Reproductive autonomy is essential for the well-being of all people. The benefits of informed decision-making in reproductive health matters are pronounced in adolescents and young adults (AYAs), here defined as people of reproductive capacity between the ages of 13-25 years.1 The United States (US) is a wealthy nation with profound disparities in access to reproductive health care and contraception, particularly among AYAs.2 Rates of unplanned adolescent pregnancies in the US are greater than most high-income countries.3 Impacts of unintended pregnancy for AYAs are far-reaching and multi-generational, disproportionately affecting Black, Latine, Native American, Native Hawaiian and Pacific Islander communities, and contributing to systemic socioeconomic disparities.3, 4, 5 Reproductive health outcomes, such as unintended pregnancy and pregnancy-related adverse outcomes are improved when AYAs play an autonomous role in contraception selection, leading to reduced morbidity and mortality, as well as improved socioeconomic conditions.1,6,7 Additionally, many AYAs require or desire hormone therapy for suppression and regulation of menses, and must navigate contraception decision-making from a young age.

There are many available effective contraception methods in the United States. All are prescribed except for norgestrel (OPill ®), which is a newly released over-the-counter oral contraception method. These treatments also provide many non-contraception benefits such as treatment of dysmenorrhea and heavy menstrual bleeding, as well as the lifestyle satisfaction conferred by menstrual regulation. Guidelines described by the American College of Obstetrics and Gynecology (ACOG), and supported by the American Academy of Pediatrics (AAP), recommend discussing sexual and reproductive health (SRH) topics including contraception by 13-15 years of age.8,9 Additionally, ACOG guidelines emphasize the necessity of patient-centered contraception counseling, in which a patient's needs and goals are ascertained without provider coercion or bias.10 Defending reproductive autonomy for all people through this model supports the tenets of reproductive justice.11 Due to the limited amount of confidential face time with clinicians and reduced access to reproductive health care for many AYAs, there is a need for teen-friendly SRH educational resources both in and outside of the clinic.2

Given the near ubiquity of internet access among AYAs, as well as its inherent privacy and affordability in most cases, the internet is an effective means to reach and educate AYAs. An estimated 95% of AYAs own a smartphone and 45% self-report “almost constant” internet use.12 Internet SRH resources such as “Bedsider,” “Planned Parenthood” and “Young Women's Health” have been shown to improve contraception literacy and decision-making, as well as rates of clinical follow-up for reproductive health care.13, 14, 15 Contraception resources containing decision support tools enable efficient, patient-centered counseling, and may complement neurocognitive developmental considerations for AYAs.16 Some SRH resources have successfully used interactive components to improve AYA engagement with their content.17,18 Tailoring contraception information to patient preferences increased the likelihood that patients would choose and adhere to effective contraception methods.19

Even among medically-accurate and professionally-produced websites, there are potential pitfalls for AYAs. Most online SRH resources, including those designed for young people, are written above a ninth grade reading level.20 Limited health literacy may direct young people to seek online sources that they perceive to be AYA-friendly, which may lead to consumption of unreliable, incomplete or misleading information.18,21 Among existing online contraception decision-making tools, there is limited educational context provided for each contraception method, and these tools align with user preferences with relatively low fidelity, approximately 40%.22

Interactive, educational reproductive health websites may effectively support AYA contraception decision-making. To address this need, the “Teen Health” website was developed. This website contained AYA-specific resources to help young people understand health care navigation. The interactive component was achieved with a contraception education tool (CET) within the website that allowed patients to identify contraception methods likely to match their health needs, lifestyle, and preferences. The website also included an animated video walk-through of a first reproductive health visit, and information about reproductive health privacy policies for minors. This online resource was designed to engage an adolescent audience, with original illustrations, animations, and infographics for visual representations of the physiology of contraception and menstruation. This study sought to determine if the “Teen Health” website could effectively be introduced to AYAs in an outpatient clinical setting. The aims of this study were to ascertain whether interaction with the “Teen Health” website and CET empowered informed contraception decision-making among AYAs, and collect qualitative feedback from website users.