Adolescent
Reproductive &
Sexual
Health
Education
Project
Physicians as Advocates
for Adolescent Reproductive
Health
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Adolescents Need Physicians
to Advocate on Their Behalf
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Adolescents Need Physicians
to Advocate on Their Behalf
 Adolescence is a unique time in life requiring
special attention
 Characterized by:
 Physical, emotional, and developmental
changes
 Emerging sexuality
 Awareness of gender identification and
sexual orientation
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Factors Shaping
Adolescence
Race
Religion
Ethnicity
Peers
Socioeconomic
status
Family
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Advocacy Can Improve
Adolescent Health
 The major causes of adolescent morbidity
and mortality are preventable
 Physician advocacy can address the
factors that contribute to negative health
outcomes
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
What Is Advocacy?
 Definition:
 Application of information and resources
 The action of advocating, pleading for, or
supporting a cause or proposal
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Examples of Advocacy
 Placing educational literature in your office
space to educate and inform patients
 Developing a community health behavior
change program that addresses STIs
among youth
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Examples of Advocacy
 Giving expert testimony to the local school
board regarding comprehensive sex education
 Writing a letter to a national or local newspaper
regarding risk factors for teen pregnancy
 Testifying before Congress to
advocate for expanded Medicaid
coverage for contraception
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Why Should Providers
Become Advocates?
1. Physicians are leaders in the community
2. It is a residency requirement
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Steps to Advocating for
Adolescents
 Identify a need
 Assess Community Resources
 Choose a level of advocacy
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Identify a Healthcare Need
 A healthcare need may be a:
 Risk factor
 Screening finding
 Disease symptom
 Condition or disease diagnosis
 Consequence of a disease
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Example: Teen
Pregnancy
 Unintended teen pregnancy is a public
health concern
 Healthy People 2010 goal: “Reduce
pregnancies among adolescent females”
 Teen pregnancy isn’t an isolated
problem and should be viewed in the
context of
 Poverty
 Barriers to health care and education
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Teen Pregnancy Rates
Worldwide, 2000
Per 1000
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Reevaluating Risks of Teen
Pregnancy and Parenting
 Teen Pregnancy: Cause for Concern?
 Unintended pregnancies can prove
challenging regardless of age
 Research indicates poor outcomes for teen
parents and their children
 Health of teen mothers and infants
 Educational outcomes
 Highlights complexity with multiple factors contributing to
outcomes
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Outcomes for Teen Mothers
 Less likely to
 Receive adequate prenatal care
 Graduate from high school
 More likely to
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Die in childbirth
Be poor as adults
Have symptoms of depression
Lack resources to foster their
children’s development
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Challenges for Teen Fathers
 Poor academic performance
 Higher school dropout rates
 Limited financial resources
 Decreased income capacity
 Difficulties staying involved
in children’s lives
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Educational Achievement
And Poverty
 Unintended pregnancy can disrupt education
 Poverty may be a stronger factor in
educational disparities than early pregnancy
 Low-income women have poor educational
outcomes
 Low-income teen mothers no different than
counterparts who delay parenting until > 20
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Addressing Teen Pregnancy
Teen Pregnancy Can Be Addressed on
Several Levels
Condition
antecedents
•Providing
access to
contraceptives
and condoms
•Educating
patients on
prevention
Symptomatic
condition
Complication
•Ensuring
improved
prenatal care
•Reduction in
substance use
and risk
behaviors
•Providing
parenting skills
training
•Enabling
continued
maternal
education
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Choosing an Area of Focus
Sexually Education
•Do local schools provide comprehensive sexuality education?
After-school programs
•Are there programs in your community to keep teens active
and involved after school?
Condom and contraceptive accessibility
• Are condoms and contraceptives available confidentially?
If not, how can you play a role in filling
these voids?
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
On which level will you
choose to advocate?
Practice
Community
Media
Legislative and Policy
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Choosing a Level of
Advocacy
Practice
 Identify your office as a safe space
 Conduct a comprehensive patient interview,
assessing risk behavior and providing
medically factual information to counter myths
 Have resources available to help patients
navigate insurance, Medicaid, and billing
process
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
What Do You Need to
Know?
Practice
 Be aware of state laws regarding minors’
legal rights to comprehensive care
 Be knowledgeable about local resources for
referrals to provide services beyond the
scope of your practice
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Choosing a Level of
Advocacy
Community
 Steps to providing community oriented
primary care
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Assessing community capacity
Identifying health priorities
Assessing population readiness
Develop Intervention
Evaluation
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Why Is Defining the
Community Vital?
Community
 Adolescent reproductive health indicators
differ by region, state, city, and community
 It is crucial to tailor interventions to the
needs of community members
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Assessing Community
Resources
Community
 Identify programs and local, faith based,
and/or national organizations that have the
potential to improve reproductive health
 Directly or indirectly:
  Reduce risk factors
  Enhance protective factors
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Assessing Capacity
Community
 Community capacity is a comprehensive set of
data that can be used to set objectives
 Assessment may include:
 Compilation of demographic data from census records
 Results of surveys conducted by others
 Responses by partnership members to questions about
the community they serve
 Focus group discussions, interviews with stakeholders
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Community-Oriented
Intervention
Community
 Develop intervention based on:
 Community Assessment
 Community Partners and Resources
 Personal and Organization Resources and
Abilities
 Even the simplest intervention can
make a difference!
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Evaluation
Community
 Decide specific measures of success
based on community assessment and
intervention initiative
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Baseline
Measures
Targets
Outcomes
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Choosing a Level of
Advocacy
Media
 The media can:
 Get the attention of community/laypersons,
colleagues/institutions, and policymakers
 Offer opportunities to provide scientifically
sound and accurate information
 Disseminate research
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Print Media
Media
 Journals
 Letters to the Editor
 Editorial
 Web-Based
 Magazines
 Health column
 Letters
 Opinion pieces
 Newspapers
 Op-Ed (700–800 words)
 Letters to the Editor (250–
300 words)
 Newsletters
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Agencies,
nonprofit organizations
professional associations
hospitals
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Broadcast Media
Media
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Television
Radio
Internet
Niche Media
 Spanish-Language Stations
 LGBT Media
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Planning the Message
Media
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Clearly highlight a discrete problem
Provide a narrow solution
Prepare sound bites
Prepare a brief summary of information that
you want to convey
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Disseminating the
Message
Media
 Contact the media
 Call the newsroom at your local paper and
find out how to submit a letter or Op-Ed
 Join a national advocacy organization,
such as Physicians for Reproductive
Choice and Health, and identify yourself
as able and willing to talk to the media
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Choosing a Level of
Advocacy
Legislation and Policy
 Your knowledge and expertise can be used in
a number of ways, including:
 Providing oral or written testimony at hearings or
other public forums
 Educating legislators and their staff members
 Following up when information is requested from
you
 Thanking legislators who vote in a manner with
which you agree
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Approaching
Policymakers
Legislation and Policy
 Introduce yourself as a healthcare provider
 Explain the overall purpose of your
communication and why specifically you are
bringing this issue to their attention
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
The Realities of Politics
Legislation and Policy
 No decision by a legislator is straightforward
 Legislators need to balance competing interests
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Meeting With
Legislators’ Staff
Legislation and Policy
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Know the details of the issue the best
Significant influence on the legislator
More likely to give helpful information
Deserve equal respect
Don’t be disappointed
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Share Personal
Experiences
Legislation and Policy
 Highlight how this legislation would affect:
 Your work as a healthcare provider
 The lives of your patients
 Public health in general
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Communicating with
Legislators
Legislation and Policy
 Know what you want to accomplish
 Prior to the meeting
 With your testimony
 From your letter
 Develop talking points
 Stick to them
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Communicating with
Legislators
Legislation and Policy
 Keep it simple
 Implications of the bill
 Reasons for your views
 Avoid technical medical explanations
 Be patient, positive, and flexible
 Be clear and concise
 Follow up
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Your Legislator’s Stance
Legislation and Policy
 Solidly in support of your issue
 Mixed on your issue
 Entirely opposed to your issue
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Supportive Legislators
Legislation and Policy
 Thank the legislator
 Mention recent votes or comments the
legislator made about your issue and
how much you (and your patients)
appreciate this support
 Express the importance of the legislation
 Reaffirm the importance of vocal
legislators
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Mixed Level of Support
Legislation and Policy
 Focus on a specific piece of legislation
 Remember your goal: passage or
elimination of one bill
 Stress the medical necessity and benefits
to the medical community and patients
 Reaffirm the importance of vocal legislators
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Opposition Stance
Legislation and Policy
 Acknowledge the legislator’s point of view
 Highlight aspects of the legislation that would
best influence the legislator’s vote
 Highlight the medical and scientific facts
 Emphasize how the bill would secure the
health of your patients
 Use logic to combat any emotionally charged
language or reasoning
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
How Can Physicians
Advocate?
 Ask questions and get involved
 Organize and speak out when necessary
 Push for stronger standards of care for
reproductive health services in your practice
and institution
 Contact the media; write a letter to the
editor for the local newspaper
 Write to or visit your public officials
 Get involved with your medical association
and Physicians for Reproductive Choice
and Health!
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Please Complete Your
Evaluations Now
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Provider Resources:
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Resources:
www.prch.org - Physicians for Reproductive Choice and Health
www.aap.org - The American Academy of Pediatrics
www.acog.org - The American College of Obstetricians and Gynecologists
www.adolescenthealth.org - The Society for Adolescent Health and Medicine
www.aclu.org/reproductiverights/ - The Reproductive Freedom Project of the
American Civil Liberties Union
www.advocatesforyouth.org – Advocates for Youth
www.guttmacher.org – Guttmacher Institute
www.cahl.org/ - Center for Adolescent Health and the Law
www.gynob.emory.edu - The Jane Fonda Center of Emory University
www.siecus.org - The Sexuality Information and Education Council of the
United States
www.arhp.org - The Association of Reproductive Health Professionals
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Provider Resources:
 PRCH’s Minors’ Access to Confidential Reproductive
Healthcare Cards and Emergency Contraception: A
Practitioner’s Guide
 ARHP Reproductive Health Model Curriculum
 AMA Guidelines for Adolescent Preventive Services
(GAPS)
 The American College of Obstetricians and
Gynecologists:
 Confidentiality in Adolescent Health Care
 Primary and Preventive Health Care for Female
Adolescents
 Tool Kit for Teen Care—available at:
 http://www.acog.org/bookstore/Tool_Kit_for_Teen
_Care_P348C84.cfm
 Info on emergency contraception, www.not-2-late.org
PRCH 2012
Physicians as Advocates for Adolescent Reproductive and Sexual Health
Provider Resources
 Centers for Disease Control and Prevention. Sexually Transmitted
Diseases Treatment Guidelines 2002:
www.cdc.gov/std/treatment/rr5106.pdf
 Building Emergency Contraception Awareness Among Adolescents,
A ToolKit, Academy for Educational Development:
http://www.aed.org/Publications/upload/ECtoolkit3283.pdf
 Henry J. Kaiser Family Foundation: public health policy, broken
down by area (e.g., reproductive, state-specific, Medicaid,
HIV/AIDS): www.kff.org.
 The Young Men’s Clinic of Columbia University:
http://www.cumc.columbia.edu/dept/sph/popfam/
 Mount Sinai Adolescent Health Center:
http://www.mountsinai.org/msh/msh_program.jsp?url=clinical_servic
es/ahc.htm
PRCH 2012