Adolescent Reproductive Health Care Research Articles

Emergency Department Directors Are Willing to Expand Reproductive Health Services for Adolescents.

Nearly 20 million adolescents receive emergency department (ED) care each year, many of whom have untreated reproductive health issues. ED visits represent an opportunity to provide appropriate care, however, ED physician reproductive health care practices and capabilities in the United States have not been described. We sought to characterize pediatric ED director's individual practice and ED system resources for providing adolescent reproductive health care. We invited pediatric ED division and/or medical directors nationally to participate in an anonymous, online survey. Outcomes included ED directors' personal practice regarding providing adolescent patients reproductive health care, and their ED's resources and standard practice regarding screening adolescents for sexually transmitted infections (STIs) and other reproductive health concerns. One hundred thirty-five of 442 (30.5%) ED directors responded. Respondents were 73% (90/124)male, with a median of 18 (interquartile range, 13-23) years of experience and 63% (84/134) working in urban EDs. Seventy-one percent (90/130) preferred face-to-face interviews for obtaining a sexual history, but only 59% (77/130) of participants "always ask parents to leave the room for sensitive questions." Eighty-four percent (106/127) were receptive to pregnancy prevention interventions being initiated in the ED, with 75% (80/106) of those willing to provide an intervention. Only 16% (21/128) indicated their ED has a universal STI screening program, and only 18% (23/126) "always" successfully notify patients of a positive STI test. ED directors are comfortable providing adolescent reproductive health care, and many individual- and ED-level opportunities exist to provide improved reproductive health care for adolescents in the ED.

Sexual and reproductive health of Brazilian adolescents: National school health survey (PENSE) 2009, 2012 and 2015

Background Sexual and reproductive healthcare for adolescents has faced some obstacles and challenges. The young population has a significant burden of disease related to unplanned pregnancy and births, as well as, sexually transmitted infections (STIs), including human immunodeficiency virus/human immunodeficiency syndrome (HIV/AIDS), maternal death and abortion. Some factors, such as lack of information about their health, difficult access to contraceptive methods, low schooling and income, violence and sexual abuse, gender inequalities, among others contribute to the persistence and increase of these problems among adolescents. The objective of the study was to analyze indicators of sexual and reproductive health of adolescents based on data from the National School Health Survey (PeNSE) in 2015, comparing them to those of 2009 and 2012. Methods Cross-sectional study, which has analyzed data from 9th graders - PeNSE 2015, 2012 and 2009. Prevalence was estimated with the respective 95% confidence intervals (95% CI) for indicators of sexual initiation, condom use at the last sexual intercourse, have received counseling regarding pregnancy prevention, sexually transmitted infections (STIs) prevention and free condoms availability in all three editions of the survey. Prevalence of all 2015 indicators were also estimated stratifying them by sex, administrative dependence of the school and region. Pearson's Chi2 test was used to evaluate statistical differences. The complex sample was used to obtain population estimates using the Stata Survey module, version 14.0. Results Prevalence of sexual initiation decreased from 30.5% in 2009 to 27.5% in 2015, as well as for condom use, from 75.9% to 66.2% in the same period. There was a decrease in the orientation of prevention of pregnancy in public schools, from 81.1% to 79.3% and of free condom in private schools, from 65.4% to 57.3%. There was a higher prevalence of use of methods other than condoms and a threefold higher prevalence of previous pregnancy among public school students (9.4 vs. 3.5%, P = 0.002). About 30% of the adolescents reported combined use of condoms and another method, setting up double protection, and 19.5% did not use any method. All indicators of sexual and reproductive health analyzed in 2015 had differences according to sex (P Conclusion There was a decrease in sexual initiation and condom use among adolescents, greater vulnerability to STIs among boys, and pregnancy among adolescents in public schools. We also noticed a worse performance of the indicators in the North, Northeast and Central West regions, reinforcing the need to invest in sexual and reproductive education, considering the peculiarities of this population, with more attractive and empathic strategies. It is worth noting that the school is an essential locus for the transfer of contents about sexual initiation, condom use, STI prevention, among others. Thus, there are no spaces for setbacks, nor the restriction of these themes for religious reasons, or gender bias.

Emergency contraception in adolescents. A grey area in Italian legislation

Objective: To explore Italian legislation and the social climate regarding the issue of emergency contraception (EC) in adolescents.Results: In recent years, in Italy, we have seen changes in the law and in attitudes towards EC. Since 2016, EC has been approved for sale as a non-prescription drug to women over the age of 18. However, the requirement for a prescription is still in force for women under 18. This raises questions such as the minor’s ability to consent to family planning services to prevent pregnancy, and whether physicians require parental consent before providing an EC prescription to minors. This article explores these issues within the social and legislative context of adolescent reproductive health care, demonstrating a need for EC among Italian adolescents.Conclusion: Making EC difficult for minors to access seems to respond to a political stance that clashes with existing social needs and with medical evidence that shows that EC is safe and reliable for use in adolescents, and that the increased use of EC has no negative effects on regular, ongoing contraceptive use or encourages risky sexual behaviour. Future interventions by Italian policy-makers should target these themes in order to make EC easily available to adolescents throughout the country.

Applying the results based management framework to the CERCA multi-component project in adolescent sexual and reproductive health: a retrospective analysis

BackgroundAdolescent sexual and reproductive health (SRH), problems such as unplanned pregnancies are complex and multifactorial, thus requiring multifaceted prevention interventions. Evaluating the impact of such interventions is important to ensure efficiency, effectiveness and accountability for project funders and community members. In this study, we propose Results Based Management (RBM) as a framework for project management, using the Community Embedded Reproductive Health Care for Adolescents (CERCA) as a case study for RBM. The CERCA Project (2010-2014) tested interventions to reduce adolescent pregnancy in three Latin American countries, Bolivia, Ecuador and Nicaragua. Activities were designed to increase adolescent SRH behaviors in four domains: communication with parents, partners and peers; access to SRH information; access to SRH services; and use of contraception. When the project ended, the outcome evaluation showed limited impact with concerns about accuracy of monitoring and attrition of participants.MethodsWe reviewed and analyzed a series of CERCA documents and related data sources. Key findings from these documents were organized within an RBM framework (planning, monitoring, and impact evaluation) to understand how CERCA methodology and performance might have reaped improved results.ResultsStrengths and weaknesses were identified in all three elements of the RBM framework. In Planning, the proposed Theory of Change (ToC) differed from that which was carried out in the intervention package. Each country implemented a different intervention package without articulated assumptions on how the activities of intervention would bring about change. In Monitoring, the project oversight was mainly based on administrative and financial requirements rather than monitoring fidelity and quality of intervention activities. In Impact Evaluation, the original CERCA evaluation assessed intervention effects among adolescents, without identifying success and failure factors related to the outcomes, the nature of the outcomes, or cost-effectiveness of interventions.ConclusionsThis analysis showed that multi-country projects are complex, entail risks in execution and require robust project management. RBM can be a useful tool to ensure a systematic approach at different phases within a multi-country setting.

MOBILE-izing Adolescent Sexual and Reproductive Health Care: A Pilot Study Using a Mobile Health Unit in Chicago.

Adolescents experience numerous barriers to obtaining sexual and reproductive health care (SRHC). Mobile Health Units (MHUs) can remove some barriers by traveling to the community. This pilot study developed Mobile SRHC through an iterative process on an existing MHU and evaluated it among adolescents and providers. Mobile SRHC was developed through a mixed-method, multiphase study. Three key informant interviews with MHU providers, an adolescent needs assessment survey, and a Youth Model Development Session informed model development. Emergency contraception (EC), oral contraceptive pills (OCPs), and depot-medroxyprogesterone acetate (DMPA) were sequentially incorporated into MHU services. Administrative data assessed method distribution and surveys assessed patient satisfaction. Key informants held positive attitudes toward implementing Mobile SRHC into their practice. Needs assessment surveys (N = 103) indicated a majority was interested in learning about sexual health (66.0%) and obtaining birth control (54.4%) on an MHU. Over 3 months, 123 adolescents participated in Mobile SRHC. Seven packs and 9 prescriptions of EC, 8 3-month packs and 10 prescriptions of OCPs, and 5 injections and 5 prescriptions of DMPA were distributed. Ninety-two percent of adolescent participants reported they would recommend Mobile SRHC to friends. Mobile SRHC is a feasible approach for reproductive health care among adolescents.

Pediatricians' Knowledge and Practices Related to Long-Acting Reversible Contraceptives for Adolescent Girls.

A 2014 American Academy of Pediatrics (AAP) policy statement identified long-acting reversible contraceptives (LARCs) as first-line choices for adolescents, but pediatricians' current knowledge and practices about intrauterine devices (IUDs) and subdermal contraceptive implants (Implants) is unknown. We aimed to characterize pediatricians' knowledge and practices about LARCs for adolescents. Cross-sectional online survey emailed to a convenience sample of AAP member pediatricians in New York, Utah, Illinois, and Kansas in 2015 and 2016. The study included 561 practicing pediatricians. We measured knowledge about the suitability of IUDs and Implants for adolescents using two 7-item scales; a score of 7 indicates all correct. We dichotomized participants' scores as high and low knowledge if they scored ≥85% correct or <85%, respectively. Mean age was 47.4 (±11) years; 73% were female; and 72% general pediatricians. Almost all, 88%, counsel about contraception; 64% counsel about IUDs, and Implants, but only 4.1% insert them; 72% prescribe short-acting hormonal contraceptives; 44% had read the AAP policy statement. Mean score on the knowledge scale was lower for IUDs than for Implants (4.2 vs 5.1, respectively; P<.001). Multivariable regression analysis indicated that female pediatricians, adolescent medicine subspecialists, agreeing that pregnancy is a serious problem for adolescents in their practice, and having read the AAP policy statement predicted high knowledge about IUDs as well as Implants for adolescents. Most pediatrician respondents provided reproductive health care for adolescents and counseled about LARCs, but few inserted the devices. We identified knowledge deficits about suitability of IUDs for adolescents.

Confidentiality in adolescent reproductive healthcare: attitudes and practices of Serbian physicians

Confidentiality in adolescent reproductive healthcare: attitudes and practices of Serbian physicians

KNOWKEDGE, ATTITUDES, PRACTICES OF REPRODUCTIVE HEALTH CARE AMONG ADOLESCENT GIRLS IN MINORITY ETHNICS, THUA THIEN HUE PROVINCE

Objectives: To describe the knowledge, attitudes, practices of reproductive health care among adolescent girls in A Luoi and Nam Dong district, Thua Thien Hue province and identify the related factors to reproductive health care in adolescent girls. Methods: A cross-sectional study design was conducted in A Luoi and Nam Dong district, Thua Thien Hue province. All 900 adolescent girls between 10 – 19 years old of 8 communes in A Luoi and 4 communes in Nam Dong district participated in the study. Results: (i) The percentage of adolescents with not good knowledge, attitudes and practices on reproductive health care has accounted for fairly high as respectively: 86.7%, 64%, 74.4%. (ii) The percentage of adolescents who have had sexual relative were 3.8%, in which 23.5% has used contraceptive methods. (iv) The percentage of adolescents who get married early were 51.9% among adolescents who get married, the percentage of consanguineous marriage were 25.9%. (v) The percentage of pregnant adolescents were 2.7%. The proportion of adolescents with abortion were 0.1%. - There is an a relationship between education level, adolescent stage with general knowledge on adolescent reproductive health care (p&lt;0.05). (vi) There is a relationship between ethnicity, education level, adolescent stage with the general attitude on adolescent reproductive health care (p &lt;0.05). (vii) There is a relationship between education level, adolescent stage, education level of the mother, the condition of the family living at the percentage of general practice on adolescent reproductive health care (p&lt;0.05) Conclusion: The knowledge, attitudes, practices of reproductive health care among adolescent girls are not good. There is an a relationship between education level, adolescent stage with general knowledge, general attitude and general practice on adolescent reproductive health care(p &lt;0.05)There is need to enhance the communication and education reproductive health for aldolescent girls and enhance communication knowlegde and skills for reproductive health staff. Key words: adolescents, get married early, reproductive health

Efforts to Increase Implementation of Evidence-Based Clinical Practices to Improve Adolescent-Friendly Reproductive Health Services

PurposeThe purposes of this study were to describe changes in implementation of evidence-based clinical practices among health center partners as part of a multicomponent, community-wide teen pregnancy prevention initiative; to better understand the barriers to and facilitators of implementation of the evidence-based clinical practices; and to describe the technical assistance and training provided to the health center partners and key lessons learned. MethodsHealth center data from the second and third years (2012 and 2013) of the teen pregnancy prevention community-wide initiative were analyzed from 10 communities (the first year was a planning year; program implementation began in the second year). Data were analyzed from 48 health center partners that contributed data in both years to identify evidence-based clinical practices that were being implemented and opportunities for improvement. In addition, data were analyzed from a purposive sample of 30 health center partners who were asked to describe their experiences in implementing evidence-based clinical practices in adolescent reproductive health care and barriers and facilitators to implementation. ResultsAcross 48 health centers in the 10 communities, 52% reported an increase in the implementation of evidence-based clinical practices from 2012 to 2013, mostly in providing contraceptive access (23%) and offering Quick Start (19%). Among health centers that reported no change (13%), the majority reported that practices were already being implemented before the initiative. Finally, among health centers that reported a decrease in implementation of evidence-based clinical practices (35%), most reported a decrease in having either hormonal contraception or intrauterine devices available at every visit (15%), having HIV rapid testing available (10%), or participating in the federal 340B Drug Discount Program (2%). In addition, health systems and community-level factors influence health center implementation of evidence-based clinical practices. In particular, support from health center leadership, communication between leadership and staff, and staff attitudes and beliefs were reported as factors that facilitated the implementation of new practices. ConclusionsTo increase adolescent's use of quality, client-centered, affordable and confidential reproductive health services, improvement in the implementation of evidence-based clinical practices is needed. Efforts to identify barriers to and facilitators for implementation of evidence-based clinical practices can inform for health centers of opportunities to build their capacity to ensure that evidence-based clinical practices are being implemented.

STUDY ON THE KNOWKEDGE, ATTITUDES, PRACTICES&amp;NBSP; OF REPRODUCTIVE HEALTH CARE AMONG ADOLESCENT GIRLS IN A LUOI DISTRICT, THUA THIEN HUE PROVINCE

Objectives: To describe the knowledge, attitudes, practices of reproductive health care among adolescent girls in A Luoi district, Thua Thien Hue province and identify the related factors to reproductive health care in adolescent girls. Methods: A cross-sectional study design was conducted in A Luoi district, Thua Thien Hue province. All 960 adolescent girls between 10 – 19 years old of 8 communes in A Luoi district participated in the study. Results: - The percentage of adolescents with not good knowledge, attitudes and practices on reproductive health care has accounted for fairly high as respectively: 85.9%, 73.9%, 68.4%. - The percentage of adolescents who have had sexual relative were 6.4%, in which 18% has used contraceptive methods. - The percentage of adolescents who get married early were 50% among adolescents who get married, the percentage of consanguineous marriage were 15.4%. - The percentage of pregnant adolescents were 4.9%. The proportion of adolescents with abortion were 0.1% - The percentage of lower genital tract infections in adolescents was 2.2%. - There is an a relationship between education level, adolescent stage with general knowledge on adolescent reproductive health care (p &lt;0.05). - There is a relationship between ethnicity, education level, adolescent stage with the general attitude on adolescent reproductive health care (p &lt;0.05). - There is a relationship between ethnicity, education level, adolescent stage, economic conditions, the condition of the family living at the percentage of general practice on adolescent reproductive health care (p &lt;0.05) Conclusion: The knowledge, attitudes, practices of reproductive health care among adolescent girls are not good. There is an a relationship between education level, adolescent stage with general knowledge, general attitude and general practice on adolescent reproductive health care(p &lt;0.05)There is need to enhance the communication and education reproductive health for aldolescent girls and enhance communication knowlegde and skills for reproductive health staff. Key words: adolescents, get married early, reproductive health

Nurses Urged to Prepare for Sex Education.

Editors' note: From its first issue in 1900 through to the present day, AJN has unparalleled archives detailing nurses' work and lives over more than a century. These articles not only chronicle nursing's growth as a profession within the context of the events of the day, but they also reveal prevailing societal attitudes about women, health care, and human rights. Today's nursing school curricula rarely include nursing's history, but it's a history worth knowing. To this end, From the AJN Archives highlights articles selected to fit today's topics and times.This month we reprint a brief "Professional Practice" note from the June 1969 issue about what was described as the first family planning conference for nurse educators. Speakers emphasized the need to make this subject a routine part of nursing school curricula (despite debates over the nurse's role in family planning), "so that nurses can counsel out of wisdom and not from piety or ignorance." Speakers included James Lieberman, MD, who years later coauthored with his daughter a teen sex guide, and Alan Guttmacher, MD, then president of Planned Parenthood, whose Center for Family Planning Program Development within that organization was later renamed the Guttmacher Institute in his honor.Nurses today are deeply involved in sexual and reproductive health care. In this issue, public health specialist Diane Santa Maria and colleagues offer ways to advance sexual and reproductive health care for adolescents by devising more friendly, youth-oriented clinical settings.

IMPLEMENTASI KEBIJAKAN PELAYANAN KESEHATAN REPRODUKSI REMAJA DI KOTA SEMARANG

This research uses descriptive qualitative research method. This study will describe and analyze Implementation Adolescent Reproductive Health Services in Kota Semarang along with the critical success factors that influence it. This policy refers to Government Regulation No. 61 Year 2014 on Reproductive Health and Planning Guide, Formation and Development PKPR in Regency / City. Data collection techniques used through interviews, observation and documentation of information. The theory used is the theory of five precision of public policy implementation and implementation models belonging to Grindle. The results of this study indicate that, implementation of the Adolescent Reproductive Health Care Policy in Semarang still less than optimal. Indicators that it is still not include policy measures, public acceptance, changes desired, the details of the implementing actor, resource availability, and the participation of the target group. Suggestions for improvement are given is to hold a special queue for teenagers, provide policy dissemination to parents, reproductive health education from grade 6, make regulations regional level descriptors, provides a dedicated space for counseling, and training of peer counselors each year at the city level.

Exploring the feasibility of mobile sexual and reproductive health care for adolescents in Chicago public schools

Objectives: This study assessed the feasibility and acceptability of integrating sexual and reproductive health (SRH) care into a mobile health unit (MHU) that provides primary care services to Chicago public high school students. Methods: To determine the need, we surveyed adolescents visiting the MHU about their perspectives on obtaining SRH care in that setting. We also conducted key informant interviews with MHU staff to assess their attitudes about providing this care. Lastly, we performed an iterative implementation, including a “plan, do, study, act” methodology, for introducing emergency contraception (EC), the pill and depot-medroxyprogesterone (DMPA). Method uptake and patient satisfaction were measured. Results: The adolescent needs assessment (n=103) revealed interest in learning about sexual health (66%) and obtaining birth control (84%) on the MHU. Three MHU provider interviews revealed endorsement of incorporating mobile SRH care into their current practice. Over a 4-month implementation period, MHU providers supplied seven packs and nine prescriptions of EC, eight packs and 10 prescriptions of the pill and five shots and five prescriptions of DMPA. Satisfaction surveys (n=126) showed that a majority of adolescent MHU users found the unit to be a safe (93%) and private (88%) place to obtain SRH care, and 92% reported they would recommend it to friends for this care. Eighty-three percent reported that the MHU made it easier to obtain birth control. MHU providers welcomed the incorporation of mobile SRH care into their current practice, finding it feasible and acceptable. Conclusions: Mobile SRH care is well-received among adolescents and health care providers, and it can be incorporated into an existing MHU.

Lessons learnt from the CERCA Project, a multicomponent intervention to promote adolescent sexual and reproductive health in three Latin America countries: a qualitative post-hoc evaluation

The Community-Embedded Reproductive Health Care for Adolescents (CERCA) Project was implemented in Bolivia, Ecuador and Nicaragua (2011–2014) to test the effectiveness of interventions preventing teenage pregnancies. As the outcome evaluation showed limited impact, a post-hoc process evaluation was carried out to determine if and how CERCA’s design, implementation, monitoring and evaluation affected the results. We did a document analysis and conducted 18 in-depth interviews and 21 focus group discussions with stakeholders and beneficiaries. Transcripts were analyzed using directed content analysis.Data showed that CERCA sensitized stakeholders and encouraged the discussion on this sensitive issue. In terms of design, a strong point was the participatory approach; a weak point was that the detailed situation analysis was completed too late. In terms of implementation, a strong point was that multifaceted activities were implemented; a weak point was that the activities were not pilot tested for feasibility/acceptability and evolved substantially throughout the Project. In terms of monitoring, strong points were that regular monitoring kept the Project on track administratively/financially; a weak point was that monitoring indicators did not change as the intervention package changed. In terms of evaluation, weak points were the substantial attrition rate and narrow focus on adolescents.This study provides recommendations for future projects.

Barriers and Facilitators to Health Center Implementation of Evidence-Based Clinical Practices in Adolescent Reproductive Health Services

PurposeDespite the substantial evidence supporting the guidelines for the provision of reproductive health services for adolescents, research points to a persistent gap in their translation into health care practice. This study examines barriers and facilitators that health centers experience when implementing evidence-based clinical practices for adolescent reproductive health services and discusses strategies to address identified barriers. MethodsSemistructured interviews were conducted with 85 leaders and staff of 30 health centers in Alabama, Georgia, Massachusetts, North Carolina, South Carolina, Pennsylvania, and Texas. Interview data were analyzed for emergent themes following a grounded theory approach. ResultsData analysis revealed that certain factors at health system and community levels influenced health centers' efforts to implement evidence-based clinical practices for adolescent reproductive health care. In particular, support from health center leadership, communication between leadership and staff, and staff attitudes and beliefs were reported as factors that facilitated the implementation of new practices. ConclusionsHealth center efforts to implement new practice guidelines should include efforts to build the capacity of health center leadership to mobilize staff and resources to ensure that new practices are implemented consistently and with quality.

All Adolescents Deserve Routine Conversations About Sexual Activity and Pregnancy Prevention.

It is essential that physicians who take care of adolescents, whether in specialty practice or primary care, learn to routinely address adolescent sexuality and reproductive health care. According to our most recent Youth Risk Behavior Survey, 64.1% of 12th graders have had sexual intercourse ≥1 time, and 49.3% of 12th graders have had sexual intercourse with at least ≥1 person in the last 3 months. Unfortunately, only 53% of those 12th graders had used a condom during their last sexual encounter, and only 32.2% of those 12th graders had used a birth control pill, intrauterine device, implant, shot, patch, or ring during their last sexual encounter.1 Despite these high levels of sexual activity and unprotected sex, we have not yet reached the point where all providers of primary … Address correspondence to Erica J. Gibson, MD, University of Vermont, Department of Pediatrics, 1 South Prospect Street, 3rd Floor, Burlington, VT 05401. E-mail: erica.gibson{at}uvmhealth.org

Effect of social and behavior change communication by using infotainment in community perception of adolescent girls for reproductive and sexual health care in high priority districts of Assam

Problem consideredAdolescence, being the transitional phase, is marked by physical and psychological changes. Considering the challenges of adolescent girls (10–19 years) and long-term potential of investment, adolescent health was given special emphasis in NHP 2015. MethodsTo assess the effect of social and behavior change communication by using infotainment in community perception of Adolescent reproductive and sexual health care in high priority districts of Assam. Interventional Study-Before-after cross-sectional study, conducted in six HPD of Assam, along with Focus Group Discussions. Adolescent girls (AGs) were interviewed using predesigned pretested format. FGDs were conducted, 2 per district in each group. Social and behavior change communication (SBCC) intervention was given using facts for life video show followed by discussion and feedback. Statistical analysis used rates, ratio, proportion, and chi square. ResultsFrom 1350 households, 528 adolescent girls were interviewed. Knowledge about anemia was poor – only 56.1% agreed that anemia can be prevented. Majority (65.3%) did not know about any contraceptive methods. Safe sexual practices and HIV were known to 25.2% AGs. Majority (74.8%) did not know about STI/RTI – many (36.2%) would not inform anybody while some (25.6%) will consult doctor for such symptoms. SBCC intervention showed significant improvement in knowledge and perception of AGs (p<0.05). ConclusionsSBCC by using infotainment in community perception and practices for adolescent health, nutrition, awareness about HIV/AIDS, and other RTI/STI was found effective in improving awareness amongst adolescent girls in High Priority Districts of Assam.

Conscientious objection to abortion and reproductive healthcare: a review of recent literature and implications for adolescents.

Conscientious objection to reproductive healthcare (refusal to perform abortion, assisted reproductive technologies, prenatal diagnosis, contraception, including emergency contraception and sterilization, etc.) has become a widespread global phenomenon and constitutes a barrier to these services for many women. Adolescents are a particularly vulnerable group because some providers object to specific aspects of their reproductive healthcare because of their status as minors. Recent peer-reviewed publications concerning conscientious objection address provider attitudes to abortion and emergency contraception, ethical arguments against conscientious objection, calls for clarification of the current laws regarding conscientious objection, legal case commentaries, and descriptions of the country-specific impact of policies in Russia and Italy. Conscientious objection is understudied, complicated, and appears to constitute a barrier to care, especially for certain subgroups, although the degree to which conscientious objection has compromised sexual and reproductive healthcare for adolescents is unknown. Physicians are well positioned to support individual conscience while honoring their obligations to patients and to medical evidence.

Improving the Implementation of Evidence-Based Clinical Practices in Adolescent Reproductive Health Care Services

PurposeThe purposes of the study were to describe baseline data in the implementation of evidence-based clinical practices among health center partners as part of a community-wide teen pregnancy prevention initiative and to identify opportunities for health center improvement. MethodsHealth center partner baseline data were collected in the first year (2011) and before program implementation of a 5-year community-wide teen pregnancy prevention initiative. A needs assessment on health center capacity and implementation of evidence-based clinical practices was administered with 51 health centers partners in 10 communities in the United States with high rates of teen pregnancy. ResultsHealth centers reported inconsistent implementation of evidence-based clinical practices in providing reproductive health services to adolescents. Approximately 94.1% offered same-day appointments, 91.1% had infrastructure to reduce cost barriers, 90.2% offered after-school appointments, and 80.4% prescribed hormonal contraception without prerequisite examinations or testing. Approximately three quarters provided visual and audio privacy in examination rooms (76.5%) and counseling areas (74.5%). Fewer offered a wide range of contraceptive methods (67.8%) and took a sexual health history at every visit (54.9%). Only 45.1% reported Quick Start initiation of hormonal contraception, emergency contraception (43.1%), or intrauterine devices (12.5%) were “always” available to adolescents. ConclusionsThe assessment highlighted opportunities for health center improvement. Strategies to build capacity of health center partners to implement evidence-based clinical practices may lead to accessibility and quality of reproductive health services for adolescents in the funded communities.

Improving adolescent sexual and reproductive health in Latin America: reflections from an International Congress

In February 2014, an international congress on Promoting Adolescent Sexual and Reproductive Health (ASRH) took place in Cuenca, Ecuador. Its objective was to share evidence on effective ASRH intervention projects and programs in Latin America, and to link this evidence to ASRH policy and program development. Over 800 people participated in the three-day event and sixty-six presentations were presented.This paper summarizes the key points of the Congress and of the Community Embedded Reproductive Health Care for Adolescents (CERCA) project. It aims at guiding future ASRH research and policy in Latin America.1. Context matters. Individual behaviors are strongly influenced by the social context in which they occur, through determinants at the individual, relational, family, community and societal levels. Gender norms/attitudes and ease of communication are two key determinants.2. Innovative action. There is limited and patchy evidence of effective approaches to reach adolescents with the health interventions they need at scale. Yet, there exist several promising and innovative examples of providing comprehensive sexuality education through conventional approaches and using new media, improving access to health services, and reaching adolescents as well as families and community members using community-based interventions were presented at the Congress.3. Better measurement. Evaluation designs and indicators chosen to measure the effect and impact of interventions are not always sensitive to subtle and incremental changes. This can create a gap between measured effectiveness and the impact perceived by the targeted populations.Thus, one conclusion is that we need more evidence to better determine the factors impeding progress in ASRH in Latin American, to innovate and respond flexibly to changing social dynamics and cultural practices, and to better measure the impact of existing intervention strategies. Yet, this Congress offered a starting point from which to build a multi-agency and multi-country effort to generate specific evidence on ASRH with the aim of guiding policy and program decision-making. In a region that contains substantial barriers of access to ASRH education and services, and some of the highest adolescent pregnancy rates in the world, the participants agreed that there is no time to lose.