On Wednesday, the Centers for
Disease Control delivered some bad news: after steadily increasing their
condom use throughout the 1990s, sexually active teens haven’t shown
any improvement in four years. They are just as likely to risk STDs
today as in 2003.
This is unacceptable. As a
primary care physician with special training in family planning, I refuse
to stand by while teenagers jeopardize their health and their futures.
Here is what I ask every teenage
patient I see: "What are your plans for birth control?" I don’t
whisper. I don’t wink. I ask the same way I ask about an earache.
Then we talk.
I wish the way I treat teens
was common practice for the majority of my fellow physicians. Instead,
I am one of a tiny minority.
Sex. Abortion. Parenthood. Power.
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Last week, Nicole, age 15,
came to me for an abortion. As we spoke, I realized that she had never
talked to a doctor about birth control or STDs. I explained the ring,
the IUD, Depo-Provera, the patch, the various birth control pills, and
the rest. Nicole asked lots of questions, and together we settled on
a shot of Depo combined with condoms. She understood that she could
come back in three months, either to have a second injection or to try
another method. She left my office calm, her worries eased.
As a doctor, I have a unique
opportunity to help my teen patients learn about and take care of their
reproductive and sexual health. Almost all of the hundreds of teens
I have treated have been relieved and grateful that they can talk about
birth control and STDs in a safe, private place where they won’t be
judged. Teenagers want our help with birth control and STD prevention.
Not enough of us provide it.
In a 2005 study of doctors’
checkups of 13- to 18-year-olds in the U.S., researchers found that
only 8% of these appointments covered birth control and only 5% covered
HIV and other STDs.
Eight percent included birth
control? Five percent for STDs? Meanwhile, 46% of 15- to 19-year-olds
have had sexual intercourse at least once. To care for teens properly,
to keep them disease-free, doctors must make reproductive health part
of the routine.
Physicians also have a responsibility
to be accurate when telling teens about birth control and STDs, but
I have found that doctors sometimes give their young patients misinformation.
When I met 18-year-old Sarah, she had a child at home and was pregnant
again. She was angry. She told me that she had an IUD for more than
a year but had it removed after an emergency room doctor told her that
the IUD is the worst method of birth control and increased her risk
of infection. Now she was pregnant for the second time in two years.
I let Sarah know that the IUD
can be the best option for some women, that the risk of infection is
low and can be kept that way if she takes certain precautions. Happy
to have information about the IUD, condoms, emergency contraception,
and other methods to discuss with her partner, Sarah thanked me for
spending so much time talking with her. She promised to return for future
To avoid situations like Sarah’s,
doctors must seek out the training to keep up with developments in birth
control and STDs as well as in adolescent health. And we can’t help
all of the Nicoles if we have trouble broaching the subject of sex or
discussing it in the ways most useful for teens. We must get the training
to handle these conversations. We must also stay current on state laws
regarding confidential care for minors.
If the training programs we
need aren’t there, we must build them. I spent two years on the faculty
of one such program, the Adolescent Reproductive Health Education Project
(ARHEP), which trains physicians to teach other healthcare providers
about teens’ sexual and reproductive health. I met with groups of
doctors and medical students all over the country, presenting contraceptive
updates, as well as creative techniques for working with teens on birth
control and STDs. Through ARHEP and other peer-to-peer learning programs,
we can educate each other to help every teen.
Let’s give the CDC something
positive to report. Let’s address reproductive and sexual health every
time we treat teens. Our patients deserve nothing less.