Adolescent use of Norplant implants: clinic services, policies and barriers to use

Abstract

Introduction: The purpose of this article is to review the experiences of family planning clinic providers in making Norplant available to adolescents. We look specifically at the proportions of women receiving the implant from these providers who are teenagers, the policies adopted regarding implant education and whether or not parental consent is required for minors. Pricing policies and the implications of high method cost for teenagers are discussed. Finally, some of the policies adopted by state agencies related to adolescent use of the implant are reviewed.

Methods: The data come from two national surveys conducted by the Alan Guttmacher Institute (AGI). The first, a survey of family planning agencies, collected data from 616 family planning providers of clinic services (response rate 69%). The second surveyed the Medicaid, health and welfare agencies in all 51 jurisdictions about policies related to Norplant.

Results: Over one-quarter of all contraceptive implants inserted by family planning agencies were provided to teenagers. Teenagers were routinely informed about the implant in about 85% of those clinics offering implant services. Few state agencies notify women about the implant. Twenty-three percent of all family planning agencies providing implant services report that parental consent must be obtained prior to implant insertion. The Medicaid program has paid for a majority of implant insertions at family planning agencies.

Conclusions: Teenagers who rely on publicly funded family planning clinics for contraceptive services face a variety of barriers in obtaining Norplant. High method cost, parental consent requirements and issues related to Medicaid eligibility are likely to deter some teenagers who might otherwise choose Norplant.

PIP: Data from two national surveys conducted by the Alan Guttmacher Institute--the Family Planning Monitoring Survey and the Norplant Accessibility Survey of State Agencies--enable a preliminary assessment of the extent to which US family planning programs have succeeded in making Norplant available to teenagers. By September 30, 1992, 40% of US family planning agencies provided Norplant and another 13% were about to begin distribution. During the first 18 months of Norplant availability, teenagers were recipients of 27% of all contraceptive implants inserted by family planning agencies. By the end of 1993, about 75,000 teens had obtained Norplant from family planning agencies by the end of 1993 and another 60-65,000 received the implants from private providers. The median cost of Norplant insertion is US$500, but 60% of insertions are funded by Medicaid. Although 85% of clinics routinely inform teenagers about the Norplant option, state health and welfare departments and Medicaid have made little effort to promote Norplant use. 23% of agencies that offer Norplant require parental consent for minors; this requirement varies, however, from a low of 6% of Planned Parenthood affiliates to a high of 40% of hospital-based programs. Potential deterrents to continued high use of Norplant by teenagers include a lack of confidentiality, Medicaid limits on the number of funded insertions, and loss of Medicaid benefits when a teen leaves home or is more than 60 days postpartum.