© 2018 North American Society for Pediatric and Adolescent Gynecology Study Objective: To understand contraceptive practices of female adolescents in the Deep South and determine barriers to their use of long-acting reversible contraception (LARC). Design: Semistructured interviews were conducted that addressed current contraceptive choice, factors influencing choice, LARC awareness, concerns, and barriers to using LARC. Interviews were audio recorded, transcribed, and analyzed using qualitative content analysis to identify themes. Setting: Adolescent medicine clinic in an urban academic medical center in the Deep South region of the United States. Participants: Sexually active girls between the ages of 14 and 21 years who were not currently using LARC. Interventions and Main Outcome Measures: Themes generated during semistructured interviews. Results: Fifteen participants were interviewed with a mean age of 17 years. Fourteen of 15 were African American. Thirteen of 15 were currently using non-LARC methods and 2 of 15 were not using any contraceptive method. Contraceptive choice was driven by perceived ease of use, desire for pregnancy prevention, and seeking relief of menstrual concerns. Thirteen of 15 participants were aware of LARC with 11 of 15 (73%) noting information came from a health care provider. Barriers to current and future LARC use included concerns about side effects, LARC ineffectiveness, device longevity, and LARC invasiveness. Sixty-three percent of participants noted that they would not consider using a LARC in the future. Conclusion: Increasing use of LARC goes beyond awareness. Concerns about effectiveness, future fertility, duration of devices, and perceived invasiveness represent barriers for adolescents. Further research is needed to determine how to address these barriers because it pertains to counseling of sexually active girls on the use of LARC.