Factors associated with provision of depot medroxyprogesterone acetate to adolescents by US health care providers

Objective: Identify factors associated with healthcare providers' frequency of depot medroxyprogesterone acetate (DMPA) provision to adolescents. Study design: We analyzed data from surveys mailed to a nationally representative sample of public-sector providers and office-based physicians (n=1984). We estimated adjusted odds ratios (aORs) and 95% confidence intervals (Cis) of factors associated with frequent DMPA provision to adolescents in the past year. Results: Although most providers (>95%) considered DMPA safe for adolescents, fewer reported frequent provision (89% of public-sector providers; 64% of office-based physicians). Among public-sector providers, factors associated with lower odds of frequent provision included working in settings without Title X funding (aOR 0.44, 95% CI 0.30-0.64), reporting primary care as their primary clinical focus versus reproductive or adolescent health (aOR 0.42, 95% CI 0.28-0.61), and providing fewer patients with family planning services. Among office-based physicians, factors associated with lower odds of frequent provision included specializing in obstetrics/gynecology (aOR 0.50, 95% Cl 0.27-0.91) and family medicine (aOR 0.21, 95% Cl 0.09-0.47) versus adolescent medicine, completing training >= 15 versus <5 years ago (aOR 0.27, 95% CI 0.09-0.83), and reporting that 0-24% of patients pay with Medicaid or other government healthcare assistance versus >= 50% (aOR 0.23, 95% Cl 0.09-0.61). The reason most commonly reported by providers for infrequent DMPA provision was patient preference for another method. Conclusions: While most providers reported frequently providing DMPA to adolescents, training on evidence based recommendations for contraception, focused on subgroups of providers with lower odds of frequent DMPA provision, may increase adolescents' access to contraception. Published by Elsevier Inc.