SCIENTIFIC
What Providers Know vs . What Providers Do : Barriers to Contraception in Adolescents
AUTHORS : Andrya J . Durr , BS 3 , 4
Elizabeth A . Critch , MBA 3 M . Paula Fitzgerald , PhD 3 , 5 Kylie A . Fuller , MD 2 , 3 Kelly M . Devlin , MD 2 , 3
Roberta I . Renzelli-Cain , DO , MHS , NCMP , FACOG , IF 2 , 3
1
Obstetrics and Gynecology , West Virginia University School of Medicine
2
Obstetrics and Gynecology , West Virginia University Medicine
3
West Virginia National Center of Excellence in Women ’ s Health , West Virginia University School of Medicine
4
Division of Exercise Physiology , West Virginia University School of Medicine
5
John Chambers College of Business and Economics , West Virginia University
FINANCIAL SUPPORT
This work was supported by the West Virginia University School of Medicine Department of Obstetrics and Gynecology and the West Virginia National Center of Excellence in Women ’ s Health . No grants were used to fund this work .
INTRODUCTION
The WV teenage birth rate is among the highest in the United States ( US ) and ranks 43rd in the nation at 27.1 births per 1,000 teenagers , totaling 1,416 teenage births in 2017 among females ages 15-19 years . 1 In 2015-2017 , 55 % of teenagers in the US had intercourse by the age of 18 years . 2 Additionally , sexually active young females , ages 15-19 years , reported the types of contraceptives they had ever used , including 97 % using condoms , 65 % using the withdrawal method , 53 % using combination oral contraceptives , and 20 % using LARC . 2 Contraceptive effectiveness , according to the Centers for Disease Con-
ABSTRACT
INTRODUCTION The teenage birth rate in West Virginia ( WV ) remains among the highest in the United States . The American College of Obstetricians and Gynecologists ( ACOG ) and the American Academy of Pediatrics ( AAP ) recommend long-acting reversible contraception ( LARC ) as first-line contraception . Because WV teenagers ’ LARC use is exceptionally low , the objective of this study was to gain insight into the current knowledge , practice , and beliefs of health care providers ( HCP ) in WV regarding LARC for adolescent patients .
METHODS An electronic survey using Qualtrics . com was distributed to WV HCPs . Of the 2,196 HCPs contacted , 132 respondents returned the survey , and 109 completed usable data .
RESULTS A majority of HCPs were aware that LARC ( i . e .,
trol and Prevention ( CDC ), varies widely ; condoms have an 18 % annual failure rate , withdrawal has a 22 % annual failure rate , and combination oral contraceptives have a 9 % annual failure rate . LARC , which includes implants and the intrauterine device ( IUD ), has an annual failure rate of less than 1 %. 3 Thus , scientific evidence suggests that increasing use of LARC methods among adolescent females could reduce the teenage birth rate and its resulting negative consequences to the young mother such as lower lifelong education levels and reduced income . 4 , 5 In 2015 , the ACOG and the AAP strongly recommended LARC methods and urged their usage in the adolescent age group . 6 , 7 In 2018 , the recommendation regarding LARC methods as first line were modified to take into account the teenager ’ s preferences for contraception . 6
Colorado had the highest percentage of teenagers using LARC in 2015 ( 25.8 %). 8 This high rate of LARC utilization is partially responsible for an estimated 50 % intrauterine devices and implantable devices ) is the first line recommendation of the ACOG and AAP for adolescent birth control . However , HCPs most frequently prescribed combination oral contraceptives and injectables , which are not first-line recommendations . Notably , 59 % of HCPs prescribing combination oral contraceptives believed they were prescribing according to ACOG and AAP recommendations . Forty-one percent of HCPs knew that combination oral contraceptives were not a first-line recommendation but prescribed them most often . The most frequently identified most important reason for not prescribing LARC was that the HCP did not know how to place them ( 16.5 % of respondents ), followed by litigious or malpractice action if there is a malfunction or complication ( 4.6 % of respondents ).
DISCUSSION These results indicate a need to provide adequate LARC training to HCPs in WV .
reduction in Colorado ’ s teenage births and abortions from 2009-2014 . 9 Nationally , sexually active females aged 15-19 years used LARC five times more frequently than WV teenagers ( 20 % and 4 % respectively ). 2 , 10 Thus , WV LARC usage among teenagers was substantially lower than Colorado and the nationally reported percentage . Lack of LARC usage may explain in part the high teenage birth rates observed in WV .
In 2005 , in response to Colorado ’ s high teenage birth rates , the Colorado Project was implemented and increased accessibility to provider training and patient accessibility to LARC . Teenage birth rates in Colorado declined from a rate of 42.6 in 2005 to 20.3 births per 1,000 females by the end of 2014 . 1 During this same time , teenage birth rates in WV only declined from 43.4 in 2005 to 36.6 births per 1,000 persons by the end of 2014 , 11 one of the highest rates in the US . 1 Thus , the objective of this study was to gain insight into why there are low LARC utilization rates by current HCPs
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