Effective, recommended, underutilized: a review of the literature on barriers to adolescent usage of long-acting reversible contraceptive methods.

PURPOSE OF REVIEW: Teenage pregnancy rates in the United States remain at epidemic proportions. To help stem the tide of adolescent pregnancy, both the American Academy of Pediatrics and American College of Obstetricians and Gynecologists have released policy statements that long-acting reversible contraceptives (LARC) be considered the first-line option for contraception in adolescents. Despite the recommendations and efficacy, LARCs are utilized by less than 5% of American teens. The purpose of this review is to elucidate the barriers to adolescent access to LARC, which are broken down into provider, patient, and cultural barriers.

RECENT FINDINGS: Recent literature suggests that shortcomings in physician training in LARC method counseling and placement begin as early as medical school and are further augmented by the clinical cost and logistical difficulty of device placement. Patients experience barriers due to cost, confidential access, and perceptions or misconceptions about contraceptive options. Cultural barriers are derived from the absence of expectation for adolescents to pursue safe and effective contraceptive options, as well as the historical complications from intrauterine devices (IUDs) and implants.

SUMMARY: These barriers have led to poor utilization of the most effective methods in preventing adolescent pregnancy. It is essential that pediatricians be up-to-date on the most current recommendations surrounding LARC to help negate barriers and provide the best care to adolescent patients.