Family planning services in adolescent pregnancy prevention: the views of key informants in four countries.

CONTEXT: Rates of adolescent pregnancy vary widely in the developed world. The prevention of adolescent pregnancy in the United States might be improved by comparing the provision of family planning services in the United States with that in some other developed countries.
METHODS: Face-to-face, semi-structured interviews were conducted with 75 key informants (clinicians, politicians, public health administrators, social and behavioral scientists, and antiabortion activists) in Great Britain, the Netherlands, Sweden and the United States. Inductive, systematic qualitative analysis was performed on verbatim transcripts of these interviews.
RESULTS: Across all four countries, interviewees described optimal family planning services for adolescents as those that include accessible, comprehensive and multidisciplinary care provided in confidence by nonjudgmental staff with good counseling and communication skills. Interviewees in Sweden and the Netherlands described a close liaison between family planning services and local schools, while key informants in the United States reported parental resistance to such coordination. Interviewees in the Netherlands and Sweden observed that family planning staffs in their countries have a clear sense of "ownership" of family planning services and better job-related prestige than did interviewees in Great Britain. Respondents in all countries except Sweden reported that providers are not always comfortable providing confidential care to teenagers. This was a particular concern for family planning providers in Great Britain who have patients younger than 16. Respondents in all countries except the United States thought that a "user-friendly" procedure for contraceptive provision should not require a pelvic examination. Finally, interviewees felt that governmental support in the Netherlands and Sweden seems to have led to adequate financing of family planning services, while in the United States, interviewees reported that there seems to be little governmental, medical or familial support for preventive health care, including family planning services.
CONCLUSIONS: As described by key informants, the family planning services available to teenagers in the Netherlands and Sweden have many of the features identified by respondents from all four countries as those that would characterize ideal family planning services for adolescents.