Information Access and Social Support for Adolescent Birth Control Selection and Follow-Up: A Pilot Study

Purpose:  Adolescent parenting put both mother and child at risk of poor health and socioeconomic outcomes and result in significant costs to our nation. Due to the high risk of unintended pregnancy, adolescents may benefit from increased access to long-acting reversible contraception (LARC) methods.  Currently, however, only 4.5% of women 15-19 use a LARC with most using IUD. In order to facilitate use of birth control and in particular LARCs, an adolescent health clinic that serves underinsured clients, conducted a pilot of a tracking program that provided intensive contraceptive counseling (including condom use in all cases), readily available access to contraceptive information via phone calls and texting, and follow-up calls from medical personnel regarding their contraceptive use and scheduled visits. Patients had access to phone contact with the Nurse Practitioner or Health Educator at all times, including evenings and weekends.  The research questions were 1) Would the adolescents use the phone and texting system for their birth control method (BCM) questions?  and 2) Would the insertion rate of requested LARCs be higher than the usual 30% before the pilot program?

Method:  All female adolescents seen in the Clinic who were started on any BCM, including condoms were the target population for the project.  One hundred adolescent females (90% of recruits) from ages 13-20 (average age of 17) consented to be part of this tracking program. Seventeen of these patients were lost after the initial clinic visit.  Phone call/texts were made to the patients 2-3 weeks after their initial visit. Follow-up visits were scheduled 4-6 weeks after the initial visit and start of the chosen birth control method. Phone call/texts were also made at 6-8 and at 12 weeks. Phone calls, birth control method requests, and follow through results were tracked using an Excel spreadsheet.

Results: The average number of phone or text contacts per patient was 3.7. Eighty-five percent of clients called or texted to ask questions about birth control methods, side effects, or other related topics, such as relationship issues surrounding birth control use.  Most often requested birth control methods were Implanon (36%), oral contraceptives (20%), and DepoProvera injection (10%).  Forty-two percent (15 out of 35) received a LARC compared to 25% before the program.  Only six out of 83 adolescents (7%)  became pregnant during the six-month study, and five of those were to teens that already had a child.

Implications: The pervasive use of the available phone call/texting service to answer questions about BCM suggests that adolescents welcome  this type of resource. It was also promising  that adolescents more often followed through on their selection of LARCs than before this pilot program.  Further research on this type of program is needed especially given the limitations of this pilot project.  Nevertheless, since many of the adolescent  questions involved relationships and family dynamics, it is believed that a social worker could be a critical part of the medical team and serve as an effective advocate for at-risk teens in achieving higher rates of birth control use and compliance.