Background: To examine the impact of on-site availability of long-acting reversible contraceptive methods (LARC) at school-based health centers (SBHCs) on interest and use of LARCs.
Aim: This study examined the association between LARC availability at nine SBHCs and LARC interest and uptake among sexually active Latinas aged 14-18 years.
Methods: Participants completed four surveys: baseline (at the recruitment visit) and at 48-hours, 3-months and 6-months post-recruitment visit. Multivariate logistic regression models analyzed the effect of on-site LARC availability and adolescents’ interest in using a LARC and on subsequent LARC utilization.
Results: Of the 334 participants, 28% reported interest in using LARC; 45% had on-site access to LARCs at their SBHC. Utilization of LARC was 6.0% at the 48- hour follow-up, 8.3% at 3-months and 7.2% at the 6-month follow-up. Initial interest in LARC use was significantly associated with subsequent LARC utilization at all follow-ups. However, on-site clinic availability to LARCs significantly increased LARC use only at the 6-month follow-up.
Conclusion: Latina adolescents’ interest in LARC use far exceeded their actual utilization. Efforts to increase LARC access are warranted to assure that all adolescents are able to get their preferred contraceptive method. SBHCs can serve a critical role in supporting adolescents’ access to contraceptive care.
Long-Acting Reversible Contraception; School-Based Health Centers; Etonogestrel Implants; Levonorgestrel Intrauterine Devices; Contraception; Women
Long-acting reversible contraception (LARC) devices, including etonogestrel implants and levonorgestrel intrauterine devices (IUDs), are highly effective contraception options for all women including adolescent and young adult nulliparous women. The American Academy of Pediatrics recommends that providers begin contraception counseling with a discussion of LARCs since they have the highest effectiveness rates of all contraceptive methods [1,2]. Professional guidelines by the Society of Adolescent Health and Medicine and the American College of Obstetricians and Gynecologists both recommend patient-centered contraceptive counseling and providing full access to a range of options including LARCs methods [3,4]. Despite these recommendations, only two-thirds of publicly funded US health centers have providers trained to place and remove both implant and IUD devices, while one fifth of health centers did not offer any LARC methods on-site . In addition, in a national survey of 561 practicing pediatricians, while more than 70% prescribe short-acting hormonal contraceptives for their adolescent patients, less than 5% insert LARC devices . The need for a referral to a LARC provider creates additional barriers for adolescents who may not have access to or the skills to navigate the health system or may feel hesitant to see a non-pediatric provider. In a study of a large urban health system, adolescent patients who were referred from a general pediatrics clinic for contraception waited an average of 45 days to see the consulting provider, approximately 42% of patients failed to keep referral appointments and 15% canceled or rescheduled their referral appointment , thereby increasing their risk of unintended pregnancy. The convenience of method access has been found to be a significant motivator for patients to choose non-LARC methods when LARC placement was not available on-site . Hence, it would follow that on-site availability of LARC placement may promote the selection of LARCs by adolescents, but evidence is lacking. Sexually active females are more likely to have used hormonal contraceptives if their school has a school-based health center (SBHC) ; however, research examining the effect of on-site LARC availability on LARC utilization at SBHCs is also lacking. Further, the impact of immediate access to LARCs on adolescent contraceptive decision making is particularly salient among Latina adolescents, since this group experiences disparities in reproductive health outcomes such as higher rates of unintended pregnancies . The provision of patient-centered contraceptive care is essential as is equitable access to the full range of contraceptive options. Understanding the role of LARC access in patient decision-making would inform public health efforts to improve utilization of highly effective LARCs for adolescents who are interested in using this method of contraception.
This study aims to examine the associations between adolescents’ interest in LARCs along with LARC access on-site at SBHCs and utilization of LARCs among previously non-LARC-using sexually active Latinas aged 14-18 years. Specifically, we hypothesized that both self-reported interest in LARCs and on-site access to LARCs would be associated with greater utilization of LARC methods. Additionally, we hypothesized that LARC interest may moderate the effect of access, whereby on-site access would have an effect on utilization in the presence of personal interest but not in the absence of personal interest in a LARC method.