Barriers and Solutions to Improve Adolescent Intrauterine Device Access


      Professional organizations agree that adolescents are good candidates for intrauterine device (IUD) use. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists affirm that IUDs should be considered first-line as contraceptive methods for adolescents. Although the number of teens using IUDs is growing, multiple barriers remain, including systems, and patient- and provider-level obstacles. Only through concerted efforts and a committed action plan will adolescents achieve better access to IUDs.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric and Adolescent Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Daniels K.
        • Abma J.C.
        Current contraceptive status among women aged 15-49: United States, 2015-2017 (NCHS Data Brief No 327).
        National Center for Health Statistics, Hyattsville, MD2018
        • Abma J.C.
        • Martinez J.M.
        Sexual activity and contraceptive use among teenagers in the United States, 2011-2015 (National health statistics reports no. 104).
        National Center for Health Statistics, Hyattsville, MD2017
        • Secura G.M.
        • Madden T.
        • McNicholas C.
        • et al.
        Provision of no-cost, long-acting contraception and teenage pregnancy.
        N Engl J Med. 2014; 371: 1316
        • Jones R.K.
        • Sonfield A.
        Health insurance coverage among women of reproductive age before and after implementation of the Affordable Care Act.
        Contraception. 2016; 93: 386
        • Law A.
        • Wen L.
        • Lin J.
        • et al.
        Are women benefiting from the Affordable Care Act? A real-world evaluation of the impact of the Affordable Care Act on out-of-pocket costs for contraceptives.
        Contraception. 2016; 93: 392
        • U.S. Department of Health and Human Services, Health Resources & Services Administration
        Women’s preventive services guidelines.
        Date accessed: December 18, 2018
        • Bearak J.M.
        • Finer L.B.
        • Jerman J.
        • et al.
        Changes in out-of-pocket costs for hormonal IUDs after implementation of the Affordable Care Act: an analysis of insurance benefit inquiries.
        Contraception. 2016; 93: 139
        • Society for Adolescent Health and Medicine; American Academy of Pediatrics
        Confidentiality protections for adolescents and young adults in the health care billing and insurance claims process.
        J Adolesc Health. 2016; 58: 374
        • Jones R.K.
        • Purcell A.
        • Singh S.
        • et al.
        Adolescents’ reports of parental knowledge of adolescents’ use of sexual health services and their reactions to mandates parental notification for prescription contraception.
        JAMA. 2005; 293: 340
        • American College of Obstetricians and Gynecologists
        Adolescent confidentiality and electronic health records (Committee opinion no. 599).
        Obstet Gynecol. 2014; 123: 1148
        • Peykoff Hardin A.
        • Hackell J.M.
        Age limit of pediatrics (American Academy of Pediatrics policy statement).
        Pediatrics. 2017; 140: e20172151
        • Hill E.L.
        • Slusky D.
        • Ginther D.
        Medically Necessary But Forbidden: Reproductive Healthcare in Catholic-Owned Hospitals (Working Paper 23768).
        National Bureau of Economic Research, Cambridge, MA2017
        • Luchowski A.T.
        • Anderson B.L.
        • Power M.L.
        • et al.
        Obstetrician-gynecologists and contraception: practice and opinions about the use of IUDs in nulliparous women, adolescents and other patient populations.
        Contraception. 2014; 89: 572
      1. Brown J. Managing the Media Monster: the Influence of Media (From Television to Text Message) on Teen Sexual Behavior and attitudes. National Campaign to Prevent Teen and Unplanned Pregnancy, Washington, DC2008
        • Anderson N.
        • Steinauer J.
        • Valente T.
        • et al.
        Women’s social communication about IUDs: a qualitative analysis.
        Perspect Sex Reprod Health. 2014; 46: 141
        • Santelli J.
        • Kantor L.
        • Grilo S.
        • et al.
        Abstinence-only-until-marriage: an updated review of U.S. policies and programs and their impact.
        J Adolesc Health. 2017; 61: 273
        • Raidoo S.
        • Kaneshiro B.
        Contraception counseling for adolescents.
        Curr Opin Obstet Gynecol. 2017; 29: 310
        • Centers for Disease Control and Prevention
        School health policies and programs study- pregnancy prevention.
        Date accessed: March 10, 2019
      2. Power to decide.
        • Pritt N.M.
        • Norris A.H.
        • Berlan E.D.
        Barriers and facilitators to adolescents’ use of long-acting reversible contraceptives.
        J Pediatr Adolesc Gynecol. 2017; 30: 18
        • Teal S.
        • Romer S.
        • Goldthwaite L.
        • et al.
        Insertion characteristics of intrauterine devices in adolescents and young women: success, ancillary measures, and complications.
        Am J Obstet Gynecol. 2015; 213: 515
        • Schmidt E.
        • James A.
        • Curran M.
        • et al.
        Adolescent experiences with intrauterine devices: a qualitative study.
        J Adolesc Health. 2015; 57: 381
        • Payne J.
        • Sundstrom B.
        • DeMaria A.
        A qualitative study of young women’s beliefs about intrauterine devices: fear of infertility.
        J Midwifery Womens Health. 2016; 61: 482
        • O’ Rourke-Suchoff D.
        • Arora K.
        • Hildebrand V.
        • et al.
        Exploring maternal attitudes towards adolescent contraception: implications for use of LARC.
        Int J Adolesc Med Health. 2017; 30
        • Ali M.
        • Amialchuk A.
        • Dwyer D.
        Social network effects in contraceptive behavior among adolescents.
        J Dev Behav Pediatr. 2011; 32: 563
        • Garbers S.
        • Chiasson M.
        • Baum R.
        • et al.
        “Get it and forget it”: online evaluation of a theory-based IUD educational video in English and Spanish.
        Contraception. 2015; 91: 76
        • Kinsler J.
        • Glik D.
        • Buffington S.
        • et al.
        A content analysis of how sexual behavior and reproductive health are being portrayed on primetime television shows being watched by teens and young adults.
        Health Commun. 2019; 34: 644
        • Gilliam M.
        • Martins S.
        • Bartlett E.
        • et al.
        Development and testing of an iOS waiting room “app” for contraceptive counseling in a Title X family planning clinic.
        Am J Obstet Gynecol. 2014; 211: 481
        • Marshall C.
        • Gomez A.
        Young men’s awareness and knowledge of intrauterine devices in the United States.
        Contraception. 2015; 92: 494
        • Hall S.
        • Ela E.
        • Zochowski M.
        • et al.
        “I don’t know enough to feel comfortable using them:” women’s knowledge of and perceived barriers to long acting reversible contraceptives on a college campus.
        Contraception. 2016; 93: 556
        • Potter J.
        • Rubin S.
        • Sherman P.
        Fear of intrauterine contraception among adolescents in New York City.
        Contraception. 2014; 89: 446
        • Curtis K.
        • Tepper N.
        • Jatlaoui T.
        • et al.
        U.S. medical eligibility criteria for contraceptive use, 2016.
        MMWR Recomm Rep. 2016; 65: 1
        • Curtis K.M.
        • Jatlaoui T.C.
        • Tepper N.K.
        • et al.
        U.S. selected practice recommentations for contraceptive use, 2016.
        MMWR Recomm Rep. 2016; 65: 1
        • Allen S.
        • Barlow E.
        Long-acting reversible contraception: an essential guide for pediatric primary care providers.
        Pediatr Clin North Am. 2016; 64: 359
        • Hubacher D.
        • Lara-Ricalde R.
        • Taylor D.J.
        • et al.
        Use of copper intra-uterine devices and the risk of tubal infertility among nulligravid women.
        N Engl J Med. 2001; 345: 561
        • Teal S.
        • Romer S.E.
        Awareness of long-acting reversible contraception among teens and young adults.
        J Adolesc Health. 2013; 52: S35
        • Abraham M.
        • Zhao Q.
        • Peipert J.
        Young age, nulliparity, and continuation of long-acting reversible contraceptive methods.
        Obstet Gynecol. 2015; 126: 823
        • ACOG Committee Opinion no
        735: adolescents and long-acting reversible contraception: implants and intrauterine devices.
        Obstet Gynecol. 2018; 131: e130
      3. American Academy of Pediatrics policy statement: contraception for adolescents.
        Pediatrics. 2014; 134: 1244
        • Wilson S.
        • Strohsnitter W.
        • Baecher-Lind L.
        Practices and perceptions among pediatricians regarding adolescent contraception with emphasis on intrauterine contraception.
        J Pediatr Adolesc Gynecol. 2013; 26: 281
        • Swanson K.
        • Gossett D.
        • Fournier M.
        Pediatricians beliefs and prescribing patterns of adolescent contraception: a provider survey.
        J Pediatr Adolesc Gynecol. 2013; 26: 340
        • Kohn J.
        • Hacker J.
        • Rousselle M.
        • et al.
        Knowledge and likelihood to recommend intrauterine devices for adolescents among school-based health center providers.
        J Adolesc Health. 2012; 51: 319
        • Kharbanda E.
        • Stuck L.
        • Molitor B.
        • et al.
        Missed opportunities for pregnancy prevention among insured adolescents.
        JAMA Pediatr. 2014; 168: 1
        • Fridy R.
        • Maslyanskaya S.
        • Lim S.
        • et al.
        Pediatricians knowledge and practices related to long-acting reversible contraceptives for adolescent girls.
        J Pediatr Adolesc Gynecol. 2018; 31: 394
        • Hoover K.
        • Tao G.
        • Berman S.
        • et al.
        Utilization of health services in physician offices and outpatient clinics by adolescents and young women in the United States: implications for improving access to reproductive health services.
        J Adolesc Health. 2010; 46: 324
        • Fleming K.
        • Sokoloff A.
        • Raine T.
        Attitudes and beliefs about the intrauterine device among teenagers and young women.
        Contraception. 2010; 82: 178
        • Berlan E.
        • Pritt N.
        • Norris A.
        Pediatricians attitudes and beliefs about long-acting reversible contraceptives influence counseling.
        J Pediatr Adolesc Gynecol. 2017; 30: 47
        • Rubin S.
        • Davis K.
        • Mckee M.
        New York City physicians views of providing long-acting reversible contraception to adolescents.
        Ann Fam Med. 2013; 11: 130
        • Rubin S.
        • Campos G.
        • Markens S.
        Primary care physicians’ concerns may affect adolescents’ access to intrauterine contraception.
        J Prim Care Community Health. 2012; 4: 216
        • Stanwood N.
        • Garrett J.M.
        • Konrad T.R.
        Obstetrician-gynecologists and the intrauterine device: a survey of attitudes and practice.
        Obstet Gynecol. 2002; 99: 275
        • Luchowski A.
        • Anderson B.
        • Power M.
        • et al.
        Obstetrician-gynecologists and contraception: long-acting reversible contraception practices and education.
        Contraception. 2014; 89: 578
        • Davis S.
        • Braykov N.
        • Lathrop E.
        • et al.
        Familiarity with long-acting reversible contraceptives among obstetrics and gynecology, family medicine, and pediatrics residents: results of a 2015 national survey and implications for contraceptive provision for adolescents.
        J Pediatr Adolesc Gynecol. 2018; 31: 40
      4. Power to decide: one key question.
        Date accessed: March 10, 2019
        • Torres A.
        • Horodenska M.
        • Witkowski G.
        • et al.
        High-fidelity hybrid simulation: a novel approach to teaching pediatric and adolescent gynecology.
        J Pediatr Adolesc Gynecol. 2019; 32: 110
        • Dumont T.
        • Hakim J.
        • Black A.
        • et al.
        Enhancing postgraduate training in pediatric and adolescent gynecology: evaluation of an advanced pelvic simulation session.
        J Pediatr Adolesc Gynecol. 2014; 27: 360
        • Dodge L.E.
        • Hacker M.R.
        • Averbach S.H.
        • et al.
        Assessment of a high-fidelity mobile simulator for intrauterine contraception training in ambulatory reproductive health centres.
        J Eur CME. 2016; 5: 30416
        • Bergin A.
        • Tristan S.
        • Terplan M.
        • et al.
        A missed opportunity for care: two-visit IUD insertion protocols inhibit placement.
        Contraception. 2012; 86: 694
        • American College of Obstetricians and Gynecologists
        Access to contraception (Committee opinion no. 615).
        Obstet Gynecol. 2015; 125: 250
        • Sufrin C.B.
        • Postlethwaite D.
        • Armstrong M.A.
        • et al.
        Neisseria gonorrhea and chlamydia trachomatis screening at intrauterine device insertion and pelvic inflammatory disease.
        Obstet Gynecol. 2012; 120: 1314
        • American College of Obstetricians and Gynecologists
        Long-acting reversible contraception: implants and intrauterine devices (Practice bulletin no. 186).
        Obstet Gynecol. 2017; 130: 1173
        • Workowski K.A.
        • Bolan G.A.
        Sexually transmitted diseases treatment guidelines, 2015. Centers for Disease Control and Prevention.
        MMWR Recomm Rep. 2015; 64: 1
        • Kavanaugh M.L.
        • Jerman J.
        • Ethier K.
        • et al.
        Meeting the contraceptive needs of teens and young adults: youth-friendly and long-acting reversible contraceptive services in U.S. family planning facilities.
        J Adolesc Health. 2013; 52: 284
        • Beeson T.
        • Wood S.
        • Bruen B.
        • et al.
        Accessibility of long-acting reversible contraceptives (LARCs) in federally qualified health centers (FQHCs).
        Contraception. 2014; 89: 91
        • Jamieson D.J.
        • Haddad L.B.
        What obstetrician-gynecologists should know about population health.
        Obstet Gynecol. 2018; 131: 1145
        • Colorado Department of Public Health and Environment
        Taking the unintended out of pregnancy: Colorado’s success with long-acting reversible contraception.