Contraceptive provision in Oregon school-based health centers: Method type trends and the role of Title X

Abstract

Objective: We describe provision of contraception to adolescents at Oregon school-based health centers (SBHCs). We examine trends over time, by race/ethnicity, and by Title X clinic status and test whether these factors are associated with provision of long-acting reversible contraception (LARC; intrauterine devices/IUDs and implants). Study design: We conducted a retrospective cohort study of 33 SBHCs participating in a shared electronic health record 2012-2016. We identified 20,339 contraception provision visits to 5,934 adolescent females ages 14-19 using diagnosis and procedure codes. We used logistic regression to evaluate the association of clinic Title X status, race/ethnicity, and year with receipt of LARC, controlling for individual-, clinic-, and residence-level factors. We calculated adjusted probabilities. Results: Provision of IUDs and implants increased at Oregon SBHCs between 2012 and 2016. IUD provision increased almost 5-fold, (from 0.9% to 4.4% of contraception provision visits), and implants increased approximately 6.5-fold (from 1.1% to 7.2%). More adolescent contraception provision visits occurred at Title X SBHCs, which had greater than twice the adjusted probability of providing LARCs than non-Title X SBHCs (4.4% versus 1.7%). After adjusting for adolescent-, clinic-, and residence-level covariates, nonwhite adolescents had lower probabilities of receiving LARC methods than white adolescents. Conclusions: SBHCs play an important role in providing access to contraceptive services to adolescents in Oregon. Access to IUDs and implants is increasing over time in SBHCs, particularly those that participate in the Title X program. Implications: Adolescents have expanding access to IUDs and implants in SBHCs over time in Oregon. Participation in the Title X program can help further increase access to effective contraception in SBHCs.

A comparison of contraceptive services for adolescents at school‐based versus community health centers in Oregon

“…We conducted a retrospective cohort study using electronic health record (EHR) data from in‐person contraceptive counseling and provision visits by adolescents ages 14–19 at Oregon SBHCs and CHCs between 2012 and 2016. Our study data have been described previously 14 . We excluded data from clinics that did not provide data for the full study period, and visits for pregnant adolescents (1357 visits; Table S1 for exclusion codes).…”

“…Our study data have been described previously. 14 We excluded data from clinics that did not provide data for the full study period, and visits for pregnant adolescents (1357 visits; Table S1 for exclusion codes). We also excluded visits for contraceptive discontinuation (1017 visits), which represented fewer than 2% of adolescent contraceptive visits.…”

“… 13 Both clinic types serve diverse populations and provide care regardless of insurance status. 12 , 13 SBHCs provide access to effective contraception 14 and can lower pregnancy rates, 15 although nationwide more than half of SBHCs cannot dispense contraception on‐site. 16 CHCs have also been shown to provide quality contraceptive services to adolescents.…”