Contraceptive Access Through School-Based Health Centers: Perceptions of Rural and Suburban Young People

Abstract

Purpose School-based health centers (SBHCs) have traditionally been concentrated in urban centers but have increasingly moved to rural and suburban settings. Adolescents living outside urban centers continue to experience barriers accessing contraceptives and reproductive health care. SBHCs are well positioned to reduce these barriers since they often offer convenient, in-school reproductive health care services. We describe the experiences of adolescents and emerging adults as they navigate access to contraceptives at SBHCs and nonschool locations in nonurban, low-income communities. Method We interviewed 30 sexually active individuals aged 15 to 21 living in rural and suburban communities in Colorado where high school SBHCs were recently introduced. Participants reflected on their experiences with or without in-school access to sexual and reproductive health services. Results Overall, young people supported within-school access to contraceptives, citing convenience, low cost, and greater confidentiality and privacy compared with out-of-school providers, particularly in rural areas. At the same time, findings point to the need for SBHCs to overcome adolescents’ and emerging adults’ misunderstanding of age requirements to access confidential contraceptive services and their remaining concerns around confidentiality in the school setting. Conclusions Our results indicate that SBHCs in low-income rural and suburban areas provide essential contraceptive services that young people access and value. Policy makers in nonurban communities should look to the SBHC model to reduce barriers for young people accessing reproductive health care, and health care providers should work to ensure confidentiality and to correct misinformation about their right to access contraceptive services.

Teaching About Contraception: Adolescent Attitudes Surrounding Sexual Education

“…Acknowledging the confidentiality of the discussion between a physician and an adolescent can increase trust and facilitate the discussion as this is often a top concern. 4 , 41 , 52 , 53 Many adolescents note that they avoid reproductive health services to prevent their parents from finding out. 54 If there is a confidential reproductive health clinic available, adolescents are often limited via transportation or appointment times that conflict with school.…”

“…Many adolescents report that they are not offered time alone with their physician, despite the desire to ask questions one-on-one. 4 , 37 , 53 They will not ask to speak to their physician alone as they worry their parent will infer it means they are doing something wrong. Girls particularly note that their parents will assume they are asking questions about sex.…”