A recent national survey of publicly funded facilities that provide family planning services found that facilities with a reproductive health focus were better able to meet the contraceptive needs of their younger clients—by incorporating youth-friendly service delivery, being accessible and ensuring confidentiality—than were primary care-focused facilities. Additionally, facilities with more youth-friendly services offered more long-acting reversible contraception (LARC), including the IUD and implant.
According to "Meeting the Contraceptive Needs of Teens and Young Adults: Youth-Friendly and Long-Acting Reversible Contraceptive Services in U.S. Family Planning Facilities," by Megan L. Kavanaugh of the Guttmacher Institute, et al., most facilities provided the IUD (82%) and implant (65%) to patients on-site. However, those that received Title X funding and those that were reproductive health-focused more commonly reported discussing IUDs and implants with teens and young adults and having staff trained on both LARC methods than their primary care-focused counterparts.
Clinic administrators reported several challenges to providing LARC services to younger clients, including the cost of the methods, inconvenient clinic hours, and staff concerns about IUD use among teens. However, current standards of care relating to LARC methods show that these methods are safe, effective and acceptable for teens and young adults, including those with no children. This research suggests that misperceptions about the methods persist among some providers.
These issues were further detailed in a complementary qualitative study, "Long-Acting Reversible Contraception for Adolescents and Young Adults: Patient and Provider Perspectives," by Megan L. Kavanaugh of the Guttmacher Institute, et al. This study included interviews with administrative directors at 20 publicly funded facilities and six focus groups with facility staff, as well as 48 in-depth interviews with young clients.
Both clinic staff and clients agreed that the "set-and-forget" nature of LARC methods and their duration were among the most significant advantages to young women using these methods. Yet both clinicians and clients expressed concerns about various aspects of access to, use of and provision of these services.
Clinic administrators and staff expressed concerns about the logistics surrounding LARC provision, including additional clinic time for education and counseling, and such practical issues as the difficulty in dilating the cervices of women who have not yet had children. Clinicians also raised concerns about low reimbursement levels for these methods by public and private insurance plans.
"Providers suggested that having insurance coverage or other supplemental funding available for LARC services that covers not just the cost of the method but also training for staff and counseling for younger clients would help clinics to better meet their clients' contraceptive needs," says Dr. Kavanaugh. "Increased use of these highly effective methods has the potential to substantially reduce unintended pregnancy among teens and young adults."
By contrast, clients were more focused on individual concerns, and were more likely than clinicians to raise questions about whether the IUD was an appropriate method choice for them. What some women saw as positive attributes of LARC methods, others saw as negatives. For example, the forgettable nature of the methods and their duration were significant advantages for many women who wanted to delay childbearing for several years, while for others the 5–10 years for the IUD and even three years for the implant were seen as too long for them to consider given their current life situation.
Yet some women felt that their busy lives made them ideal candidates for the IUD or implant. One young adult client said, "I think [IUDs and implants] are good for women my age because I think we all have 5,000 things on our plate…and something like that, where it's just done, taken care of, check that off the list and move on with life, that's probably good."
These juxtaposed concerns highlight the importance of offering women of all ages a broad range of contraceptive methods to choose from in the context of comprehensive, patient-focused counseling. The authors suggest that counselors manage expectations around LARC methods, highlighting both the reversible nature of these methods and that they are "set and forget," making them highly effective. They also suggest that misconceptions about LARC methods that persist among both providers and patients be addressed through better education and counseling. Additionally, improved training on LARC methods for staff at all levels, not just clinical staff, will help facilities move toward a more comprehensive package of contraceptive services for young women, integrating IUDs and implants into the range of methods offered, which will ultimately help young women avoid unintended pregnancy and meet their reproductive goals. However, all of this requires financial support.
"Expanding insurance coverage that includes the full range of contraceptive methods is key to giving women access to the most highly effective—and often most expensive—methods," said Adam Sonfield, senior policy associate with the Guttmacher Institute. "Implementation of the Affordable Care Act may go a long way toward easing cost issues related to LARC methods for U.S. women. In particular, it will make it easier for providers to offer these highly effective methods to younger clients, and provide the counseling they need to understand their options and choose the method that best meets their needs."
"Meeting the Contraceptive Needs of Teens and Young Adults: Youth-Friendly and Long-Acting Reversible Contraceptive Services in U.S. Family Planning Facilities," by Megan L. Kavanaugh of the Guttmacher Institute, et al., will appear in a forthcoming issue of the Journal of Adolescent Health.
"Long-Acting Reversible Contraception for Adolescents and Young Adults: Patient and Provider Perspectives," by Megan L. Kavanaugh of the Guttmacher Institute, et al., will appear in a forthcoming issue of the Journal of Pediatric and Adolescent Gynecology.
For more information on LARC use among teens, click here.