Moving beyond outreach: Decreasing barriers to access for adolescents living in poverty

Title X family planning providers have made great strides in drawing attention to the sexual and reproductive health care needs of adolescents and young adults, recognizing that a majority of adolescent and young adult pregnancies are unintended. Agencies have expanded their outreach and education efforts to include school-based programming, social marketing, and partnership with youth service organizations. However, these strategies sometimes miss the most vulnerable adolescents – those with family incomes at or below the Federal Poverty Level (FPL).

While many adolescents report individual income as their family income (and subsequently screen as having incomes below the FPL), there are critical distinctions in the realities of adolescent clients who screen as living at or below the FPL and those actually living in poverty—distinctions that translate to increased risk for negative reproductive health outcomes. Young people who live in poverty are more likely than their wealthier counterparts to lack access to quality sexual and reproductive healthcare services.1 Adolescents and young women living in poverty also are more likely to engage in risky sexual behaviors, such as sex without a condom, coerced sex, and sex in exchange for money or shelter.1,2

Family planning providers are aware of these and many other statistics that make the case for engaging and bringing low-income adolescents into care. Yet, many are confronted with the challenge of “prioritizing” adolescents, all of whom are at greater risk for unintended pregnancy than their older counterparts. The question then becomes: how can family planning providers make services more accessible to adolescents living in poverty? Outreach and community education are critical components to reaching prospective clients. Equally important is assuring a positive patient experience once an adolescent walks through the door. Are young people met with clinic systems that take into account the obstacles encountered in order to reach the health center, as well as the realities of their daily lives?

Adolescents living in poverty face several barriers that make it challenging for them to access sexual and reproductive health services. For low-income adolescents, concerns around confidentiality and affordability of services, which are common among all adolescents, are compounded by issues of transportation, social isolation, and community mistrust. Family planning providers consequently wonder what steps they can take to eliminate some of these barriers.

A brief assessment of your clinic systems and practices may hold the answer to this question:

  • Slide fee scales and financial assistance - Does your agency clearly state its sliding fee policies for all clients? Are there dedicated staff who can sit with the clients and reassure them that you will provide them quality service, regardless of their insurance status?
  • Staff attitudes and beliefs – Are your staff trained to be aware of the different challenges that adolescents, and especially those living in poverty, face in trying to access care? Does your staff deliver a welcoming message, assuring clients that your staff will do whatever they can to serve them, even if the client arrives 20 minutes late to their appointment?
  • Assistance with transportation - Is your team able to provide MetroCards or partner with medical transportation companies to provide car service at a discounted rate? Does your program have access to a mobile van that allows your team to take your services to communities that need it most?
  • Additional services and resources - Whether it is summer job opportunities, GED programs, clothing and food drives, or other community resources, individuals may be more likely to walk through your doors if they are able to access multiple services at once. There is no doubt that sexual and reproductive healthcare services are relevant to adolescents. Does your team have up-to-date resource lists with contacts for job placement agencies, educational programs, food and shelter assistance, etc.? Better yet, does your agency work alongside staff from these organizations to have them at your agency to assist your clients with enrollment?

1Ganchimeg T, Ota E, Morisaki N, et al. Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study. BJOG Int J Obstet Gynaecol. 2014;121:40-48. doi:10.1111/1471-0528.12630.
2US AID. Fact Sheet on Youth Reproductive Health Policy: Poverty and Youth Reproductive Health. November 2009. http://pdf.usaid.gov/pdf_docs/Pnadr402.pdf.