Availability of Long Acting Reversible Contraceptives for Adolescents in Urban vs Rural West Virginia Counties

Abstract

The study objective was to evaluate long acting reversible contraceptive (LARC) method availability and access for adolescents in rural and urban counties in West Virginia (WV). A cross-sectional survey of Title X family planning providers throughout WV was conducted from January 2016 to July 2017. This survey was sent to 226 family planning providers in WV to assess patterns of LARC availability. The survey assessed provider training level, LARC services provided and frequency, clinical practice, referral patterns, and comfort level providing adolescent LARC services. Survey results were analyzed by providers’ rural vs urban status, based on US census county codes. Survey responses yielded 127 total responders, 65 (51.2%) were urban, and the remaining 62 (48.8%), were rural. Urban providers had a larger representation of medical doctors, while rural providers were primarily nurse practitioners (p<0.001). Intrauterine devices (IUD) had lower availability with rural providers (p<0.006). Years of experience doing IUD placement (p<0.010), frequency of placing implants (p<0.010), and frequency placing implants in teenagers (p<0.012) were significantly less in rural providers. This survey showed significant differences in practice between urban and rural settings including training, experience, contraceptive options, barriers to care, and practice guidelines.