5- Family Planning Services in Adolescent Pregnancy Prevention

5- Family Planning Services in Adolescent Pregnancy Prevention

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Unformatted text preview: Family Planning Services in Family Planning Services in Adolescent Pregnancy Prevention The Views of Key Informants in Four Countries B. Gromer and M. McCarthy Methods Methods Study population: 75 key informants with interest and/or expertise in adolescent pregnancy clinicians, politicians, public health admin., social Group of interviews, Great Britain 18, and behavioral scientists, antiabortion activists Face­to­face, semi­structured interviews Netherlands 19, Sweden(20) and United States 18 Introduction Introduction U.S. has very high rates of teen pregnancy compared to other industrialized nations (decreased slightly since 1992, still highest in the industrialized world) Rates in Netherlands and Sweden very low Britain’s rates are between the two extremes Family Planning Sources Family Planning Sources For Teens Sweden Care is generally free Network of youth clinics staffed by nurse­midwives Netherlands: provides family planning services Alternatively teenagers may access maternity clinics Most contraception is available for small fee general practitioners provide most contraception (all ages) public clinics provides family planning services Family Planning Sources Family Planning Sources For Teens Great Britain: general practitioners through network of family United States: planning clinics Brook Advisory Centers provide birth control to young people Contraception paid through National Health Services Public insurance pays for family planning services family planning clinics for teenagers concentrated in federally funded family planning clinics Family planning services is available from doctors (OBGYN, family practice, pediatricians) Results: Access Results: Access Sweden: few services in rural and suburban areas should be low cost but NOT free 2 clear pathways for teen access Netherlands: School and family planning services should be low cost but NOT free 2 clear pathways for teen access School and family planning services Results: Access Results: Access Great Britain: services should be low cost lack of transportation barrier to access A barrier to refer adolescents to FPC are School nurses wide variety of access points Informants unsure of best point of access for teens Results: Access Results: Access United States: services should be low cost few services in rural and suburban areas lack of transportation barrier to access wide variety of access points informants unsure of best point of access for teens Results: Schools and Family Results: Schools and Family Planning Services Liaisons between schools and services more functional in Sweden and Netherlands than Britain and U.S. clinics located near schools school field trips Sweden: outreach efforts (condom can be obtained at school) Results: Schools and Family Results: Schools and Family Planning Services Great Britain: school nurses give referrals confusion about legality of providing services United States: parents and referrals (school nurses are a barrier to referral) Barriers to access political sensitivity of school boards Results: Staff Results: Staff Netherlands and Sweden have higher levels of training in family planning services Staff counseling and communication skills are important in four countries Sweden: Midwives expressed sense of pride, It is a profession you can be proud of Strong commitment by primary care providers Confident in local practitioners’ ability to communicate with teens. They are much better and more equipped to talk about sexual items Results: Staff Results: Staff Great Britain: provider training inadequate no physician certification required commitment by general practitioners variable “My personal feeling is that no doctor in this country is actually trained to communicate with teenage people” Results: Confidentiality Results: Confidentiality Concerns about confidentiality in all countries except Sweden United States: medical bills goes home to parents providers hesitate to provide family planning to teens for provider fear of parental reaction moral objection by some Results: Results: Comprehensive care Swedish believe on importance of prevention and they believe Prevention health care is crucial and cost­effective US perform poorly in the area of preventive health All four country felt multidisciplinary team needed to provide comprehensive health care Best family planning services offer more than contraceptive services but all other problems such as sex and drugs Results: Results: Procedures for Contraception All but U.S. utilize emergency contraception & reminders at doctor visits More contraception methods available in U.S. than other countries Pill is method of choice in other countries European communities felt pelvic exam unnecessary, unlike U.S. Results: Results: Personal and Family Attitudes Netherlands and Sweden: felt teens had high knowledge of family United States: Britain: planning services and contraception perceived low level of knowledge by teens low level of knowledge about confidentiality Results: Results: Personal and Family Attitudes 3 beliefs associated with adolescent comfort in accessing services: teen must believe staff is trustworthy teen must think accessing family planning services and contraception is personal responsibility teen must have the courage to access family planning services Results: Results: Personal and Family Attitudes Family attitudes: In Netherlands and Sweden parents are comfortable with teens getting contraception In U.S. many parents complain, though most eventually accept Results: Financing Results: Financing Netherlands and Sweden: government supports financing services government supports related research United States: government focus not on prevention little money for family planning RECOMMENDATIONS RECOMMENDATIONS Ideal family planning should provide the following quality services Continuity of care Multidisciplinary staff, friendly and nonjudgmental Counseling should be included in visits Outreach efforts by staff to inform teenagers about services Location of services close to teenagers home or schools Flexible hour Low cost for services Discussion Discussion ...
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