Determinants of Long-Acting Reversible Contraception (LARC) Initial and Continued Use Among Adolescents in the United States

  • C. Emily HendrickEmail author
  • Joshua N. Cone
  • Jessica Cirullo
  • Julie Maslowsky
Systematic Review


Long-acting reversible contraception (LARC) has gained attention as a promising strategy for preventing unintended adolescent pregnancies in the US. However, LARC use among adolescents at risk for unintended pregnancy remains low compared to women in their 20s. The purpose of the current study was to synthesize the empirical literature published between 2010 and 2018 identifying the facilitators of and barriers to adolescents’ (< age 20) LARC use in the US. Thirty quantitative and qualitative studies were included in the current systematic review. The facilitators of and barriers to adolescent LARC use fell within five themes: LARC method characteristics, individual characteristics, social networks, healthcare systems, and historical time and geographical region. Barriers to adolescent LARC use largely echoed those identified in previous research noting the barriers to LARC use among young adult women (e.g., navigation of healthcare system logistics, common adverse side effects associated with some LARC methods). However, qualitative studies identified adolescents’ mothers as central figures in helping adolescents successfully obtain the LARC methods they desired. Conversely, adolescents’ partners seemed to only play a minor role in adolescents’ contraceptive decisions. The findings also suggested some subpopulations of adolescents may be experiencing pressure to initiate LARC use or have less ability to have their LARC device removed if they wish to discontinue use. Adolescent health practitioners and clinicians should consider the unique social–environmental influences of adolescents’ contraceptive access and behaviors to best meet adolescents’ contraceptive needs and desires.


Long-acting reversible contraception LARC Adolescent pregnancy Adolescents Women Facilitators Barriers Systematic review 



This research received support from Grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development: T32HD049302 and K01HD091416. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Authors' Contributions

CEH designed and coordinated the study, participated in the extraction and interpretation of the data, and drafted the manuscript; JNC participated in the extraction and interpretation of the data, and helped to draft the manuscript; JC participated in the extraction and interpretation of the data, and helped to draft the manuscript; JM conceived of the study, participated in its coordination, participated in interpretation of the data, and helped to draft and critically revise the manuscript for important intellectual content. All authors read and approved the final manuscript.

Compliance with Ethical Standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • C. Emily Hendrick
    • 1
    Email author
  • Joshua N. Cone
    • 2
  • Jessica Cirullo
    • 2
  • Julie Maslowsky
    • 2
  1. 1.Health Disparities Research Scholars Program, Department of Obstetrics & Gynecology—Division of Reproductive & Population Health, School of Medicine and Public HealthUniversity of Wisconsin-MadisonMadisonUSA
  2. 2.Health Behavior & Health Education Program, Department of Kinesiology & Health EducationThe University of Texas at AustinAustinUSA

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