“you don't want to mess up your own body:” barriers to family planning clinic use among adolescents in California

California has seen dramatic reductions in adolescent pregnancies and births in recent years. However, despite the availability of family planning services for low-income and adolescent populations, such as California's Family PACT program, many teens do not take full advantage of these prevention services. As part of a statewide evaluation of California's Teen Pregnancy Prevention program, researchers conducted a mixed-methods study to explore the social, economic, and neighborhood context of ten communities with elevated or declining teen birth rates. Twenty-two single-sex focus group discussions were conducted with 186 youth, including a brief quantitative survey. Topics covered included access to clinical services and perceptions of teen pregnancy and parenting. Data were analyzed in Atlas.ti using a grounded theory approach. Although 75% of teen participants reported knowing where to get family planning services, group discussions revealed significant social and logistical barriers to service use, such as embarrassment, judgment, fears about confidentiality, negative experiences with clinic staff, lack of transportation, and inability to leave school without parental consent. As one participant explained, “If you're seen at the clinic, it goes viral.” Teens relayed persistent myths and misinformation about contraceptive methods, sharing concerns that “You don't want to mess up your own body.” Both boys and girls reported relying primarily on condoms, due to their availability beyond the clinic, in less “embarrassing” settings. Preliminary findings indicate the need for programs and policies to reduce barriers facing adolescents in accessing reproductive health services throughout the state.