Barriers & Facilitators to Providing Contraceptive Counseling to Previously Pregnant Latina Adolescents: Perspectives from Health Care Providers Located in the Midwest
Background: Despite dramatic declines in adolescent pregnancy and birth rates, U.S rates remain higher than other comparable countries and disparities, both geographic and racial/ethnic, persist. Moreover, nearly 1 in 5 adolescent births are repeat births (RB) and Latina adolescents, when compared to their white counterparts, are 1.5 times more likely to experience a RB. Four contraceptive behaviors including nonuse, inaccurate, inconsistent or gaps in contraception coverage underlie the high prevalence of unintended pregnancies and RBs. Health care providers (HCPs) can play a critical role in reducing RB-risk by providing at-risk adolescents’ contraceptive counseling that addresses these risky contraceptive behaviors in a comprehensive way. Purpose & Methods: This study sought to identify perceived barriers to providing comprehensive contraceptive counseling to Latina adolescents with a pregnancy history among HCPs who are geographically located in the Midwest. Midwestern HCPs (N=21) were interviewed using semi-structured interview techniques. Qualitative data was content analyzed and key themes were extracted. NVivo 11 software was used to analyze data. Results: Findings surrounding content and function of contraceptive counseling discussions revealed three key themes: 1) assessing contraceptive use, 2) educating adolescents on contraceptive use and options, and 3) being a resource. Four themes related to barriers also emerged including: 1) education and training, 2) clinic-level constraints placed on providers, 3) perceived cultural barriers, and 4) access. Some of these themes were present across three levels: clinic-, provider-, and adolescent-level. Additionally, facilitators to contraceptive counseling were also identified such as, being trusted & providing non-judgmental counseling, providers seeking out additional training, previously pregnant adolescents being highly receptive to contraceptive information, and the presence of the adolescent’s mother being a positive addition to contraceptive counseling visits. Conclusions: Providing comprehensive contraceptive counseling to Latina adolescents with a pregnancy history has great potential as a strategy to reduce RBs. HCPs can play an important role, but study findings suggest that barriers including clinic-level barriers, access barriers, determining how best to ensure cultural awareness at the clinic-level, and understanding how best to involve the adolescent’s parent require attention.
Chang Alexander, Purdue University.
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