Los Angeles County’s Martin Luther King Jr. Medical Center provided a hormonal birth control implant to a foster youth in its care for the first time last week, part of a new program to offer free long-acting reversible contraceptives (LARCs) to young women and girls, some as young as 12, who are in or at risk of entering foster care.
Started in 2014 by the director of a clinic for pregnant and parenting teens at the Los Angeles County-University of Southern California Medical Center (LAC-USC), a program to provide LARCs to foster youth is being expanded to include the other six medical hubs affiliated with the county‘s Department of Health Services.
The so-called LARCs include Nexplanon, an implant placed inside the upper arm that delays pregnancy for three years, and two different IUD options that last five and 10 years, respectively.
The contraceptives will be offered to all sexually active foster youth who are seen at the county’s system of medical hubs. The medical hubs are designed to provide initial assessments for children who are reported as suspected victims of abuse or neglect, as well as offer comprehensive health care services to children in the county’s foster care system.
Pregnancy is a critical issue for youth in Los Angeles County’s massive foster care system even as the rate of teenage pregnancies has receded across the country. A new study from USC researcher Emily Putnam-Hornstein and colleagues at the Children’s Data Network found that more than 35 percent of young women in California’s child welfare system will have given birth before the age of 21.
Eunice Rios, the medical director of the Adolescent Care and Transition Clinic at LAC-USC, says that implants and IUDs are the most effective methods of preventing teen pregnancy. Since February 2014, she has placed more than 100 LARCs in young women who were seen at LAC-USC. After a counseling session in which teens are advised about different methods of contraception and sexual health, they can obtain the implant, IUDs, a shot or a prescription for the pill during the same visit.
In addition to training dozens of residents at LAC-USC hospital, in recent months Rios has also been training staff from the Martin Luther King Jr., Harbor-UCLA and Olive View-UCLA hubs to perform the procedures for foster youth who access Medi-Cal services at the hospitals.
“It’s gone well here, and the other hubs really wanted to implement it,” Rios said.
Rios points to the Contraceptive CHOICE study in St. Louis as proof of the effectiveness of LARCs for sexually active teens. The 1,404 teens who participated in the study from 2008 to 2013 were provided with no-cost contraception and education about implants and IUDs. About 72 percent used LARC methods, and the group experienced significantly lower rates of pregnancy, birth and abortion than American teens in the general population.
The county’s medical hubs provide a mandated medical evaluation for youth who have recently been placed in foster care. But Rios says that many of these youth run away from placements or move. They rarely return for another visit, making it very difficult to provide a steady program of birth control.
“The LARCs are ideal,” she said. “If the patient runs away, the implant or IUD goes with her.”
Janice Woods, the medical director of the medical hub at the county’s Olive View-UCLA Medical Center in Sylmar, says that staff training for LARCs at the hub will be completed in October. Before staff at a medical center can offer the birth control, though, they must receive authorization from the hospital. Plus, they must also perform several IUD and implant procedures under the supervision of other experienced doctors before being able to do them on their own.
Woods believes LARCs are a particularly good idea for the highly mobile population of adolescent girls in the county’s foster-care system.
“It’s simply good medicine and good county policy that women of a reproductive age are offered choices for their reproductive health,” Woods said. “But we want something that is going to be effective for girls in foster care who don’t always have a stable home or the same doctor because they’re always moving from place to place.”
Across the country, the use of LARCs among adolescent girls has been increasing even as teenage pregnancy rates have been falling, according to Heather Boonstra, director of public policy at the Guttmacher Institute, a nonprofit advocacy organization for sexual and reproductive health issues.
She pointed to a study that found plummeting teen birth rates in Colorado were associated with an initiative to provide no-cost LARCs to low-income adolescents and youth ages 15-24. Follow-up reporting by The New York Times in July revealed a 40 percent drop in teen birth rates for counties that participated in the Colorado Family Planning Initiative. While Boonstra cautioned that it is difficult to definitively pin down why teen birth rates are declining, she noted that the use of LARCs is gaining momentum.
“It doesn’t surprise me that government agencies are thinking, ‘Boy, these youth are already in our care, how can we protect them more?’” Boonstra said.
But, she added, providers should not settle just on LARCs as the only form of contraception.
“On the flip side, you have to be aware of promoting just one method of contraception for young people,” she said. “It’s important that they hear about different options and that people have choices.”
At LAC-USC, Rios says that the foster youth who receive contraceptive counseling always leave with condoms, no matter which method they prefer. And she makes sure that the teens understand that IUDs, implants and the pill do not protect against sexually transmitted infections. But Rios believes that the sooner she can tell the teens at the LAC-USC clinic for pregnant and parenting teens about the contraception, the better, as more of them will be prevented from having their own children end up entering the system.
“A lot of my girls have had their children detained because they’re not able to parent their child,” she said. “They’re teenagers.”
For Rios, this means approaching foster youth at a young age. Because California has no floor on the age of consent for contraception, pregnancy care or pregnancy termination, children 12 years old or younger can be offered contraception if a doctor thinks the patient is ready.
The new program of LARCs for foster youth has yet to roll out across Los Angeles County. But Rios has a big goal in mind for it.
“My dream is to stamp out teen pregnancy and put my clinic for pregnant and parenting teens out of business.”
More staff from the Martin Luther King Jr. and Harbor-UCLA medical hubs will be trained this week at LAC-USC. Administrators hope that LARCs will be available at both in the next month and at all county medical hubs within six months.