Long-acting forms of contraception (think IUDs, or hormone implants that go under the skin) have long been available. But despite their effectiveness and ease of use, it’s been a tumultuous road to public acceptability. And while clinicians have a good sense of adult attitudes, teenagers’ attitudes toward such contraceptives – together called long-acting reversible contraceptives, or LARC – are less well understood.
“Rates of teenage pregnancy are going down nationally, but until very recently stayed steady in our clinic population,” says Pamela Burke, a nurse practitioner in Children’s Division of Adolescent Medicine. “Teenage girls who have access to LARC could have some advantage over their peers through the use of a more reliable birth control method, one that is not dependent upon human effort or memory.”
Burke, with colleagues at Children’s Martha Elliot Health Center (MEHC), the Dimock Center in Roxbury and the Division of Family Planning at Beth Israel Deaconess Medical Center (BIDMC), is currently running a study aimed at understanding teen’s knowledge about and attitudes toward LARC.
“Unprotected sex continues to be a problem, and teen mothers can face some pretty serious consequences in terms of poverty, limited resources and access to care,” Burke says. “We as healthcare providers need to know what’s going on among teenagers, especially teenage girls, if we are to improve our practice and provide effective counseling before and when a girl becomes sexually active.”
Funded with a Patient Services Research Grant, Burke and her colleagues started interviewing teenage girls seen in Children’s Young Parents Program, the Children’s Hospital Primary Care Center and the adolescent clinics at the main hospital campus and MEHC at the beginning of July. They will soon start recruiting at Dimock and BIDMC as well. “This project has really brought obstetricians and pediatricians at the different sites together,” Burke says.
The girls are asked about their thoughts about LARC, birth control in general and why they choose to use birth control or not. “We also are trying to learn more about parents’ roles and attitudes about contraception, because we know it can be difficult for parents to have these conversations with their children,” Burke says. “We are also looking for gaps or missed opportunities for counseling or education on the provider side.” She also notes that some healthcare providers may not have access to the most recent information or research about LARC, and could inadvertently transmit old myths about risks or ineffectiveness.
The survey also probes the question of birth control and sexually transmitted diseases. “STDs are prevalent among teenagers and young adults, and there’s the risk that a teen who uses LARC could get complacent about STD risk and decide to not use a condom.”
Only halfway to their recruitment goal, the team is already starting to glean some lessons. “One interesting observation is that girls want their healthcare provider to just tell them what to use,” Burke notes. “But they don’t often understand or haven’t had explained to them what can happen while their body is adjusting to the contraceptive. We need to figure out better ways to educate girls about these options and help them understand what can happen during the adjustment period.”
Since it takes two to tango, Burke hopes to expand the project in the future to include boys. “There are male attitudes that factor into contraception, and the interviews that we’ve had thus far can have something of a ‘he said/she said’ aspect to them,” she says. “We know there must be more to the story.”
[Ed. Note: This is the fifth in a series of occasional posts about Children’s Hospital Boston staff who received Patient Services Research Grants in 2011. This grant program engages the professional staff in the Department of Patient Services in high quality pediatric research with the ultimate goal of improving child health.]