Teen Use of IUDs, Implants Hampered by Clinician Knowledge

April 07, 2015

More adolescents might use long-acting reversible contraception (LARC), which is better at preventing pregnancy than condoms or the pill, if more clinicians were educated about its effectiveness, safety, and use, the Centers for Disease Control and Prevention (CDC) announced today.

LARC refers specifically to intrauterine devices (IUDs) and implants. IUDs were popular in the 1970s, but their use tailed off because of safety concerns. However, redesigned IUDs and implants have sparked renewed interest in LARC, according to an article published online April 7 in the Morbidity and Mortality Weekly Report. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists have both recommended LARC as a first-line choice for teenage contraception, provided it is combined with a condom to protect against sexually transmitted diseases.

The good news about IUDs and implants has yet to fully filter through the public or the healthcare industry. High upfront costs, unfounded safety fears, and a general lack of awareness about this form of contraception have conspired to keep adolescent use of LARC below 5%. LARC gets discussed with teenaged clients at less than 50% of publicly funded family planning clinics, according to one recent survey. Clinic directors attribute this spotty record to the high cost of LARC, staff concerns about teenagers using IUDs, and lack of training on how to implant and remove the devices. Some teenagers think they are too young for LARC as well.

However, there are signs of progress for adolescent contraception and reliance on LARC in particular. The birth rate among teenagers aged 15 to 19 years fell from 61.8 births per 1000 in 1991 to an all-time low of 26.5 births in 2013. Nearly 90% of teenagers used some form of contraception, usually condoms and birth control pills, the last time they had sex.

In addition, the use of LARC among low-income female adolescents seeking help in the government's Title X family planning program rose from less than 1% in 2005 to 7% in 2013. Implants represented most of that growth.

The CDC and the US Office of Population Affairs have recommended that in their family planning talks with teenagers, clinicians should discuss the most effective methods of contraception — namely, LARC — before any others. They also should encourage teenagers not to have sex in the first place.

Morb Mortal Wkly Rep. Published online April 7, 2015. Full text


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