When it comes to effective birth control for teens, “the pill” might be considered a reproductive relic.
An updated policy statement released today by the American Academy of Pediatrics suggests doctors counsel teens about the advantages of other birth control options — like intrauterine devices (IUDs) or birth control implants — before the pill.
“On some level, when people see ‘teens should have IUDs,’ it sounds surprising,” said Dr. Mary Ott, associate professor of pediatrics at the Indiana University School of Medicine, and one of the lead authors of the policy statement.
The AAP “is not recommending that young people have sex. It is recognizing that young people will have sex and we want them to be safe and protected with the most effective methods available.”
For the uninitiated, the pill is taken on a daily basis to inhibit ovulation. And that detail — taking it daily — is part of why unintended pregnancy occurs about 9% of the time for this method among adults. Experts say the rates are likely higher among teens.
The failure rate for IUDs — a T-shaped device inserted into the uterus to prevent pregnancy — and implants is less than 1%.
IUDs and implants are more effective, in part because the risk of failure and pregnancy does not hinge on taking a pill daily. They are implanted and last for years, not days — part of a category of contraceptives called long-acting reversible contraception, or LARC.
“Adult women can’t remember to take the pill every day,” said Dr. Tonya Chaffee, director of the Teen and Young Adult Health Center at San Francisco General Hospital. “How should we expect adolescents to remember?”
It would seem to be simple: Use the most effective birth control methods, and rates of teen pregnancy — and maybe even abortions and STDs — could plummet. It is what happened when health officials in Colorado introduced low-cost IUDs to young women at high risk of pregnancy: The state’s teen birth rate dropped 40%.
But the conversation is far from simple. American culture is still skittish about the idea of teens having sex, say experts. That makes practical conversations about contraception between doctors and teenagers that much more difficult, says Chaffee.
“Our culture in general is so afraid of sex, and that has led to high adolescent pregnancy and STD (sexually transmitted disease) rates,” she said.
According to a 2012 study, U.S. teens are about twice as likely to give birth as teens in Canada; four times as likely as teens in Germany.
“Teen pregnancy rates in the United States are unacceptable,” said Ott. “It’s not about differences in sexual behavior. What’s different is we don’t use contraceptives as well as kids in other countries.”
Not as well and not as often, said Ott.
One way to broach this issue is by parents and doctors broadening their talks with teens, said Chaffee.
“The conversation should be more above the waist, not just about latex and IUDs,” said Chaffee, adding that conversations should be about relationships, break-ups, cheating, falling in love, trust and self-respect.
“We don’t have those conversations — that’s the problem,” said Chaffee, a professor of pediatrics at the University of California, San Francisco. “So we’re not preparing (teens) in an adequate way.
“Once we get to that level, having the conversation about what kind of birth control to use is easy.”