Last week, the American Academy of Pediatrics (AAP) suggested sexually active teenagers use contraceptive implants and intrauterine devices (IUDs) over other forms of birth control.
This is the first time the AAP has suggested pediatricians recommend long-acting reversible contraceptive methods (LARCs) such as IUDs and implants before recommending other, less-effective forms of birth control to sexually active teens. The new policy statement, which says pediatricians play a large role in reducing teen pregnancy, replaces a statement that was written in 2007. The AAP first began recommending contraceptive methods to members in 1980; the academy suggests pediatricians be fully educated on different methods of contraception.
“Pediatricians should be able to educate adolescent patients about LARC methods, including the progestin implant and IUDs,” the AAP writes in the October issue of Pediatrics. “Given the efficacy, safety, and ease of use, LARC methods should be considered first-line contraceptive choices for adolescents. Some pediatricians may choose to acquire the skills to provide these methods to adolescents.”
The AAP also emphasized that pediatricians should stress that “all methods of hormonal birth control are safer than pregnancy.” Adolescent pregnancy is associated with higher risk of illness and death for mother and infant. Pregnant teenagers are at increased risk for hypertension, pre-eclampsia, and anemia. Pregnancy also increases the risk of violence for some teens.
In announcing the new policy, the AAP stressed the importance of pediatricians encouraging “healthy sexual health decision-making,” which includes abstinence as well as proper condom use for sexually active teens as a method of preventing sexually transmitted infections, including HIV. The AAP notes that “perfect adherence to abstinence is low,” and recommends that pediatricians “not rely on abstinence counseling alone but should additionally provide access to comprehensive sexual health information to all adolescents.”
About 750,000 adolescents become pregnant in the US every year, according to the AAP, and more than 80 percent of those pregnancies are unplanned. Of all teen pregnancies in the US, 60 percent result in birth. And about 5 percent of all abortions in the US are obtained by minor. In part because it does not require its user to remember to take or use something every day or every time they have sex, the IUD’s failure rate is less than 1 percent and implants have a failure rate of .05 percent – that’s compared with a 9 percent failure rate for oral contraceptives and a 18 percent failure rate for male condoms.
The AAP revised policy on LARCs comes after the American College of Obstetricians and Gynecologists (ACOG), based on research and expert opinions, revised its guidelines on LARCs in 2012, saying sexually active adolescents should be encouraged to use these methods. In its revision, ACOG noted that 42 percent of people ages 15-19 years old have had sexual intercourse, and that most adolescents use birth control but tend to use short-acting contraceptive methods (oral contraceptives, condoms, vaginal rings, etc.), which are less effective than LARCs. More information on different types of LARCs can be found here.
Media Resources: RH Reality Check 9/30/2014; American Academy of Pediatrics 9/29/14; Pediatrics 9/29/2014; Guttmacher Institute 5/2014; Centers for Disease Control and Prevention 8/28/2013; Advocates for Youth 10/2012; The American College of Obstetricians and Gynecologists 10/2014; California Family Health Council; National Institutes of Health