Chapter 2, Section 1: Reproductive Health Services

The provision of reproductive healthcare services is a crucial component in the teen pregnancy prevention puzzle. About three-quarters of the drop in teen pregnancy rates in the United States between 1988 and 1995 has been due to changes in the behavior of sexually experienced teens. Overall contraceptive usage increased slightly, but perhaps more important, teens were choosing more reliable methods of birth control (Boonstra, 2002). Most of these methods are long-acting hormonal methods (e.g., the injectable and the implant). Such methods can only be obtained through a healthcare provider, which underlies the importance of easily accessible and affordable reproductive health services including contraceptive methods (AGI, 1999). In fact, a sexually active teen who doesn’t use contraception will have a 90 percent chance of getting pregnant within a year (AGI, 1994). There are newer hormonal methods now available including the contraceptive ring, the contraceptive patch, and a progestin-releasing intrauterine system, increasing the number of reliable options for women (Long, 2002).

Many programs offer access to reproductive health services that may include gynecological care (pelvic exams and pap tests), pregnancy testing, HIV counseling and testing, sexually transmissible disease testing and treatment, emergency contraception, and other forms of reproductive health counseling and education. These services may take place at family planning clinics, school-based health centers, school-linked clinics, or private physicians’ offices. Research has consistently shown that condom availability programs in schools do not increase sexual activity and that they may increase condom usage among sexually active students, although findings have been mixed on usage outcomes (Kirby, 2001). Dawson (1986) reviewed the literature and concluded that the most successful programs for influencing contraceptive behavior were based in a clinic setting.

A set of common characteristics for the provision of reproductive health services that have been shown to be effective in increasing condom or other contraceptive use among teens has been identified. These programs focused primarily or solely on reproductive health; provided youth with a combination of educational materials and opportunities for one-on-one counseling or discussions; gave a clear message about abstinence, as well as condom or contraceptive use; and provided condoms or other contraceptives (Kirby, 2001).

Research Demonstrates

The following are important components of reproductive health services:

• Teens should be able to get an appointment within 24–48 hours (National Campaign to Prevent Teen Pregnancy, 1999). Adolescents tend to focus on the present and are less likely to keep appointments set days or weeks in advance. Successful programs often have drop-in appointment times.
• Make services accessible by offering after-school, evening, and weekend appointments (National Campaign to Prevent Teen Pregnancy, 1999). Services provided at non-traditional times may increase teen utilization of clinic services.
• Offer sexuality education within provision of clinical services. Most successful adolescent pregnancy prevention programs combine sexuality education with direct access to contraceptive services and have increased contraceptive use by up to 22 percent (Frost & Forrest, 1995).
• Ensure confidentiality (National Campaign to Prevent Teen Pregnancy, 1999). Teens often have strong concerns about their privacy. Confidential access to family planning services has been found to help prevent unintended adolescent pregnancy (Kahn, Brindis, & Glei, 1999). Many teens may not know about
  confidentiality laws and procedures so it is important to create awareness about confidentiality policies among teens.
• Offer counseling at negative pregnancy tests. Zabin, Emerson, Ringer, and Sedivy (1996) found adolescents who receive negative pregnancy test results from healthcare providers to be an accessible and high-risk pregnancy group because they are sexually active, likely to be exposed to ongoing risk for pregnancy, and available for intervention. In their study of adolescents 17 years of age and younger who received a negative pregnancy test, 58 percent were pregnant within 18 months of that pregnancy test. More research is needed to determine whether or not counseling at a negative pregnancy test would show a reduction in adolescent pregnancy in teens who access that service.
• Offer assertiveness counseling to young women when they test positive for an STI (Rickert, Sanghvi, & Wiemann, 2002). Clinic staff can seize this important window of opportunity to counsel and use role-play to help girls feel comfortable discussing condom and other contraceptive use with partners, set sexual limits, or refuse sexual intercourse. Often times, teen girls may need permission to set their own limits, to know that they have sexual rights, and to practice skills needed to assert themselves.
• Support and encourage parent-child communication about sexuality (Rickert et al., 2002). Clinicians can educate parents who visit the clinic about the importance of talking with their daughters about sex-related topics, offer them resources, and teach parenting skills. Adolescent girls can be asked about comfort levels in discussing sexuality with parents and encouraged to do so. Strong parent-child communication may have positive effects on adolescent females being able to have better communication with their partners (Shoop & Davidson, 1994).
• Include males in reproductive health care services. Traditionally, males have been left out of reproductive health care and their own needs have been largely ignored (AGI, 2002). It is not only important to acknowledge the role males play in reproductive health outcomes of females, but also to address the specific needs of males themselves. See Section 5, Male Involvement (page 23), for other ways to meet the needs of males and create a clinic atmosphere that welcomes them.
• Promote a clear message about consistent and correct use of effective methods of contraception. The Alan Guttmacher Institute (1999) has analyzed the factors reducing the number of teen pregnancies and found that since 1991, sexually experienced youth have become more successful at avoiding pregnancy through effective contraception. In addition, more teens are reporting using methods the first time they have intercourse.
• Utilize a teen advisory board (National Campaign to Prevent Teen Pregnancy, 1999). Inclusion of teens in the planning and delivery of services ensures that such services are truly youth-centered and reflect their needs. Teens listen to what other teens say. The success of social marketing campaigns, websites, brochures, and other educational media may hinge on teen input. Involving teens every step of the way, although challenging, is critical for effective provision of services that meet the needs of adolescents.

Implementation Tips

• Set specific after school or weekend “drop-in” hours for teen clients.
• Post “confidential services” signs in waiting and exam rooms.
• Inform every teen client about the rules and exceptions to confidentiality.
• Follow-up negative pregnancy tests with risk assessment counseling including specific discussion of, or practice with, birth control methods.
• Ask teens who make appointments if they have a partner or friend they would like to accompany them to their appointment.
• Find out what teens know about your clinic and their opinion of the services and staff. Word travels fast among teens and it is important to find out what your reputation is in the community you serve.
• Begin to assemble a youth advisory board. Some ideas include accessing existing community youth leaders, doing outreach to youth through volunteer activities, or partnering with a youth-service organization in your area.

Reproductive Health Services Program Assessment .pdf

To download a free copy of the Adobe Acrobat Reader, which you can use to view .pdf documents, select (click on) the Acrobat Reader icon.