Some clinic features that might facilitate teenagers’ and young adults’ use of contraceptive services can be found in the majority of U.S. publicly funded family planning facilities, but other youth-friendly practices and accommodations are less common.[1] For example, four in five facilities that responded to a 2011 survey reported having staff who are trained to meet teenagers’ specific contraceptive needs. However, fewer than one in 10 said that they use text messages to contact clients. The presence of youth-friendly features varied by facility characteristics. Sites with staff trained to meet adolescents’ contraceptive needs were more likely than others to provide long-acting reversible contraceptive (LARC) services to teenagers.
To assess the availability of services that are "equitable, accessible, acceptable, appropriate and effective" for teenagers (individuals aged 15–19) and young adults (those aged 20–24), researchers mailed a four-page questionnaire to a nationally representative sample of nearly 1,200 publicly funded family planning providers. They conducted chi-square analyses on data from the 584 facilities that completed the survey to examine differences by key clinic characteristics in 20 measures of youth-friendly services and in the provision of LARC services.
Thirty-three percent of facilities in the sample were operated by health departments, 28% were federally qualified health centers, 10% were Planned Parenthood sites, 9% were hospital clinics and 20% were some other type of facility. Fifty-two percent received Title X funding, and the same proportion had a reproductive health (rather than primary care) focus. The majority provided contraceptive care to at least 1,000 clients annually and said that at least half of their clients were 15–24 years old.
The most frequently available youth-friendly practices and services (reported by 77–78% of facilities) were the provision of hormonal contraceptives without requiring a pelvic exam, the presence of staff with special training on meeting teenagers’ contraceptive needs and a policy requiring minors’ consent for parents or guardians to access their records. Other common features (reported by 67–70%) were outreach or education through schools or other outlets (e.g., community organizations), provision of method refills on a walk-in basis and proximity to public transportation. By contrast, only 8–9% of providers offered online appointment scheduling or used text messages to reach clients for follow-up or educational purposes.
With few exceptions, the presence of youth-friendly features varied by facility type, Title X status and service focus. For example, Planned Parenthood sites were more likely than others to offer hormonal contraceptives without requiring a pelvic exam (100% vs. 66–83%) and to have evening or weekend hours (91% vs. 34–65%). Health department clinics were the most likely to provide outreach at schools (80% vs. 53–72%) or other venues (82% vs. 39–76%).
Among other differences, greater proportions of facilities receiving Title X support than of others did not require a pelvic exam before clients began using hormonal contraceptives (86% vs. 69%), conducted outreach (78–82% vs. 57–60%) and had staff who were specially trained to provide contraceptive care to teenagers (91% vs. 65%). Clinics that did not receive Title X funding were more likely than those that did to have evening or weekend hours (58% vs. 50%) and to say that clients did not need an appointment to get method refills (72% vs. 62%).
In general, facilities with a reproductive health focus were more likely than primary care sites to provide youth-friendly services. Notable differences were apparent in the proportions that used social networking to reach potential clients or provide education (42% vs. 11%), had online scheduling capability (16% vs. 2%) and had programs for reaching male teenagers about contraception (31% vs. 21%).
IUDs were often or always discussed with teenagers during an initial contraceptive visit at 43% of facilities, and with young adults at 56%; implants at 40% and 44%, respectively. Forty-seven percent of clinics reported that IUD use had increased among youth in the past two years; 37% said that implant use had risen. The majority provided the devices on-site (74% inserted IUDs, and 59% implants); while others provided a prescription (8% and 6%, respectively), some did neither or referred women elsewhere (9% and 27%). In the previous two years, staff at 73% of clinics had received training in implant provision; recent IUD training was less common (43% for hormonal and 29% for copper devices). Similarly, 71% of sites reported that staff were scheduled to receive implant training within the next year, but only 26–30% reported this for IUD training.
Provision of LARC services to teenagers and young adults differed by facilities’ type, Title X status and primary focus. It also differed by whether clinics had staff who were trained to address adolescents’ contraceptive needs, which the researchers used as a broad definition of "youth-friendly." For example, youth-friendly clinics were more likely than others to report that discussion of LARC methods often or always occurred during a teenager's first visit for contraception (45% vs. 34% for IUDs, 43% vs. 31% for implants). They also were more likely to say that use of these methods had increased among youth in the past two years (49% vs. 36% for IUDs and 39% vs. 29% for implants). A greater proportion of youth-friendly sites than others inserted IUDs on-site (75% vs. 68%), but a smaller proportion inserted implants (58% vs. 69%). When asked what they considered challenges to providing LARC services for youth, respondents most often cited cost of the methods (60%), staff concerns about teenagers’ using IUDs (47%) and the need for staff training in implant insertion (47%).
The researchers acknowledge that the self-reported nature of their data may have biased results and that the findings cannot be generalized to private providers. They also note that it is not clear whether youth-friendly services directly affect levels of teenage pregnancy. Nevertheless, they contend that supporting the provision of services that are "appropriate to the needs, goals, and life circumstances" of youth may increase young people's use of highly effective contraceptive methods.—D. Hollander
Reference
1. Kavanaugh ML et al., Meeting the contraceptive needs of teens and young adults: youth-friendly and long-acting reversible contraceptive services in U.S. family planning clinics, Journal of Adolescent Health, 2013, 52(3):284–292.