Availability of Long Acting Reversible Contraceptives for Adolescents in Urban vs Rural West Virginia Counties

Abstract

The study objective was to evaluate long acting reversible contraceptive (LARC) method availability and access for adolescents in rural and urban counties in West Virginia (WV). A cross-sectional survey of Title X family planning providers throughout WV was conducted from January 2016 to July 2017. This survey was sent to 226 family planning providers in WV to assess patterns of LARC availability. The survey assessed provider training level, LARC services provided and frequency, clinical practice, referral patterns, and comfort level providing adolescent LARC services. Survey results were analyzed by providers' rural vs urban status, based on US census county codes. Survey responses yielded 127 total responders, 65 (51.2%) were urban, and the remaining 62 (48.8%), were rural. Urban providers had a larger representation of medical doctors, while rural providers were primarily nurse practitioners (p<0.001). Intrauterine devices (IUD) had lower availability with rural providers (p<0.006). Years of experience doing IUD placement (p<0.010), frequency of placing implants (p<0.010), and frequency placing implants in teenagers (p<0.012) were significantly less in rural providers. This survey showed significant differences in practice between urban and rural settings including training, experience, contraceptive options, barriers to care, and practice guidelines.

Changes in Adolescent Birth Rates within Appalachian Subregions and Non-Appalachian Counties in the United States, 2012–2018

“…Insurance coverage is important for enabling access to effective contraception and contributes to positive health outcomes. 7 , 17 – 19 While not independently associated with adolescent births, HPSA designation was also more common among Appalachian counties. Taken collectively, these findings underscore the potential impact of structural, financial, and geographic barriers to accessing providers and contraceptive services among vulnerable populations, such as the Appalachian region.…”

“…Taken collectively, these findings underscore the potential impact of structural, financial, and geographic barriers to accessing providers and contraceptive services among vulnerable populations, such as the Appalachian region. 17 , 20 …”

Acceptability of a Comprehensive Sex Education Self-Study Website for Teaching Reproductive Health: A Pilot Study Among College Students and Obstetrics and Gynecology Resident Physicians

“…11,12 Previous studies have demonstrated that the rural adolescent population in West Virginia has low reproductive health knowledge, 13,14 and may face unique obstacles to contraception access. 15 Barriers to rural adolescents include distance to healthcare providers, limited access to certain contraceptives such as intrauterine devices and implants, and variability of sex education curriculum presented at school. 13,15 Therefore, a technology-based sexual health tool that is tailored to this population to provide education and local resources, could have a significant impact on adolescent risk reduction.…”

“…15 Barriers to rural adolescents include distance to healthcare providers, limited access to certain contraceptives such as intrauterine devices and implants, and variability of sex education curriculum presented at school. 13,15 Therefore, a technology-based sexual health tool that is tailored to this population to provide education and local resources, could have a significant impact on adolescent risk reduction. In order to develop a tool for this demographic, a pilot study was necessary among populations that could give feedback as to the acceptability, feasibility, and accuracy of the website prior to distribution among rural adolescents.…”