Long-Acting Reversible Contraceptives Are Best for Teens, Says AAP

By Will Boggs, MD, and Nancy Lapid

NEW YORK (Reuters Health) - For adolescents who choose not to abstain from sex, an updated American Academy of Pediatrics (AAP) policy statement favors the use of long-acting reversible contraceptives.

"All methods of hormonal birth control are safer than pregnancy," Dr. Mary A. Ott from Indiana University School of Medicine, Indianapolis, Indiana told Reuters Health. "Long acting reversible contraceptive (LARC) methods, including the contraceptive implant and the intrauterine device, are considered first line contraceptive choices for adolescents who choose not to be abstinent."

Dr. Ott and colleagues on AAP's Committee on Adolescence updated the 2007 policy statement with a description and rationale for best practices in counseling and prescribing contraception for adolescents. Their statement in the September 29th Pediatrics online issue was accompanied by a related technical report coauthored by Dr. Ott.

After reviewing such issues as confidentiality, sexuality history taking, and counseling about abstinence and contraception, the report describes the available methods of contraception. A section on special populations follows, and the policy statement concludes with nearly a dozen recommendations for pediatricians.

Pediatricians are advised to counsel about and ensure access to a broad range of contraceptive services, with a special focus on LARC 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.

It is appropriate to prescribe contraceptives or to refer adolescents for IUD placement without first conducting a pelvic examination, according to the policy statement.

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, pediatricians must recognize that the contraceptives discussion is ongoing, and this requires time for their adolescent patients to address their needs "using a developmentally appropriate, patient-centered approach, such as motivational interviewing."

"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 (11-14 years of age)," Dr. 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 (STI) prevention and contraception by late adolescence (18-21 years of age)."

"Adolescents are capable of understanding complex messages about sexual health," Dr. 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, University of Kentucky, Lexington, Kentucky, 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 LARC are the most effective means of preventing unwanted pregnancy."

"Counseling should start around menarche because most pregnancies occur the first 6 months of sexual activity, so earlier knowledge does help," he explained.

"Counseling should always include abstinence, STIs, and condom use," Dr. Omar concluded.

SOURCES: http://bit.ly/1u6tgVw and http://bit.ly/1wRJnFM

Pediatrics 2014.

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