Sexual and reproductive health information and referrals for resettled refugee women: A survey of resettlement agencies in the United States.

BACKGROUND: Refugee resettlement offices are the first point of contact for newly arrived refugees and play a significant role in helping refugees acclimate and settle into life in the United States. Available literature suggests that refugee women are vulnerable to poor sexual and reproductive health (SRH) outcomes, including sexually transmitted infections and HIV infections as well as adverse pregnancy outcomes, but little is known about the role that refugee resettlement offices play in supporting refugee women's SRH. This study examines the capacity and interest of resettlement offices in providing SRH information and referrals to newly arrived refugees. METHODS AND FINDINGS: The research team conducted an online survey of staff members at refugee resettlement offices throughout the US in 2018 to determine (1) available SRH resources and workshops; (2) referrals to and assistance with making appointments for SRH and primary care appointments; (3) barriers to addressing SRH needs of clients; and (4) interest in building the capacity of office staff to address SRH issues. The survey was created for this study and had not been previously used or validated. Survey data underwent descriptive analysis. A total of 236 resettlement offices were contacted, with responses from 100 offices, for a total response rate of 42%. Fifteen percent (N = 15) of refugee resettlement agencies (RRAs) who responded to the survey provide materials about SRH to clients, and 49% (N = 49) incorporate sexual health into the classes they provide to newly arrived refugee clients. Moreover, 12% (N = 12) of responding RRAs screen clients for pregnancy intention, and 20% (N = 20) directly refer to contraceptive care and services. This study is limited by the response rate of the survey; no conclusions can be drawn about those offices that did not respond. In addition, the survey instrument was not validated against any other sources of information about the practices of refugee resettlement offices. CONCLUSIONS: In this study, we observed that many resettlement offices do not routinely provide information or referrals for SRH needs. Responding offices cite lack of time and competing priorities as major barriers to providing SRH education and referrals to clients.

Pharmacists' perspectives on prescribing hormonal contraception in Washington, DC, with a focus on young people.

OBJECTIVE: To assess pharmacists' interest, comfort level, training needs, and barriers to prescribing hormonal contraceptives, particularly in the context of serving young people in Washington, DC. DESIGN: In this mixed-methods study, we conducted a focus group discussion with pharmacists in February 2017, which was analyzed thematically using inductive and deductive coding. In January 2018 to June 2018, we conducted a survey with pharmacists, which was analyzed using descriptive statistics. SETTING AND PARTICIPANTS: Community and outpatient pharmacists in Washington, DC. OUTCOMES MEASURES: Pharmacists' interest and comfort level to begin prescribing hormonal contraception, particularly in the context of serving young people. RESULTS: A total of 6 pharmacists participated in the focus group discussion, and 82 pharmacists participated in the online survey. In the survey, 59% of pharmacists were interested in prescribing hormonal contraception as independent practitioners and 63% through collaborative practice agreements; focus group participants believed that other pharmacists might be less likely to participate. In addition, focus group and survey respondents reported high levels of comfort with activities related to prescribing hormonal contraception, including 96% of survey participants reporting comfort taking blood pressure and 93% reporting comfort counseling young women on hormonal contraceptive methods. Only 25% of pharmacists reported having a private consultation space that provided both visual and auditory privacy. To ensure that pharmacies were ready to implement this service, pharmacists identified multiple concerns that needed to be addressed, including workload, liability issues, compensation, and a need for additional training on hormonal contraceptive methods, and how to counsel young people on them. CONCLUSION: Pharmacists in Washington, DC, are interested in and comfortable with activities related to prescribing hormonal contraception, including to young people. However, to become ready to offer these services, pharmacists desire additional training, and pharmacies need to ensure confidentiality for young people and address pharmacists' concerns about workload, liability, and compensation.

Youth Perspectives on Pharmacists' Provision of Birth Control: Findings From a Focus Group Study.

PURPOSE: Young women face numerous obstacles to accessing contraception, including lack of money, time, or transportation to visit a doctor. In addition, concerns about confidentiality deter many adolescents from seeking contraceptive care. Pharmacists in Washington, D.C. will soon be able to prescribe hormonal birth control, which can potentially increase contraceptive access for adolescents. This study explores the needs and concerns of teens and young women residing in Washington, D.C. to inform implementation of this service. METHODS: In this community-based participatory research study, four focus group discussions were conducted in February 2017, two with teen females aged 14-17 years and two with young women aged 18-24 years. A youth advisory council, comprising 13 women aged 16-22 years living in Washington, D.C., helped develop the discussion guide and interpret findings. Data were analyzed thematically by age group using inductive and deductive codes. RESULTS: Young people viewed pharmacies as convenient locations to access contraceptives but expressed concerns about privacy, affordability, and pharmacist approachability. Younger participants viewed these concerns as significant barriers for their peers. Participants suggested pharmacies protect privacy and confidentiality by offering private consultation spaces and clear information about what insurance plans can disclose to parents. Participants also recommended pharmacies create a youth-friendly, nonjudgmental environment and offer pharmacists training on contraceptive counseling for young women. CONCLUSIONS: Addressing concerns about privacy, costs, and pharmacist approachability can help ensure that youth seeking contraceptives can easily access their preferred method. Pharmacies should continuously incorporate young people's feedback to ensure this service remains accessible and acceptable to adolescents.