Employing a multilevel approach to examine contraceptive service provision for youth in New York City

In the United States, concerns about adolescent pregnancy and its purported consequences-negative health effects for mother and child, the disintegration of the nuclear family, and overdependence on public resources-began to widely circulate in policy spheres and the news media in the 1970s, resulting in a proliferation of policies, programs, and services designed to address its prevention. Though national adolescent birth rates are currently at their lowest since reaching a peak in the early 1990s, this decline masks persistent and significant disparities between groups of young people by race, ethnicity, geography, and poverty level, reflecting a complex intersection of social and economic inequities and diverse sociocultural meanings attached to adolescent childbearing. Using ethnographic methods, the research described in this article examines the values and priorities undergirding the promotion of hormonal and long-acting reversible contraception for sexually active youth in New York City, an urban center of vast extremes in health, wealth, and opportunity, but which boasts extensive reproductive health services for young people, including confidential care and availability of free or low-cost contraception. It examines the interpretation of this strategy from the perspectives of reproductive health leaders and health care workers, highlighting the ways in which adolescence, sexual risk, and youth relationships are characterized. It also describes the needs and priorities identified by these participants with regard to contraceptive counseling and reproductive decision making, contextualized by the experiences of youth participants for whom this strategy is intended, elucidating the broader sociocultural contexts in which young women negotiate intimate relationships and contraceptive use. The utility of multilevel and holistic approaches to the study of reproductive health services for youth is discussed, along with implications for clinical practice and policy development.