Long-acting reversible contraceptives best for teens: pediatricians
By Will Boggs MD and Nancy Lapid NEW YORK (Reuters Health) - For adolescents who choose not to abstain from sex, the American Academy of Pediatrics (AAP) favors long-acting reversible contraceptives, such as contraceptive implants and intrauterine devices. All methods of hormonal birth control, including contraceptive pills, are safer than pregnancy, Dr. Mary A. Ott from the Indiana University School of Medicine in Indianapolis, Indiana told Reuters Health by email. But long acting reversible contraceptive (LARC) methods, including the contraceptive implant and the intrauterine device (IUD), should be the first-choice contraceptive methods for adolescents who choose not to be abstinent, she added. Today in the medical journal Pediatrics, Ott and colleagues on the AAP’s Committee on Adolescence updated the organization’s 2007 policy statement on prescribing contraception for adolescents. After reviewing such issues as confidentiality, discussing a teen’s sexual history, and counseling about abstinence and contraception, the policy statement advises pediatricians to counsel teens about a broad range of contraceptive services, with a special focus on long-acting reversible contraceptives. The policy statement also urges pediatricians to ensure that adolescents have access to these methods. In order to do so, they must be familiar not only with national best practice recommendations for confidential care, but also with state and federal laws regarding consent to contraceptive care and information disclosure, the paper notes. Once an appropriate contraceptive method has been selected, the pediatrician should encourage its consistent use along with consistent and correct use of condoms with every act of sexual intercourse. These principles should also apply to the care of adolescents with chronic illnesses and disabilities, while recognizing that those illnesses may complicate the contraceptive choices. Finally, the AAP says, pediatricians must recognize that the contraceptives discussion is ongoing, and this requires time for their adolescent patients to have their needs addressed in a “developmentally appropriate” way. “The Bright Futures best practice guidelines from the American Academy of Pediatrics and the Maternal and Child Health Bureau recommend starting to speak to adolescents confidentially about puberty, relationships, and sexual behaviors starting in early adolescence,” at ages 11 to 14, Ott explained. “Bright Futures recommends that counseling be developmentally tailored to the adolescent, with a stronger focus on abstinence in early adolescence gradually focusing more on healthy relationships and sexually transmitted infection prevention and contraception by late adolescence,” or ages 18 to 21, she continued. “Adolescents are capable of understanding complex messages about sexual health,” Ott said. “Adolescents trust pediatricians and understand that their pediatricians can simultaneously encourage abstinence and provide non-judgmental contraceptive information and care.” Dr. Hatim Omar, Division of Adolescent Medicine chief at the University of Kentucky in Lexington, told Reuters Health, “Teens are less likely to be compliant and because of their development are not fully aware about consequences (‘it won’t happen to me’), so proper counseling and using long-acting reversible contraceptives are the most effective means of preventing unwanted pregnancy.” “Counseling should always include abstinence, STIs, and condom use,” Omar concluded. Not all parents will welcome the interventions, however. Eric Scheidler, executive director of the Chicago-based Pro-Life Action League, told Reuters Health that as a father of daughters he finds it “horrifying” that their pediatrician would promote contraception. “I’d prefer for this discussion about teen sexuality to be a discussion between parents and children and not a girl and her doctors,” he said in a phone call. “It’s not just a medical decision, it’s a moral decision. It ties into a girl’s aspirations, her personality, her state of mind” – things a parent knows better than the child’s doctor, he added. “The recommendation from the APP can’t replace the parental relationship,” Scheidler said. SOURCES: http://bit.ly/1u6tgVw and http://bit.ly/1wRJnFM Pediatrics, online September 29, 2014.
