2018 Family Medicine Cares Resident Service Award

The LARC Initiative

INTRODUCTION

Family planning is an important aspect of Family Medicine. Patients, including adolescents and young women, should have the right to explore their values and preferences when it comes to birth control and family planning. As medical residents practicing in the city of Detroit, Diahann Marshall, MD and Pamela Castro-Camero, MD, second year residents from Henry Ford Health System/Wayne State – Family Medicine Program, noted increased rates of sexually transmitted diseases and unintended pregnancy.  A recent report from the Michigan Department of Human Services confirms that the teen birth rate remains higher in Detroit when compared to its counterparts within the state of Michigan [1]. Unintended pregnancy has been recognized by the World Health Organization as a public health issue that affects not only mothers, but also children as it exposes them to higher risk of domestic violence, illicit substance abuse, delayed prenatal care and low birth weight [2].  Due to its complications and impact on the morbidity and mortality of patients, Family Medicine providers should be at the forefront of addressing efforts to decrease unintended pregnancy through increased access to birth control and sexual education for teenagers.   

Long-acting reversible contraceptive options (LARCs) are effective and convenient for teenage women [3]. Nevertheless, knowledge about them as well as their use continues to remain as low as 5% among teenagers [3]. Cost barriers have also been recognized as contributing to the current health disparity being faced by Detroit teenagers. For all the reasons mentioned, they believe that providing public health education and LARC workshops to Detroit teens will help alleviate the current disparity burden.

A.   Clinic/facility where the project will take place

The Detroit Health Department has been providing important public health services to Detroiters for over 100 years.  Under the leadership of Dr. Joneigh Khaldun, MD, MPH, FACEP, the Health Department’s mission is to work in partnership with Detroiters to protect and promote their health, well-being, safety and resilience, and to respond to every public health need with exceptional leadership, policies, programs and services.

B.   Target population

The target population would be junior and senior high school girls to address teen unintended pregnancy rates and its prevalence in the city of Detroit.

C.   Why this population was chosen

The resident continuity clinics are conveniently located in an area that is surrounded by multiple Detroit high schools. This provides us an advantage to assure that teenagers will have access to LARC insertion if interested. Drs. Marshall and Castro-Camero, will team up with a current project being led by the Department of Health called “iDecide” which is a campaign aimed at addressing teenage pregnancy in the area. Along with the Detroit Health Department, they will create educational workshops to be offered at local high schools for female students and parents. Furthermore, they will contact companies and use part of the granted monetary funds to obtain samples that will make their educational workshops more interesting and appealing to their target population. To facilitate access, they will utilize part of the money from the grant to fund LARCs for students that may be uninsured or under-insured. They will assess pre-workshop and post-workshop LARC knowledge via a survey as we believe that education is a powerful tool in changing attitudes and behaviors towards birth control. Ultimately, their primary goal will be to increase knowledge and access to LARCs among teenagers in Detroit.

D.   Unmet health need

The need for accessible reproductive health services for Detroit residents is crucial. Although fewer Detroit teens are having babies than last decade, the city remains among the top three (3) Michigan communities with the highest percentage of teen births. In addition, there are racial, ethnic and socioeconomic disparities that contribute to the high rates of teenage pregnancy. This disparity contributes to the high infant mortality rates seen throughout the state as well as health care costs. This burden is driven by several factors including decreased awareness of contraceptive options, stigma associated with contraception, limited sexual health education in schools and lack of access to reproductive care.

The Detroit Health department has a decentralized model of providing sexual health services. Their resident clinics are strategically located within walking distance of high schools. However, since the clinics do not accept all insurance plans, it is concerning to think that there will be young women who may be interested in LARC placement but may not be able to access such services at their clinics due to insurance issues. The grant funds from the AAFP would be used to bridge that gap and allow young women who are interested in getting a LARC, regardless of insurance status, to have it placed at a location that is within walking distance of their school. This would also help reduce barriers such as requiring parental transportation to the appointment.

E.   Measurable outcomes that will be used to assess the impact of this project

The primary goal with this project is to increase awareness and knowledge of LARCs among junior and senior high school girls and parents as well as to increase access to LARCs by identifying primary care physicians/facilities that offer these services. They will utilize pre and post surveys that will provide insight on the effectiveness of their educational component.

The secondary goal is to provide LARCs for students who are interested, but have financial, insurance or transportation barriers. They will track those students who come to the clinic for LARCs as a result of the “iDecide” educational sessions as another way to assess their efficacy.

F.    How the project and/or its components will continue to provide an enduring benefit to patients, even after you have completed the project.

The Detroit Health Department has already begun taking steps toward reducing unintended teen pregnancy with several programs and initiatives. Their goal is to reduce rates by 30% by expanding access to long acting reversible contraception (LARCs) and other contraceptive options [1]. Programming will continue after their project has ended to not only reach but exceed expectations. 

References

  1. Michigan Department of Health and Human Services. (2015). Teen Pregnancy in Detroit. Retrieved from https://www.michigan.gov(www.michigan.gov)
  2. Lesnewski, R. (2004). Preventing Unintended Pregnancy: Implications for Physicians. American Family Physician, 69 (12):2779-2782.
  3. Center for Disease Control and Prevention. (2015). Preventing Teen Pregnancy. Retrieved from https://www.cdc.gov/vitalsigns/larc/index.html

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