Provider News Fall 2015 - Teen contraception

Majority of sexually active adolescents not using effective contraceptive methods

In the U.S., 43% of adolescents ages 15-19 are sexually active, but fewer than 5% use the most effective types of contraception. Many adolescents prefer methods with relatively high typical use failure rates, such as condoms (18%), withdrawal (22%) and oral contraception (9%) compared to the low failure rates of IUD (0.2-0.8%) and implants (0.05%). Nonuse, inconsistent or incorrect use of these types of contraception have led to 82% of adolescent pregnancies being unintended. Long-acting reversible contraception (LARC) - intrauterine devices and contraceptive implants - are safe and appropriate contraceptive methods for most sexually-active (or likely to be so soon) adolescent females. LARC methods have a pregnancy rate of less than 1% per year for perfect use, and they have the highest rates of satisfaction and continuation of all reversible contraceptives.

Barriers to wide use of LARC methods by adolescents include lack of familiarity with or misperceptions about the methods, high cost, lack of access, and health care providers’ potential concerns about the safety of LARC use. Both IUDs and contraceptive implants are safe to use among adolescents and do not increase the risk of infertility. An IUD may be inserted without difficulty and has a low rate of expulsion among adolescents (5-22%). Both IUD and the contraceptive implant can cause changes in bleeding patterns, but proper anticipatory counseling and guidance may improve satisfaction and continuation.

A large study that removed cost and other common barriers to LARC methods and included counseling on the full range of birth control options found that more than two-thirds of females aged 14–20 years chose contraceptive implant or IUD methods. When comparing continuation of LARC methods to short-acting contraception in all ages of women, 86% of LARC users versus 55% of short-acting users continued to use the same contraception after 12 months. The short-acting contraception group was also 22 times more likely to have an unintended pregnancy than their LARC counterparts.

When choosing contraceptive methods, encourage adolescents to consider LARC methods. Intrauterine devices and contraceptive implants are the best reversible methods for preventing unintended pregnancy. Complications of IUDs and the contraceptive implant are rare and differ little between adolescents and older women.

California and Oregon will be the first states in the nation to allow women to get birth control pills from pharmacists without a prescription. In California, pharmacists can only dispense hormonal contraceptives (pill, patch, ring) after providing a health screening to women and taking their blood pressure. Minors have the same access as adults. The rules should take effect in late 2015 or 2016. For more information, see www.pharmacy.ca.gov/laws_regs/regulations.shtml.

Sources:

American Academy of Pediatrics: https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/AAP-Updates-Recommendations-on-Teen-Pregnancy-Prevention.aspx

American Congress of Obstetricians and Gynecologists: http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Adolescent-Health-Care/Adolescents-and-Long-Acting-Reversible-Contraception

CDC: http://www.cdc.gov/vitalsigns/larc/