Long-acting reversible contraception for adolescents and young adults: patient and provider perspectives

Abstract

Study objective: To describe and explore provider- and patient-level perspectives regarding long-acting reversible contraception (LARC) for teens and young adults (ages 16-24).

Methods: Data collection occurred between June and December 2011. We first conducted telephone interviews with administrative directors at 20 publicly funded facilities that provide family planning services. At 6 of these sites, we conducted a total of 6 focus group discussions (FGDs) with facility staff and 48 in-depth interviews (IDIs) with facility clients ages 16-24.

Results: Staff in the FGDs did not generally equate being a teen with ineligibility for IUDs. In contrast to staff, one-quarter of the young women did perceive young age as rendering them ineligible. Clients and staff agreed that the "forgettable" nature of the methods and their duration were some of LARC's most significant advantages. They also agreed that fear of pain associated with both insertion and removal and negative side effects were disadvantages. Some aspects of IUDs and implants were perceived as advantages by some clients but disadvantages by others. Common challenges to providing LARC-specific services to younger patients included extra time required to counsel young patients about LARC methods, outdated clinic policies requiring multiple visits to obtain IUDs, and a perceived higher removal rate among young women. The most commonly cited strategy for addressing many of these challenges was securing supplementary funding to support the provision of these services to young patients.

Conclusion: Incorporating young women's perspectives on LARC methods into publicly funded family planning facilities' efforts to provide these methods to a younger population may increase their use among young women.

Figure 1

Client and staff perspectives on advantages and disadvantages of LARC methods, listed in descending order from most to least common within groups. Top four characteristics mentioned in client IDIs and staff FGDs are presented. Underlined characteristics represent agreement between clients and staff.

Figure 2

Challenges to providing LARCs to young women and strategies to combat these challenges, as identified by administrators and staff at lower rates of LARC provision facilities (challenges) and higher rates of LARC provision facilities (both challenges and strategies).