Given that 82 percent of teen pregnancies are unintended, it should come as no surprise that sexual health advocates are eager to make information and services even easier to access and more appealing to emerging adults. Planned Parenthood of the Great Northwest, which serves Western Washington, Alaska, and Southern Idaho, recently rolled out a telemedicine pilot project that may help to do just that.
The new plan offers virtual office visits via video conference with a trained reproductive health professional. A virtual visit allows a care provider and patient to see each other and have a conversation in real time, but without the scheduling and transportation challenges that cause some young people to delay care. It provides an alternative way to get mail order contraceptives, or (soon) home tests for Chlamydia and Gonorrhea. These two sexually transmitted infections are most common among youth ages 15 to 24 and together affect almost 4 million Americans per year.
In particular, Planned Parenthood hopes the new service will help meet the needs of young people in rural areas where simply getting to and from a clinic may take several hours. For youth in small communities, confidentiality can also be an issue: young people seeking services may not want to risk bumping into someone they know.
Planned Parenthood’s pilot unites two broader trends in healthcare. First, remote primary and urgent care services are exploding to the point that the American Telemedicine Association is working toward the autumn launch of an accreditation program. The second trend is a broad movement to bring reproductive health services to young people wherever they may congregate. The American Congress of Obstetricians and Gynecologists encourages doctors to bring up sexual health in sports physicals, for example, or during the management of chronic conditions like diabetes, rather than waiting for them to show up at the office after a pregnancy or infection scare. The Oregon Foundation for Reproductive Health has launched a campaign nudging medical providers to ask “One Key Question” during any primary care visit: Would you like to become pregnant in the next year? Innovative school-based health centers now include contraceptive services in high school clinics.
But where young people live, increasingly, is online, on phones and other mobile devices, which explains why medical providers serving teens and young adults are diving into new social media and communications tools. For years, reproductive public health advocates have been scrambling to create youth friendly media like Stay Teen or Bedsider.org. Direct service via video conference is a logical next step.
Using Planned Parenthood’s service still requires a serious commitment to self-care. Just like a traditional medical appointment, the patient has to fill out (electronic) paperwork ahead of time, including a medical history. If the goal of the appointment is birth control, she may also have to stop into a local drug store to get a blood pressure reading, required for safety reasons. Also, like all medical services, somebody needs to cover costs. Insurance coverage is in the works and may be available by November, but for the time being, the patient is responsible for the fee ($45) and the cost of any medications or STI tests.
Opponents have expressed concern about young women being able to get birth control without an exam, but according to Chris Charbonneau, CEO of Planned Parenthood of the Great Northwest, doctors have long since stopped requiring pelvic exams prior to prescribing birth control. In fact, some oral contraceptives are so safe that efforts are now underway to make them available over the counter in US drug stores, as they are in many other countries. In the meantime, telemedicine options may be a boon for young women who want reproductive health care without a waiting room.
Across the United States this year, good news about unintended teen pregnancy keeps rolling in. Yes, the US rate is still twice that of Canada, but both abortion and birth rates are dropping for almost all income and ethnic groups. The change is due mostly to increased and earlier use of contraception, and based on a growing pile of evidence, the magic formula appears to be this: better access to better birth control.
For example, when 1,400 Missouri teens were offered the contraceptive of their choice for free (including top tier long-acting methods), the pregnancy rate dropped to 3.4 percent, 80 percent below the norm for sexually active teens. In 2009, Colorado implemented a program that provided free top-tier long-acting contraception to low-income women via public clinics. As of 2013, teen births had dropped by 40 percent, and state officials attributed three quarters of the decline to the program and its ripple effects.
A video visit will never be able to provide the most highly effective contraceptives, modern IUDs and implants that the American Academy of Pediatrics now recommends as the best option for most teens. Top-tier methods require a brick-and-mortar appointment because a trained provider has to do the insertion. But, as Charbonneau likes to say, the perfect can be the enemy of the good. Mail order options like the Pill, Patch, or Ring may not have the 1 in 2,000 failure rate of an implant, but when it comes to preventing surprise pregnancies, they sure beat withdrawal, douches, or denial—or any other method panicked teens may fall back on after the fact.
Public health advocates talk about the fog zone, a “haze of misperceptions, magical thinking and ambivalence” that puts teens at risk for unwanted pregnancy. Pregnancy still remains the top cause of girls dropping out of school, and one of the top three for boys. Even so, trends are in the right direction. Young men and women are not only using better birth control; they are also using it earlier. Now, through programs like Planned Parenthood Care, virtual visits with skilled medical providers may move the dial even further. Narrowing the gap between sex and self-care will help to ensure that teens can align their lives with their expressed values and dreams, and that children come into the world when parents are ready to welcome them with open arms.
