Same-Day Access to Full Range of Contraceptive Methods

Clinical Service Goal

Low or no-cost contraception, provided with same-day access in accordance with medical eligibility and practice recommendations, reduces barriers often faced by adolescents. This includes improving access to intrauterine devices and implants, also known as long-acting reversible contraception (LARC). It is critical to use a patient-centered approach to support reproductive autonomy and health equity.

Key Foundations
Strategies related to assessment, policy, and environment
Equipping Teams
Strategies that build clinic staff capacity
Service Delivery
Strategies to strengthen processes, procedures, and systems involved in delivering clinical services
Engaging Adolescent Patients and Families
Strategies to educate and build productive partnerships with adolescents and their families+ (These strategies recognize the important role that parents can play in relation to ASRH, even while protecting confidentiality remains a cornerstone of adolescent care).

Strategies

Key Foundations

Implementation Tips

Design policies to be consistent with CDC Contraceptive Guidance for Health Care Providers and to reinforce practices that minimize barriers to the full range of contraceptive methods for the adolescent patient, including

  • Most contraceptive methods can be started on the same day if desired by the adolescent patient and if reasonably certain that the patient is not pregnant
  • Follow recommendations for exams and tests needed for contraceptive method initiation. (Few, if any exams are needed before providing contraception.*)
  • Stock and offer a broad range of methods so that the needs of individual adolescent patients can be met. (Optimally, all methods are available onsite to be able to provide same-day access but strong referrals can serve to make methods accessible when having all methods available onsite is not possible.)
  • Recognize that LARC methods (intrauterine devices [IUDs] and implants) are safe contraceptive options for adolescents
  • Provide or prescribe emergency contraception to adolescent patients for future use
  • Provide or prescribe a 1-year supply of oral contraceptives
  • Provide condoms onsite, available for free or at low-cost
  • Offer contraception at every visit regardless of reason for visit (e.g., urgent, preventive, sports physical) to prevent missed opportunities

Tools & Resources

LARC-specific Resources
Equipping Teams

Implementation Tips

  • Look to community-based organizations, academic institutions, and professional organizations for training opportunities
  • Consider factors such as travel logistics and care team member schedules when determining if trainings should be on-site, off-site, online, or virtual
  • Select trainings that include content on CDC Contraceptive Guidance for Health Care Providers (U.S. Medical Eligibility Criteria for Contraceptive Use, U.S. Selected Practice Recommendations for Contraceptive Use, Quality Family Planning)

Tools & Resources

Equipping Teams

Implementation Tips

  • Look to community-based organizations, academic institutions, and professional organizations for training opportunities
  • Ensure supplies are in stock by time of LARC insertion/removal training
  • Build an ongoing precepting/mentoring component (e.g., see one, do one)

Tools & Resources

Service Delivery

Implementation tips

  • Use process mapping techniques or co-design to document current clinic workflow and identify opportunities to free up clinician availability to provide same-day access to the full range of contraceptive methods
  • Use staffing strategies such as utilizing health educators, nurses, or medical assistants to provide contraceptive counseling to free up clinician availability for same-day appointments
  • Maintain sufficient stock of the full range of contraceptive methods to be prepared for same-day appointments
  • To decrease charting burden, develop electronic health record templates to document procedures, orders, patient education, and coding
  • Create a mobile cart with needed LARC supplies and devices

Tools & Resources

Service Delivery

Implementation tips

  • Develop and share written reimbursement protocols specific to LARC acquisition and stocking costs and insertion, removal, and reinsertion costs. These should provide guidance on existing LARC reimbursement policies and actively implement payment strategies to address implementation challenges.

Tools & Resources

* Most women do not require additional STD screening at the time of IUD insertion. If a woman with risk factors for STDs has not been screened for gonorrhea and chlamydia according to CDC’s STI Treatment Guidelines (available at https://www.cdc.gov/std/treatment), screening can be performed at the time of IUD insertion, and insertion should not be delayed. Women with current purulent cervicitis or chlamydial infection or gonococcal infection should not undergo IUD insertion.3

3.Curtis KM, Tepper NK, Jatlaoui TC, Berry-Bibee E, Horton LG, Zapata LB, Simmons KB, Pagano HP, Jamieson DJ, Whiteman MK. U.S. Medical Eligibility Criteria for Contraceptive Use, 2016. MMWR Recommendations and Reports. 2016;65(3):1-103. doi:10.15585/mmwr.rr6503a1

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