Long-acting reversible contraceptives (LARC) should be the first-line option for sexually active teenagers, according to a new guidelines on teenaged pregnancy prevention from the American Academy of Pediatrics (AAP).
The updated policy statement and accompanying technical report were published online September 29 in Pediatrics.
The recommendation for LARC, which is an intrauterine device (IUD), a subdermal implant, or an injection of depot medroxyprogesterone acetate, as the first-line contraceptive choice is a change from the previous AAP guidelines, issued in 2007. According to the AAP, evidence from the last 10 years suggests that LARCs, which offer contraceptive protection for 3 to 10 years, are safe for adolescents.
“Each year, approximately 750 000 adolescents become pregnant, with more than 80% of these pregnancies unplanned, indicating an unmet need for effective contraception in this population,” write Mary Anne Ott, MD, and colleagues. “Although condoms are the most frequently used form of contraception (52% of females reported condom use at last sex), use of more effective hormonal methods, including combined oral contraceptives…and other hormonal methods, was lower, at 31% and 12%, respectively, in 2011. Use of highly effective [LARCs], such as implants or [IUDs], was much lower.”
Pediatricians should not rely on abstinence alone when providing their patients with contraceptive information. “Abstinence is 100% effective in preventing pregnancy and STIs and is an important part of contraceptive counseling. Adolescents should be encouraged to delay sexual onset until they are ready,” the authors write. “However, existing data suggest that, over time, perfect adherence to abstinence is low (ie, many adolescents planning on abstinence do not remain abstinent)”.
The technical report accompanying the policy statement describes evidence underlying the recommendations regarding sexual history taking, confidentiality, and counseling; use and adverse effects of newer and of older contraceptives in adolescents; and contraceptive use in adolescents with complex medical conditions.
Specific recommendations include the following:
- Pediatricians should educate and counsel adolescent patients about a wide range of contraceptive strategies and ensure they have access to them while emphasizing safety, appropriateness, and efficacy.
- Pediatricians should educate adolescents about LARC as a first-line contraceptive choice, including the progestin implant and IUDs. Pediatricians who are unable to provide these methods to adolescents should refer them to healthcare providers who can do so.
- Despite their adverse effects, depot medroxyprogesterone acetate and the contraceptive patch are not only effective but are much safer than pregnancy, according to the AAP.
- Pediatricians should allow adolescents to consent to contraceptive care and to control the disclosure of this information within the limits of state and federal laws.
- Contraceptive prescription or referral for IUD placement without prior pelvic examination is appropriate, as are screenings for chlamydia or other sexually transmitted infections.
- Pediatricians should counsel adolescents to use condoms consistently and correctly with every act of sexual intercourse.
- Pediatricians should be aware that combined hormonal methods and regimens offer excellent cycle control both for contraception and medical management of common conditions, including acne, dysmenorrhea, and heavy menstrual bleeding.
- Pediatricians should remember that adolescents with chronic illness and disabilities have sexual health and contraceptive needs similar to those of healthy adolescents while recognizing that medical illness may complicate contraceptive choices.
- Pediatricians should regularly update their adolescent patients’ sexual histories and confidentially and nonjudgmentally discuss needs for contraception, sexually transmitted infection screening, and sexual risk reduction counseling.
- Pediatricians should allow sufficient time to address contraception using a developmentally appropriate, patient-centered approach, with contraceptive follow-up if needed.
- Pediatricians should be aware of state or federally subsidized insurance programs and clinics offering free or low-cost reproductive healthcare services and supplies.
The authors have disclosed no relevant financial relationships.
Pediatrics. Published online September 29, 2014. Policy statement full text, Technical report full text
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