Why Youth Need Equitable Access to Sexual and Reproductive Health Services

Comprehensive, confidential, and accessible sexual and reproductive health care is a cornerstone of a young person’s health and well-being. All youth are entitled to have access to information and sexual and reproductive health services that are: available in adequate numbers, accessible physically and economically, accessible without discrimination, medically accurate, and culturally appropriate.

Pediatric health clinicians can play a critical role in fostering reproductive health at all developmental stages by:

• Helping youth make informed decisions.
• Delivering developmentally- and clinically appropriate health services.
• Linking young people to additional sexual and reproductive health care services that they need.

Access to reproductive health care is a health equity issue.

Longstanding systemic inequities impact access to sexual and reproductive health services. Many populations have traditionally experienced added barriers when accessing comprehensive sex education, contraception, and abortion.

Clinical efforts are needed to expand access to comprehensive, effective, and culturally appropriate care to youth populations, including (but not limited to):

• Youth who are Black and Hispanic.
• Youth who are Indigenous and American Indian/Alaska Native.
• Youth who are Asian-American and Pacific Islander.
• Youth who are Immigrant.
• Youth who identify as lesbian, gay, bisexual, transgender, queer, or two-spirit (LGBTQ2S+), non-binary, asexual, and intersex.
• Youth in rural and medically underserved areas.
• Youth involved with the child welfare system or those who have experienced family disruption.
• Youth involved with the juvenile justice system.
• Youth who are undocumented.
• Youth with special health care needs, including youth with developmental disabilities.
• Youth who live in states that require parental involvement in sexual and reproductive health decisions, including abortion.

Systemic inequities that impact access to reproductive health care services include:

• Racism.
• Homophobia or transphobia.
• Economic inequities, including being under-insured or having no health insurance.
• Under-resourced schools.
• Medically underserved areas.
• Sexism.
• Lack of school and community-based reproductive health education.
• State legislation that prevents access to local reproductive health providers.

What you can do:

Promote health equity in adolescent sexual and reproductive health care in the following ways:

• Consult AAP policy, which states that pediatric health clinicians should be trained to understand and address the impact of systemic racism and discrimination on health.
• Incorporate youth and family experiences with systemic discrimination into clinical history taking and counseling discussions.
• Discussing topics such as sexual orientation and gender identity in a way that includes non-judgmental listening and promotes inclusion.

Employ universal screening to support equity in youth access to sexual and reproductive health care:

• Universal screening helps ensure that specific questions to address the sexual and reproductive health care needs are asked of all patients, not just those deemed by the pediatric health clinician to be in-need or at high-risk for these services.
• AAP policy states that pediatric health clinicians should use sexual and reproductive health care related interventions that are patient-centered and focus on the emotional, intellectual, physical and social aspects of a young person’s sexual and reproductive health, and address physical, social, and/or emotional challenges.
• AAP recommends that pediatric health clinicians provide confidential time during health maintenance visits to discuss sexuality, sexual health promotion, and risk reduction.

Address disparities by discussing cultural considerations when providing reproductive health services. Specific strategies include:

• Ensure all care is comprehensive, patient-centered, and is delivered with a reproductive justice lens and following best practices in trauma-informed care.
• Remember that any decision a young person makes may be rooted in strongly held beliefs that vary across culture, religion, and individual values.
• Reach out to and engaging members of the community when developing office protocols and patient care resources.
• Recognize that health care tends to be heteronormative/cisgender-normative in focus and work to use inclusive language and avoid assumptions about identity or behavior.
• Ask about a young person’s goals related to sexual health, relationships, and parenting and frame all care accordingly.
• Integrate reproductive health into the life course approach to health, to be clear that sexual and reproductive health is part of overall health, and not something separate.
• Begin developmentally-appropriate reproductive health conversations at a young age and continue them throughout childhood and adolescence.
• Reflect upon cultural differences and ensure all services are provided in a way that centers the patient’s needs, feelings, and experiences.
• Respect that patients may have different levels of health literacy and meet them where they are, both physically where they are (eg, offering care in the community, vs an office), but also in language (eg, not over-medicalizing visits).
• Integrate methods to engage and educate parents/caregivers to serve as champions and supporters of their child’s sexual and reproductive health.
• Provide assurances of confidentiality and establish limits of confidentiality by clarifying state and/or institutional laws and limits of confidentiality, including how it will be maintained throughout the billing process.

Build a welcoming practice to serve all patients:

• Focus on the safe, stable, and nurturing relationships that surround each youth. These relationships buffer adversity and build resilience.
• Encourage clinicians and staff to recognize and reflect on their own biases and work to prevent these biases from impacting care delivery.
• Use inclusive language and imagery in signage, materials, and office art.
• Ask patients about their names and pronouns and use them consistently during clinical visits.
• Use respectful language when interacting with patients and families.
• Utilize translation services, interpreters, and assistive technology to support accessible written, electronic, and verbal communication.
• Provide opportunities for confidential discussions.