The United States continues to have the highest adolescent birth rate of any industrialized country. Recently published guidelines by the American Academy of Pediatrics create a new consensus among professional organizations around the suitability of long-acting reversible contraceptives as first-line contraception for adolescents. Through a narrative review of U.S. studies published after 2000, this study seeks to summarize existing access barriers to long-acting reversible contraceptives for adolescents and highlight areas that warrant further intervention so that the recommendations of these professional organizations can be effectively integrated into clinical practice. Existing barriers include costs for institutions providing contraceptive care and for recipients; consent and confidentiality for adolescent patients; providers' attitudes, misconceptions and limited training; and patients' lack of awareness or misconceptions. Systemic policy interventions are required to address cost and confidentiality, such as the Affordable Care Act's mandate that contraceptive coverage be a part of essential health benefits for all insurance providers. Individual-level access barriers such as providers' misconceptions and gaps in technical training as well as patients' lack of awareness can be addressed directly by professional medical organizations, health care training programs, and other interventions.

INTRODUCTION: Significant disparities in access to gynecologic services persist for uninsured women, who are far less likely to obtain preventive screenings against breast or cervical cancer than insured women. Safety net institutions reduce health disparities, but gaps in service provision for gynecologic services remain. Student-run clinics, or clinics coordinated and staffed by medical students that are supervised by licensed physicians, provide preventive services at rates similar to other safety net institutions. METHODS: A retrospective chart review examined the prevalence of gynecologic issues addressed by a student-run women's clinic at a free clinic in Providence, Rhode Island and quantified the service provision provided to this population of uninsured, predominantly Latina women. RESULTS: Between May 2015 and 2017, the women's clinic saw 138 patients over 171 encounters during 48 clinics. Most visits included Pap smears or mammograms (85.2%). Other prevalent issues were abnormal uterine bleeding (23.9%), contraception (13.0%), abnormal vaginal discharge (12.3%), and infertility (11.6%). The clinic provided 83 Pap smears, 35 STI tests, 19 vaginitis screens and referrals for mammograms (n=42), colposcopy (n=7), and sub-specialists (n=14). Culturally sensitive interventions were designed to address linguistic and social barriers to care for patients seeking subspecialty care. CONCLUSION: Student-run clinics can effectively deliver gynecologic services to safety net populations. With their unique access to faculty preceptors and funding, medical students can play a significant role in expanding the specialty services available to uninsured patients. Safety net institutions should consider empowering medical students to create student-run specialized clinics under appropriate supervision to address the needs of their patient populations.

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