'Start the dialogue'
Physicians urged to counsel teens, ensure they have access to contraceptive services
Hilary Rasch
AAP News 2014;35;16
DOI: 10.1542/aapnews.20143510-16
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Volume 35 • Number 10
October 2014
www.aapnews.org
‘Start the dialogue’
Physicians urged to counsel teens, ensure
they have access to contraceptive services
by Hilary Rasch • Correspondent
An important part of caring for adolescents is
addressing their sexual health needs, including pregnancy prevention and contraception.
While the Academy recommends that adolescents
be encouraged to delay sexual activity until they are
ready, data show that perfect adherence to abstinence
is low. Therefore, pediatricians should have a working knowledge of
a range of contraceptive methods, according to Contraception for
Adolescents, an updated AAP policy statement (Pediatrics.
2014;134:e1244-e1256) and technical report (Pediatrics. 2014;134:
e1257-e1281). The reports provide the latest guidance for best practices in counseling and prescribing contraception for adolescents.
Nearly half of U.S. high school students report having had sexual
intercourse. Additionally, about 750,000 adolescents become pregnant
each year, with more than 80% of these pregnancies unplanned.
“One reason is lack of access to comprehensive
sexual health information and to contraceptives
themselves,” said Mary A. Ott, M.D., M.A., FAAP,
lead author of the policy statement and technical
report. “Nationwide, there is frequently a gap of
Dr. Ott
up to a year from when teens first have sex and
when they see a doctor for more effective hormonal contraceptives.
This gap year represents a very high-risk period for unintended pregnancy. Pediatricians are well-positioned to fill that gap.”
‘LARCs’ most effective
One important update in the statement is that it recommends
counseling patients about contraception starting with the most effective methods — long-acting reversible contraception (LARC) —
and proceeding to the least effective methods.
“In the past, we generally recommended starting with combination
oral contraceptive pills or injectable contraceptives,” Dr. Ott said.
“However, the past decade has documented the safety and efficacy
of LARCs.”
LARCs include intrauterine devices and contraceptive implants.
These methods are highly effective for adolescents because they
AAP News Photo by Jeff Knox
An updated AAP policy statement recommends that pediatricians
counsel patients about contraception starting with the most effective
methods — long-acting reversible contraception (LARC) — and proceeding to the least effective methods.
provide long-lasting protection and do not require regularly scheduled
adherence. The statement recommends that pediatricians place
LARCs in their offices or identify referring physicians.
The statement also includes expanded sections on special populations of adolescents, such as those with obesity, solid organ transplant
and HIV. Studies show that these special populations have similar
levels of sexual activity, when compared with healthy adolescents,
and so have similar contraceptive needs. However, illness can alter
contraceptive options. For example, for patients with HIV, pediatricians must consider whether a combined oral contraceptive will
interact with antiretroviral agents.
Ensure confidential care
Additionally, the statement emphasizes that confidential care
remains important to providing contraception to adolescents effectively. Limits on confidential care are linked to lower use of contraceptives and higher pregnancy rates, according to the statement.
In addition to providing confidential care in accordance with state
© 2014 AAP News
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and federal laws, lead author Gina S. Sucato, M.D.,
M.P.H., FAAP, stressed creating an environment
where teens know they can comfortably discuss
sexual health care needs. “Start the dialogue!” Dr.
Sucato said. “Adolescents are not likely to ask about
contraception unless their pediatrician brings up
sexual activity, more than once. Give information
Dr. Sucato
before patients need it, and let them know the
pediatric office is a safe place to discuss these issues. …Many adolescents only see their pediatrician yearly, and a lot changes in a year
for adolescents.”
Guidance for pediatricians
The Academy recommends the following to provide comprehensive
sexual health care services to adolescents:
• Counsel about and ensure access to a range of contraceptive services. Describe the most effective methods first.
• Educate patients about LARC methods as the first-line contraceptive choices. Acquire skills to provide these methods or identify
health care providers to whom patients can be referred.
• Continue to make depot medroxyprogesterone acetate, also
known as Depo-Provera, and the contraceptive patch available
to patients, as they are highly effective.
• Allow adolescents to consent to contraceptive care and to control
the disclosure of this information within the limits of state and
federal laws.
• Be aware that it is appropriate to prescribe contraceptives or refer
for IUD placement without first conducting a pelvic examination.
Screening for sexually transmitted infections (STIs), especially
chlamydia, can be performed without a pelvic examination and
should not be delayed.
• Encourage the consistent and correct use of condoms with every
act of sexual intercourse.
• Have a working knowledge of combined hormonal methods and
regimens.
• Remember that adolescents with chronic illness and disabilities
have similar sexual health and contraceptive needs as healthy
adolescents, while recognizing that medical illness may complicate
contraceptive choices.
• Regularly update adolescents’ sexual histories. Provide a confidential setting in which to address needs for contraception, STI
screening and sexual risk reduction counseling for patients who
choose not to be abstinent.
• Allow time with adolescents to address contraceptive needs using
a patient-centered approach, such as motivational interviewing.
• Be aware of state or federally subsidized insurance programs and
clinics that provide confidential and free or low-cost reproductive
health care services.
RESOURCES
• Information on contraceptive needs of young women
with medical conditions, overview of minor consent laws,
www.guttmacher.org/statecenter/spibs/spib_OMCL.pdf.
• Parent Plus, http://bit.ly/aapnewslabc.
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'Start the dialogue'
Physicians urged to counsel teens, ensure they have access to contraceptive services
Hilary Rasch
AAP News 2014;35;16
DOI: 10.1542/aapnews.20143510-16
Updated Information &
Services
including high resolution figures, can be found at:
http://aapnews.aappublications.org/content/35/10/16
References
This article cites 2 articles, 2 of which you can access for free at:
http://aapnews.aappublications.org/content/35/10/16#BIBL
Subspecialty Collections
This article, along with others on similar topics, appears in the following
collection(s):
Adolescent Health/Medicine
http://aapnews.aappublications.org/cgi/collection/adolescent_health:medicine_s
ub
Contraception
http://aapnews.aappublications.org/cgi/collection/contraception_sub
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