title: Access Barriers to Long-Acting Reversible Contraceptives for Adolescents.
abstract: The United States continues to have the highest adolescent birth rate of any industrialized country. Recently published guidelines by the American Academy of Pediatrics create a new consensus among professional organizations around the suitability of long-acting reversible contraceptives as first-line contraception for adolescents. Through a narrative review of U.S. studies published after 2000, this study seeks to summarize existing access barriers to long-acting reversible contraceptives for adolescents and highlight areas that warrant further intervention so that the recommendations of these professional organizations can be effectively integrated into clinical practice. Existing barriers include costs for institutions providing contraceptive care and for recipients; consent and confidentiality for adolescent patients; providers' attitudes, misconceptions and limited training; and patients' lack of awareness or misconceptions. Systemic policy interventions are required to address cost and confidentiality, such as the Affordable Care Act's mandate that contraceptive coverage be a part of essential health benefits for all insurance providers. Individual-level access barriers such as providers' misconceptions and gaps in technical training as well as patients' lack of awareness can be addressed directly by professional medical organizations, health care training programs, and other interventions.
authors.affiliation: Warren Alpert Medical School of Brown University, Providence Rhode Island. Electronic address: natasha_kumar@brown.edu.
authors.forename: Natasha
authors.initials: N
authors.lastname: Kumar
authors.affiliation: Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Joanna D
authors.initials: JD
authors.lastname: Brown
mesh_terms: D000293:Adolescent; D001291:Attitude of Health Personnel; D003219:Confidentiality; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D000075523:Long-Acting Reversible Contraception / Q000706:statistics & numerical data*; D008297:Male; D010342:Patient Acceptance of Health Care; D058991:Patient Protection and Affordable Care Act; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control*; D014481:United States
keywords: Adolescent health; Delivery of health care; Health services accessibility; Intrauterine device