Introduction: Federally qualified health centers (FQHCs) and health departments (HDs) are essential in providing contraceptive care and ensuring reproductive autonomy for adolescents. Through offering adolescent-specific services and by training providers in adolescent-specific care and patient-centered contraceptive counseling, clinics can ensure access to high quality contraceptive care for adolescents. Despite the significant decrease in adolescent pregnancy rates, rates remain high in the South and in rural counties, suggesting that clinics in these areas may not have the capacity to provide adolescent-specific services and patient-centered counseling. This study compares the capacity to provide adolescent-specific and patient-centered contraceptive services in rural and urban FQHCs and HDs in two southeastern states -- South Carolina (SC) and Alabama (AL). Methods: Data were collected from a statewide survey of FQHC and HD clinics in SC and AL in 2020. A total of 239 clinics were included (FQHC N=112 and HD N=127) and were identified as rural (N=101) or urban (N=138) using Rural-Urban Continuum Codes. Capacity to provide patient-centered adolescent care is defined as 1) a clinic offering adolescent-specific services; 2) providers at the clinic receiving training in patient-centered counseling; and 3) providers receiving training in adolescent-specific care. To measure capacity, these three survey items were dichotomized into Yes/No responses and then combined into a new variable to measure clinics who responded Yes to each survey item. The type of adolescent-specific services was also measured as being onsite, offsite, outreach, or none. Capacity to provide patient-centered adolescent care was compared across clinics located in rural and urban settings and by clinic type. Statistical differences were determined using the Chi-Square test of independence (α= 0.05). Results: Overall, 44.8% of participating clinics in SC and AL had the capacity to provide patient-centered adolescent contraceptive services. Approximately 51.8% of rural and 66.1% of urban HDs reported the capacity to provide adolescent-specific services. In contrast, 26.7% of rural and 35.4% of urban FQHCs reported the capacity to provide adolescent-specific services. Approximately 55.4% of rural and 71.4% of urban HDs provided any adolescent-specific services, but fewer rural HDs (30.2%) provided onsite services than urban HDs (59.3%) (p=0.003). Fewer than half of rural (42.2%) and urban (48.8%) FQHCs provided adolescent-specific services, with approximately 23.8% of rural and 27.9% of urban sites providing onsite services. Conclusions: The capacity of clinics in SC and AL to provide contraceptive counseling to adolescents, which is anchored in reproductive autonomy, is contingent upon the provision of adolescent-specific services and provider training. Most clinics, especially rural clinics, did not have the capacity to provide patient-centered contraceptive counseling to adolescents. This gap in services may contribute to the higher adolescent pregnancy rates in rural areas of SC and AL. Clinics in SC and AL, especially FQHCs, should develop policies that support adolescent-specific contraceptive services and provider training.

Introduction: Over 420,000 women aged 13-44 in Tennessee depend on publicly funded contraceptive services, yet only 42.9% receive them. Lack of access to contraception leads to unintended pregnancies, which are associated with higher rates of maternal and neonatal morbidity and mortality. This study explores perceived barriers to contraception and patient awareness of preexisting resources to mitigate such barriers in a rural region. Methods: Women with a confirmed pregnancy establishing obstetric care at East Tennessee State University’s resident clinic were offered a 20-question survey assessing demographic variables and perspectives to contraceptive care. Results: 141 survey respondents met inclusion criteria. 95.7% denied using contraception prior to conception. Of these, 24.8% reported their pregnancy was unintended. Only 59.6% reported knowing where they could access free long-acting, reversible contraception (LARC) in the community. 50.4% agreed it would be helpful to have a free community clinic providing reproductive health care. Specifically, 73.7% of participants reported they would benefit from free LARCs; 61.0% expressed need for evening hours and 67.4% for weekend hours. Conclusions: One in four women experienced an unintended pregnancy. The known risks of unintended pregnancies to the mother and fetus will likely increase secondary to recent changes in abortion policies. Two in five women reported no awareness of resources for free LARCs in our community, suggesting that knowledge about and access to contraception is lacking at a time which women need autonomy over reproductive choices the most. Initiatives which aim to educate women regarding contraceptive care and to eliminate barriers which hinder access are warranted.

Introduction: Improving the quality of contraceptive care that youth receive improves the patient-provider relationship, satisfaction with care, and contraceptive method use and continuation. In recent years, high-quality contraceptive care for youth has shifted away from tiered effectiveness counseling and toward youth-friendly, person-centered contraceptive counseling (YFPCCC). Rooted in the reproductive justice movement, YFPCCC requires that counseling encourages youth to say what matters to them in their contraceptive method, respects youth’s preferences in their contraceptive method, provides youth with the information necessary to make the best choice for them, and is respectful of youth’s choices. YFPCCC is especially important for minor youth and youth of color who have historically received biased care and for youth in the United States South where restrictive policies may prevent youth from receiving care. This study examined youths’ perspectives of YFPCCC at safety-net clinics in two states in the U.S. South. Methods: Between 2018 and 2022, a survey measuring patient perspectives of their contraceptive counseling was collected from youth (ages 16 to 24) who received care at federally qualified health centers (FQHCs) and health departments (HDs) in Alabama (AL) and South Carolina (SC). A total of 1,052 youth were included in the study (AL n=513 and SC n=539). Four survey items measuring the four components of person-centered counseling and two survey items measuring youth-friendliness (knowledgeable and trustworthy providers) were dichotomized into Yes/No responses and combined to create two new variables measuring PCCC and providers’ youth-friendliness. PCCC and youth friendliness were compared across clinic type, state, age, race/ethnicity, and insurance coverage using logistic regression. P-values less than 0.05 were considered significant. Results: Overall, 56% of youth in the study reported that they received all four components of PCCC and 71% reported that their providers were youth-friendly. Minor youth (ages 16 and 17) were 34% less likely than older youth (ages 20-24) to report receipt of PCCC (aOR 0.66, 95% confidence interval (CI) [0.45, 0.98]). Minor youth were also 39% less likely than older youth to report that their provider was youth-friendly (aOR 0.61, 95% CI [0.40, 0.93]). Non-Hispanic Black youth were 45% less likely than non-Hispanic White youth to report PCCC (aOR 0.55 95% CI [0.40, 0.70]). Similarly, non-Hispanic Black youth were 44% less likely than non-Hispanic White youth to report that their provider was youth-friendly (aOR 0.56 CI [0.41, 0.77]). Discussion: Providing contraceptive care that is both person-centered and youth-friendly is essential in improving the quality of care that youth receive. In this study, minors and non-Hispanic Black youth were the least likely to report that their care was both person-centered and youth-friendly. This gap in the quality of care that non-Hispanic Black youth receive may contribute to lower satisfaction with care which may contribute to lower contraceptive use rates and higher unintended teen birth rates for this group. Clinics can improve their ability to provide YFPCCC by ensuring providers are trained in youth-friendly and person-centered contraceptive care.

Introduction: In recent years, high quality contraceptive care for adolescents has shifted away from tiered effectiveness counseling and toward youth-friendly, patient-centered counseling (YFPCCC). YFPCCC is essential in the South, which has higher rates of sexual activity, lower rates of contraception use, and higher teen birth rates. This study examined Southern clinics’ characteristics which support YFPCCC and youth’s perceptions of the contraceptive care they receive. Methods: This mixed methods study examined secondary data collected in two surveys and primary data collected through key-informant interviews. The first survey examined clinic characteristics impacting YFPCCC, and the second survey examined adolescents’ (aged 16-24) perspectives of their care. For each survey, outcome measures were dichotomized and examined through logistic regression models. Lastly, interviews with administrators at FQHCs and HDs in AL and SC and examined the facilitators and barriers to providing YFPCCC in these clinics. Results: FQHCs were 89% less likely to notify youth of their right to confidentiality (aOR 0.11, 95% CI (0.05, 0.26)) and 80% less likely to notify youth of their right to consent to care (aOF 0.20, 95% CI (0.10, 0.40)). Non-Hispanic Black youth were 47% less likely to receive patient-centered contraceptive care (aOR 0.53, 95% CI (0.40, 0.70)). Minor youth (ages 16-17) were 34% less likely to receive patient-centered contraceptive care (ages 20-24) (aOR 0.66, 95% CI (0.45, 0.98)). Clinic administrators noted the continued use of tiered effectiveness counseling. SC administrators noted that minor youth were allowed to consent to receiving the implant but could not consent to removing it. Discussion: Overall, clinic capacity to provide YFPCCC varied by clinic type, with FQHCs less likely to have notify youth of their rights to consent to and receive confidential contraceptive care. The receipt of YFPCCC varied by youth’s age and race/ethnicity, with minors and non-Hispanic Black youth being less likely to report YFPCCC. Clinic administrators noted that they continue to use the tiered effectiveness model of counseling, which may inadvertently pressure or coerce youth. To improve their capacity to provide YFPCCC, clinics should enhance their policies protecting consent and confidentiality and ensure that their providers are trained in patient-centered contraceptive care for youth.