take steps to prepare for the appointment so you can feel ready and empowered to advocate for your health.

Make sure to bring an insurance card, a list of medications, and questions for the provider to answer.

Liane MacPherson, an adjunct faculty member of the Georgetown School of Nursing & Health Studies, recommends young women reach out to the clinic ahead of time and ask what its routine procedures are. Does the provider always do a breast exam? Will you be asked to change into a paper gown? These details vary by practice. Knowing what to expect ahead of time can allow you to prepare.

Offices have different policies on whether providers spend time alone with an adolescent patient. Do you want to have one-on-one time with your provider? Would you prefer for your chaperone to be present at all times?

Your caregiver may be surprised to hear that you want to talk with your provider without them present. Review the office’s policy together and communicate what you want before your visit. If you are not comfortable having this conversation with your parent, tell any member of the staff.

MacPherson advises young women to keep in mind that having a chaperone present during exams is an important policy meant to ensure young patients’ safety. The provider can take steps to maintain your privacy.

If something about a previous visit made you feel unsafe or uncomfortable, tell your provider, says MacPherson. For example: “He or she pinched me with the speculum at my last exam, and I have been afraid since then.”

During the Appointment

Health care providers exist to help patients better take care of their health. Do not be afraid to bring up your concerns and ask questions you care about. “That’s what we signed up for,” said MacPherson.

During an appointment, the provider should respect a patient’s rights and wishes. Do not hesitate to speak up about your preferences. If your health care team does not seem to hear you, know that you have options.

The provider’s job is to help you better understand your body — so ask as many questions as you want. “The more honest [girls and women] are, the better I can provide care,” said MacPherson.

If you are not comfortable asking aloud, you can write your question down and give it to the person who checks you in. Some electronic medical systems allow you to submit questions online.

Providers typically take your measurements as reference points at every appointment. If you would prefer not to know the number, you can request a blind weight. Blind weighing means the provider conceals the number from you, by having you stand backward on the scale, for instance. Anxiety about being weighed is a good concern to bring up with your provider.

Some providers, especially those working at teaching hospitals, have students shadow them at appointments. Providers should ask your permission first, and remember that you have the right to decline.

Bodily autonomy means that your body belongs to you. “Ultimately, no one can do anything without [your] consent,” said MacPherson. If you are uncomfortable about a certain part of your exam, you have three options:

By speaking up, you can help the provider understand what you are thinking and feeling, which can help the provider offer better, more compassionate care.

What To Expect With Gynecological Care

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There is not a set rule on what kind of provider patients should see for gynecological care, said MacPherson. In most cases, a certified nurse-midwife or a women’s health nurse practitioner will have the expertise to offer the care that adolescent girls need.

“Sometimes it’s just a conversation,” said MacPherson. Checkups will not necessarily involve pelvic exams or pap smears unless the provider sees a need.

Young women who have never received gynecological care before may not know what to expect. Bear the following insights from MacPherson in mind as you prepare physically and emotionally.

• Patients can receive care while menstruating.
• Depending on patient preference, a family member can be present or not.
• Many clinics have a policy of having a chaperone present with minors. If not, patients can request one.
• Patients can decline or ask to discuss any part of the exam.

During puberty, a breast exam is appropriate. Expect the provider to look at and possibly touch the breast tissue to make sure the body is developing normally. An exam of the genital area (without underwear on, but with a gown and sheet to cover the patient) is also normal during puberty.

What To Do If You Feel Uncomfortable or Unsafe

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If something about your interactions with the provider felt off, tell a trusted adult who is familiar with the health care system. That adult can clarify whether what happened is standard procedure or not.

Some potential flags of concern include:

• Any touching that is beyond the reason for the appointment (e.g., if you need care for severe menstrual cramps, you would not need to remove your shirt).
• Any touching that has not been fully explained and produces unwanted stimulation.

If a provider’s request makes you uncomfortable, ask for the reason behind it. Raena Granberry, a maternal health advocate at Black Women for Wellness suggests saying, “I’d actually like to leave my bra on. Is there a reason why my bra would need to be off?”

If the answer is not satisfactory, you can decline the assessment. Later, follow up with a trusted adult.

If you still feel threatened, harassed, or unsafe, remember:

You are not being overdramatic.

“If your instincts are telling you that something isn’t right, listen to them and stop the exam or ask for a chaperone,” MacPherson said.

You can step outside.

Simply ask, “Can I please speak with my parent?” Step outside the examination room and tell your advocate, “I’m not feeling comfortable with this.” Together, you can develop a plan for managing the scenario.

You can reschedule.

Getting your appointment “over with” is not a reason to sacrifice one’s sense of safety and comfort. An appointment can be rescheduled, and having more time can allow you to better prepare and understand what to expect. If needed, this could be an opportunity to find a provider you feel more comfortable with.

You can tell someone.

“If you’re in any place where you feel uncomfortable, hurry up and text that adult advocate,” Granberry said. If the advocate is in the room, they can take immediate action to ensure you are safe. If not, the advocate can guide you in taking steps to protect yourself.

After the Appointment

How did the appointment go? Did you feel respected by your provider? If your needs aren’t being met, you can request a different provider or find a different practice.

“I tell patients you wouldn’t let just anybody cut your hair,” said MacPherson. “You’d probably talk to 10 friends first. And yet, people will just pick a clinic out of a quick online search.”

Ask women in your community for recommendations or try researching providers with “adolescent health” listed as a specialty. Some schools offer health programs where students can receive care from health professionals.

Now is a good time to practice managing your own health paperwork. Most clinics have electronic health records; when you receive a test result or follow-up note, MacPherson advises saving a digital copy in a separate, secure file on your desktop or cellphone.

Data experts recommend the 3-2-1 backup rule, which means saving three copies in two mediums, with one copy at an “offsite” location. For example: a paper copy stored in a filing cabinet; a digital copy on your hard drive; and a digital copy on a flash drive stored at a separate location, such as a locked cabinet in a parent’s office. Also, be sure to password-lock your devices and use two-factor authentication to keep your records safe.

If you feel your concerns weren’t being taken seriously or you were discriminated against, provide that feedback to the clinic — if possible, in writing. You could write an anonymous note to the desk staff or write about your experience in a patient satisfaction survey.

Resources for Further Reading

Citation for this content: Nursing@Georgetown, the online Women’s Health Nurse Practitioner program from the Georgetown University School of Nursing & Health Studies