ACOG recommends long acting contraception for all adolescents

In the United States, 42% of female and 44% of male adolescents aged 15–19 years have had sexual intercourse. According to an estimate, United States continues to have the highest adolescent pregnancy and birth rates among developed countries.In view of the same probably ACOG has recommended long-acting contraception for all adolescents.

The American College of Obstetricians and Gynecologists (ACOG) recommends that obstetrician/gynecologists counsel all sexually active adolescents on all possible methods of birth control including long-acting reversible contraception (LARC) and make options easy to obtain.

The phenomenon of adolescent childbearing is complex and far-reaching, affecting not only the adolescents but also their children and their community. The prevalence and public health effect of adolescent pregnancy reflect complex structural social problems and an unmet need for acceptable and effective contraceptive methods in this population.

LARC are birth control methods that provide effective contraception for an extended period without requiring action of the user. They include intrauterine devices (IUDs), injections, and subdermal contraceptive implants.

Adolescents who use contraception most often use short-acting methods, such as condoms, withdrawal, or oral contraceptives. These methods have higher discontinuation and pregnancy rates compared with LARC methods. Poor continuation coupled with higher failure rates significantly decrease the efficacy of short-acting contraception in young women.

Why this matters

• LARC has higher efficacy, higher continuation rates, and higher satisfaction rates compared with short-acting contraceptives among adolescents who choose to use them.


• A reproductive justice framework for contraceptive counseling is essential to providing equitable healthcare, promoting access and coverage for all contraceptive methods, and avoiding potential coercion.

Recommendations

• LARC have higher efficacy, higher continuation rates, and higher satisfaction rates compared with short-acting contraceptives among adolescents who choose to use them.


• Complications of intrauterine devices (IUDs) and contraceptive implants are rare and differ little between adolescents and women, which makes these methods safe for adolescents.


• Patient choice should be the principal factor driving the use of one method of contraception over another, and respect for the adolescent’s right to choose or decline any method of reversible contraception is critical. A reproductive justice framework for contraceptive counseling is essential to providing equitable health care, promoting access and coverage for all contraceptive methods, and avoiding potential coercion. Obstetrician-gynecologists should use this framework and offer LARC alongside all other reversible methods to adolescents who wish to prevent pregnancy.


• New-onset abnormal uterine bleeding unrelated to the initial placement of a LARC should be evaluated similarly to abnormal bleeding in non-LARC users.


• Because adolescents are at higher risk of sexually transmitted infections (STIs), obstetrician-gynecologists should continue to follow standard guidelines for STI screening. They should advise adolescents who choose LARC methods to use male or female condoms consistently (dual method use) to decrease the risk of STIs, including human immunodeficiency virus (HIV).

Guidance for Adolescent Health Care Providers

Intrauterine devices:

• Are safe to use among adolescents


• Do not increase an adolescent’s risk of infertility


• May be inserted without difficulty in most adolescents and nulliparous women


• Expulsion is uncommon in adolescents


• Cause changes in bleeding patterns

Contraceptive Implants:

• Has minimal or no effect on bone density or weight


• Cause changes in bleeding patterns.

The Study design was by literature review and expert opinion. The present recommendations, however, may change with future research and evaluation.

For further reference log on to:

https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Adolescent-Health-Care/Adolescents-and-Long-Acting-Reversible-Contraception