New York City Physicians’ Views of Providing Long-Acting Reversible Contraception to Adolescents

The Article in Brief

New York City Physicians' Views of Providing Long-Acting Reversible Contraception to Adolescents

Susan E. Rubin, and colleagues

Background Despite their safety and efficacy, only 3 percent of adolescents who use contraceptives use an intrauterine device (IUD), and far fewer use implantable contraception. Yet increasing use of such long-acting reversible contraceptives (LARC) could decrease unintended adolescent pregnancy rates. This study explores primary care physicians' experiences, attitudes, and beliefs about LARC counseling and provision to adolescents with a focus on enablers and barriers to access.

What This Study Found Through in-depth interviews with 28 New York City-based family physicians, pediatricians and obstetrician-gynecologists, researchers identify multiple factors affecting their likelihood of prescribing long-acting reversible contraception to adolescents, and they find numerous barriers, including financial concerns, the clinical environment, and physicians' knowledge, attitudes, and beliefs. In short, the authors found physicians rarely counsel about implantable contraception because of knowledge gaps (capability) and limited access to the devices (opportunity). Notably, many physicians, in particular pediatricians, did not know that girls who have not previously given birth can be appropriate candidates for IUDs and consequently never counsel about this option. Specific enablers to counseling included the availability of the device in the clinic, a "culture" within the clinic supportive of adolescent contraception provision, and the ability to insert IUDs or easy access to someone able to insert the device. Factors enabling motivation included a belief in the positive consequences of IUD use, which was particularly influenced by physicians' perception of adolescents' risk of pregnancy and sexually transmitted disease.

Implications

• The authors assert that a concrete step to addressing the persistent public health issue of adolescent pregnancy is optimizing access to reliable, forgettable forms of reversible contraception, and they call for future research to explore strategies to increase adolescents' LARC access in primary care.