Birth control: What does the AAP recommend?

Recently, the American Academy of Pediatrics (AAP) came out with new recommendations on birth control. Pediatrician Jason Yaun, MD, weighs in on these recommendations below.

Addressing pregnancy prevention is a cornerstone of caring for adolescent health needs. The AAP recommends that adolescents be encouraged to delay sexual activity until they are ready, as abstinence is 100 percent effective in preventing pregnancies and sexually transmitted infections. However, data show that perfect adherence to abstinence is low with nearly half of US high school students reporting having had sexual intercourse. This leads to 750,000 adolescents becoming pregnant each year, about 80 percent of which are unplanned pregnancies. There is frequently a gap of up to one year from when teens first have sex until they talk to their doctor about sex, leaving a high risk period for unintended pregnancy. Also, adolescents frequently use oral contraceptive pills incorrectly, and less than half of teens remain on contraception one year after starting it.

Given these factors and the new contraceptive methods available to adolescents, the AAP has recently recommended changes in how pediatricians should counsel patients on contraception. Their statement recommends that pediatricians start by recommending the most effective methods of contraception first, which are long-acting reversible contraception (LARC) options.

LARCs include intrauterine devices (IUDs) and contraceptive implants. These methods are highly effective for teens because they provide long-lasting protection against pregnancy and do not depend on regularly scheduled adherence for effectiveness.

Implanon and Nexplanon are both single rod implants that are highly effective with failure rates of less than 1 percent and may remain in place for three years. Common reasons for discontinuation include unpredictable bleeding or spotting.

There are currently three IUDs approved in the U.S.: Mirena, Skyla, and Paragard. These are inserted directly into the uterus by a trained provider, have failure rates of less than 1 percent and may remain in place for three to 10 years depending on the device. Despite previous concerns, we now know that IUDs are safe even for women who have never been pregnant, and studies show rapid return to fertility once they are removed. Half of young women may report moderate to severe pain with insertion, and while typical expulsion rates for women are less than 5 percent, this may be increased in younger women. However, continuation rates for IUDs exceed those for other hormonal methods.

A recent study showed that when teens were given thorough education on contraception that more than 75 percent chose LARC. One year later, 86 percent were still using this method, and 82 percent reported satisfaction.

Condoms should still be used with every act of sexual intercourse in addition to another form of birth control in order to prevent the transmission of sexually transmitted infections.

Adolescents consider their pediatrician a highly trusted source for sexual health information. Guidelines also recommend protecting adolescent confidentiality when discussing sexuality, contraception and sexually transmitted infections. Ensuring confidentiality in these matters is crucial, as limitations on confidentiality are linked to lower contraception use and higher adolescent pregnancy rates. Please talk to your health care provider about which option for contraception may be best for your adolescent. We encourage parents and adolescents to talk about these decisions openly with each other and their pediatrician.