For the first time, the American Academy of Pediatrics (AAP) has recommended that pediatricians consider long-acting reversible contraceptive (LARC) methods—namely, hormonal and copper intrauterine devices (IUDs) and hormonal implants—as "first-line contraceptive choices for adolescents." The statement, published in the journal Pediatrics, encourages pediatricians to counsel their adolescent patients on the broad range of contraceptive methods, starting with LARC methods because they are easy to use and extremely effective. The new recommendations also encourage pediatricians to acquire the skills to provide these methods themselves or identify providers to whom they can refer patients.
In the United States, 614,000 teens became pregnant in 2010, and the overwhelming majority (82%) reported that their pregnancy was unintended. Despite the high level of unintended pregnancy, the overall U.S. teen pregnancy rate has declined steadily—in all 50 states and among all racial and ethnic groups—since its peak in 1990. Between 2008 and 2010, the rate dropped by 15%, a decline for which increased use of LARC methods among teens may be partially responsible.
Indeed, the evidence clearly shows that contraception is driving the long-term decline in U.S. teen pregnancy. As a recent Guttmacher analysis highlights, contraception accounted for 86% of the decline in teen pregnancies between 1995 and 2002, while abstinence accounted for 14%. Between 2003 and 2010, the proportion of teens who had ever had sex did not change, indicating that abstinence did not play a role in the teen pregnancy declines during that time. However, teen contraceptive use continued to improve during this period. Highly effective LARC methods have the potential to help even more teens avoid unintended pregnancy. While still small, the proportion of teens using LARC methods is growing: Among women aged 15–19, LARC use increased substantially between 2002 and 2009, from less than 1% to 4.5%—and may have increased even more since that time.
LARC methods offer adolescents who want to avoid childbearing several advantages over other contraceptive methods. In particular, they may appeal to teens who do not want to worry about remembering to take birth control pills at the same time every day. LARC methods require little maintenance and can provide long-term protection during the years when many young women are at highest risk for unintended pregnancy, between when they initiate sexual activity (around age 17) and when they have their first child (around age 25). Indeed, a new study released in the New England Journal of Medicine documents the potential for LARC methods to significantly decrease pregnancy and abortion rates among teens.
Thanks to the Affordable Care Act, more women—including teens—now have private or public insurance coverage that funds contraception without out-of-pocket costs, which can otherwise be a critical barrier to use. Still, other practical barriers stand in the way of teens’ access to LARC methods, and many teens report they know little or nothing about them. The AAP’s recommendation could go a long way toward increasing provider training and adolescents’ awareness of LARC methods. As advocates and providers consider ways to improve access to LARC methods, it is important to be vigilant that such efforts fully respect adolescents’ informed consent, given the historical context of coercive practices related to contraception, especially those targeting disadvantaged groups. To ensure adolescents’ choices are fully informed and completely voluntary, the new recommendations emphasize educating teens about all contraceptive methods that are safe and appropriate for them, so they can choose freely from among the range of contraceptive options, including highly effective LARC methods.
For more information:
Analysis: Leveling the Playing Field: The Promise of Long-Acting Reversible Contraceptives for Adolescents Analysis: What Is Behind the Declines in Teen Pregnancy Rates? Fact sheet: American Teens’ Sexual and Reproductive Health Report: U.S. Teenage Pregnancies, Births and Abortions, 2010: National and State Trends by Age, Race and Ethnicity Infographic: An American women’s age at first sex has changed little over time, but she is now getting married later and having children later Analysis: Guarding Against Coercion While Ensuring Access: A Delicate Balance