Policy Priorities for Promoting Youth Access to Sexual and Reproductive Health Services

Promote universal access to comprehensive sex education for all youth.

• Establish national standards for comprehensive sex education in schools that:
  • Provide medically accurate education around anatomy, sexual development, gender identity, sexual behavior, sexually transmitted infection (STI) prevention, and reproductive health care.
  • Teach skills and behaviors for healthy relationships, communication, consent, and decision-making
  • Address social pressures and influences from a trauma-informed and culturally responsive lens
  • Rely on evidence-based and developmentally appropriate curriculum.
  • Include tailored curricular materials that are responsive to the diverse needs of all historically disenfranchised and underserved.
• Encourage school-based comprehensive sex education programs that emphasize prevention of unintended pregnancy and sexually transmitted infections (STIs).
• Oppose abstinence-only sex education in schools.
• Oppose federal funding for abstinence-only sex education curriculum.
• Incentivize and support pediatricians and healthcare providers to provide comprehensive, developmentally appropriate, longitudinal sex education to children, adolescents, and young adults in the context of primary care.

Promote equitable access to contraception for all youth and young adults who are sexually active or considering becoming sexually active.

• Promote policies that reduce barriers to accessing contraception, including:
  • Mail-order purchasing of contraceptives without age-limits.
  • Encouraging FDA review of oral contraceptives for over-the-counter use, and approval for all age groups as supported by the data.
• Promote low-cost or free nonprescription access to emergency contraception, regardless of age and insurance coverage and without cost-sharing.
• Encourage federal agencies to make regulatory decisions around contraception based on sound evidence, not politics.
• Oppose policies limiting the distribution of contraception or emergency contraception on school property.

Promote equitable access to abortion for all youth and young adults who wish to terminate a pregnancy.

• Oppose legislative efforts to restrict access to abortion for adolescents and adults.
• Promote the expansion of access to medication abortion.
• Support the use of telehealth services for medication abortion.
• Support policies that prohibit interference in medical care and decision making.
• Support the codification of affirmative protections for abortion care in state and federal law.
• Oppose state policies designed to prevent people from seeking abortions by instating:
  • Logistical/financial burdens (e.g., mandatory waiting periods, requiring multiple clinic visits to obtain an abortion).
  • Interference in care delivery (e.g., mandatory ultrasounds, requirements to provide misleading information, or other clinical interventions that are not based in scientific evidence).
• Oppose laws that criminalize abortion for patients or providers.
• Oppose targeted restrictions for abortion providers or “TRAP” laws.

Promote adolescents’ right to confidential care when accessing gender, sexual, and reproductive health services.

• Promote and incentivize confidential care and private, one-on-one time for all adolescent patients.
  • This includes promotion and incentivization of financial resources and reimbursement for additional staffing and longer patient visits to enable confidential time.
• Promote adolescents’ right to confidential care when accessing contraception and abortion.
• Oppose mandatory parental consent and notification laws for sexual and reproductive health services, including abortion services.
• Oppose judicial bypass provisions for abortion care, as these do not ameliorate risk to adolescents and may delay access to safe and appropriate care.
• Promote and incentivize adolescent confidentiality protections in electronic health record (EHR) systems and insurance coverage and ensure confidentiality in billing and issuance of explanation of benefits (EOB).
  • Pharmacy benefits managers (such as SureScripts) can share information about contraception dispensed in school-based health centers with pediatric health clinicians, even when the young person’s insurance is not paying for the contraception.
  • This promotion and incentivization includes confidentiality protections for immunization registries in states where youth who are sexually active and consent to receive the human papillomavirus (HPV) vaccine without parental consent.
• Oppose efforts to penalize/criminalize pediatric health clinicians and other clinicians for providing evidence-based, age/developmentally-appropriate gender, sexual, and reproductive health care. Pediatric health clinicians can consider collaborating with allied medical specialties and other youth advocates in opposition to such measures.

Support adolescent access to evidence-based, medically accurate sexual and reproductive health services in their communities.

• Support and incentivize the provision of clinical sexual and reproductive health services in schools and on college campuses.
• Support resources and funding for outpatient clinics providing comprehensive sexual and reproductive health services, including STI screening and treatment, contraception, pregnancy testing and care, pregnancy options counseling, and abortion services.
• Promote timely and complete HPV vaccination for adolescents.
• Oppose the provision of federal funding to crisis pregnancy centers.

Increase funding and resources to promote innovative care strategies for sexual and reproductive health services in medically underserved areas, including efforts to support:

• Telehealth services.
• Teleconsultation models.
• Collaborative or integrated care models.
• Health educators.
• Community health workers.

Strengthen linkages between medical settings, social services, and other youth-serving systems to address intersecting needs of youth and families where they are, including:

• Schools.
• Colleges, universities, and vocational settings.
• Primary and subspecialty care.
• Juvenile justice.
• Child welfare system.

Promote and incentivize clinician education and training in developmentally appropriate, gender-affirming, patient centered care for sexual and reproductive health services, including:

• Sexual development.
• Gender identity.
• Prevention of STIs and unintended pregnancies.
• Counseling, education, and provision of all safe and effective contraceptive methods.
• Provision and use of emergency contraception.
• Options counseling for adolescents who are pregnant.
• Reproductive justice in pediatric training.

Promote sexual, reproductive health, and reproductive justice competencies during training and in continuing medical education requirements across disciplines, including:

• Pediatricians.
• Adolescent medicine physicians.
• Family medicine physicians.
• Internal medicine physicians.
• Obstetrics/Gynecology.
• Primary care physicians.
• Subspecialty care physicians.
• Nurse practitioners.
• Nurses.
• Physician assistants.
• Community health workers.
• Other medical clinicians.

Educate providers, policymakers, and the public on disparities in access to sexual and reproductive health services and the social, health, and economic impacts of these disparities.

Support policies that improve access to sexual and reproductive health services for communities of color and promote health equity.

Promote sexual and reproductive health care services in schools:

• Support funding to increase the workforce of school nurses, pediatric health clinicians, and other school-based health personnel to provide services in schools.
• Support programs to increase delivery of sexual health services, including STI screening, in schools and on college campuses.
• Promote trauma-informed care principles in schools.
• Provide incentives to ensure school-based health providers are adequately trained to recognize and respond to sexual and reproductive health needs.
• Normalize conversation about sexual and reproductive health in schools.

Promote sexual and reproductive health services for youth in the child welfare system:

• Ensure all youth entering the child welfare system have timely access to initial and ongoing comprehensive health assessments and all necessary services indicated during assessment, including the full spectrum of sexual and reproductive health services.
• Expand access to trauma-informed, evidence-based, and confidential community-based care for youth in the child welfare system.
• Promote education about adolescents’ rights to sexual and reproductive health care for all foster parents, case workers, administrators, and youth involved in the welfare system.
• Promote policies to support youth involved in the child welfare system, including those with special health care needs, as they transition to adulthood and adult medical care.
• Promote training for caregivers and child welfare professionals in using trauma-informed care to provide support to youth who have experienced sexual abuse and exploitation, including trafficking.

Promote sexual and reproductive health services for youth in the juvenile justice system

• Promote efforts to ensure that confined youth receive at least the same level and standards of healthcare as non-confined youth accessing care in their communities.
• Support implementation of trauma-informed care in detention settings.
• Promote continuation of Medicaid coverage for youth while in juvenile detention.
• Support confinement facilities in recognizing and responding to the unique health needs of youth who are justice-involved, including those with chronic medical conditions and developmental needs.

Promote equity, diversity, and inclusion in sexual and reproductive health services

• Promote policies, training, and hiring practices to establish culturally and linguistically competent clinics, clinicians, and care navigators.
• Require anti-bias and cultural sensitivity training during medical training, continuing education, and board certification.

• Encourage family-centered gender, sexual, and reproductive health care with parental involvement or consultation with another trusted adult where appropriate.
• Provide parent education about adolescent gender, sexual, and reproductive development to foster improved outcomes for youth.
• Provide counseling for parents of youth with special health care needs to understand their unique gender, sexual, and reproductive health needs, including typical developmental behavior for children who are functioning cognitively at a level younger their chronological age and potential for increased risk for sexual abuse for specific subpopulations.

Encourage funding and resources for evidence-based community/school programs intended to increase knowledge of sexual health and support healthy sexual development in youth and families.

Increase funding for research to develop and scale up-stream interventions to promote sexual and reproductive health in youth and families.

Promote sexual and reproductive health in online spaces frequented by adolescents and young adults by incentivizing the promotion of evidence-based information and content and the removal of misinformation.

Support policies and programs that address and mitigate the underlying risk factors that can impact sexual and reproductive health, including:

• Poverty.
• Discrimination.
• Racism.
• Stigma.
• Gaps in access to health care.
• Gaps in insurance coverage.
• Gaps in education or school resources.

Increase funding and support for community programs that foster youth engagement, connection, and participation in activities to promote sexual and reproductive health.

Ensure adequate payment to primary care providers for provision of appropriate sexual and reproductive health care to adolescents and young adults.

Support provider payment for sexual and reproductive health services, via development (if necessary), recognition, and appropriate valuation of codes used to report necessary services.

• Preventive services.
• Sexual and reproductive health screening and counseling.
• STI screening.
• Counseling around contraceptive options.
• Options counseling for pregnant adolescents.
• Telehealth for sexual and reproductive health services.
• Expedited partner therapy.
• Care management.
• Consultation services.
• Team-based approaches to care.

Incentivize screening and follow-up for sexual and reproductive health services at adolescent well-child visits.

Incentivize financially sustainable collaborative care models for sexual and reproductive health needs.

Support the development of payment models that better account for patient needs across specialties and clinical disciplines.

Preserve and extend public and private insurance coverage for sexual and reproductive health services for adolescents and young adults.

Increase availability of providers in medically underserved areas.

Increase diversity of sexual and reproductive health workforce.

• Support the development and funding of pipeline programs to increase diversity in the sexual and reproductive health workforce.
• Incentivize fellowship training and college programs to recruit diverse groups of students to pursue careers in sexual and reproductive health.
• Support the development and funding of programs that mentor diverse groups of people over the course of their education, training, and careers in sexual and reproductive health.

Increase provider knowledge and capacity in identifying and providing treatment for sexual and reproductive health needs.

Expand workforce training programs.

Recognize health educators, and community health workers as important members of the health care team providing sexual and reproductive health education.

Expand funding for culturally informed research into sexual and reproductive health services.

• Understanding and addressing stigma around sexual and reproductive health.
• Establish and validate culturally and developmentally appropriate education, screening, and intervention programs to promote sexual and reproductive health.

Expand funding for research to increase access to sexual and reproductive health services for youth who are Black, Indigenous, Latinx, Asian-American, and other underrepresented, with a focus on studies that aim to:

• Identify risk and protective factors that influence sexual and reproductive health.
• Understand cultural views of sexual and reproductive health.
• Explore utilization, engagement, and attitudes toward sexual and reproductive health services.
• Adapt and validate existing screening tools for youth from diverse cultural backgrounds.
• Build, adapt, and validate evidence-based care pathways and interventions that are developmentally, culturally, and linguistically appropriate.
• Understand and address practical, systemic, and cultural barriers to sexual and reproductive health services.
• Understand the health and economic impacts of systemic barriers to care.

Expand funding for research to increase access to sexual and reproductive health services for youth who identify as lesbian, gay, bisexual, transgender, queer, questioning, or two-spirit (LGBTQ2S+), with a focus on studies that aim to:

• Identify risk and protective factors that influence sexual and reproductive health.
• Understand cultural views of sexual and reproductive health.
• Explore utilization, engagement, and attitudes toward sexual and reproductive health services.
• Adapt and validate existing screening tools for youth who are LGBTQ2S+.
• Build, adapt, and validate evidence-based care pathways and interventions that are developmentally, culturally, and linguistically appropriate.
• Understand and address practical, systemic, and cultural barriers to sexual and reproductive health services.
• Understand the health and economic impacts of systemic barriers in access to care.

Expand funding for research to increase access to sexual and reproductive health services for youth with special health care needs, with a focus on studies that aim to:

• Identify risk and protective factors that influence sexual and reproductive health.
• Explore utilization, engagement, and attitudes toward sexual and reproductive health services.
• Understand how to implement developmentally appropriate screening protocols, education, and health services for youth with disabilities.
• Understand the health and economic impacts of systemic barriers in access to care.
• Understand the intersectionality of sexuality, disability and health equity, including racism, gender dysphoria, and poverty.

Expand funding for research to understand the impact of policy changes on access to sexual and reproductive health services.

Require that research studies addressing sexual and reproductive health services include communities of color, LGBTQ2S+ populations, and other diverse populations in their sampling.

Promote diversity in sexual and reproductive health research:

• Prioritize diversity in allocation of grant funding and in study section membership, including race, gender identity, sexual orientation, and age.
• Encourage the continued investment and expansion of research programs that increase funding to researchers from underserved communities.
• Encourage researchers and funders to engage lower-resourced institutions that are more likely to support underserved communities.
• Prioritize efforts to enhance the workforce pipeline to engage new researchers from communities that are underrepresented in medicine and science.