When Barriers are Removed: Increased Use of Long-Acting Reversible Contraceptives among Adolescents in Primary Health...

To evaluate the uptake of long-acting reversible contraceptive (LARC) methods among adolescents attending Primary Health Care (PHC) unit when methods were offered at no cost and accompanied by comprehensive counseling.

We conducted an analytical cross-sectional study including adolescents aged 12-19 years who sought LARC initiation at a public Primary Health Care unit in Campinas, Brazil, between October 2024 and December 2025. Participants received standardized counseling and freely choose among the etonogestrel (ENG) implant, the 52-mg levonorgestrel-releasing intrauterine device (52 mg LNG-IUD), and the copper (Cu) IUD. Sociodemographic and reproductive history data were collected. Factors associated with method choice were analyzed using Poisson regression with robust variance.

A total of 207 adolescents were included (median age 17 years). Most participants (82.1%) selected the ENG implant, while 16.9% chose the 52 mg LNG-IUD and 1.0% the Cu-IUD. IUD users were older and more likely to report previous pregnancy compared with implant users (P < .001). IUD insertion was considered easy in 82.9% of cases, with low complication rates and no insertion failures. Prior to enrollment, LARC use was uncommon, with most adolescents relying on short-acting methods.

When provided with comprehensive counseling and free access within Primary Health Care unit, adolescents demonstrated high uptake of LARC methods, particularly the ENG implant. These findings support expanding LARC provision in public health services as a strategy to promote reproductive autonomy and reduce unintended adolescent pregnancy.