In new recommendations released Monday, the American Academy of Pediatrics (AAP) suggests intrauterine devices (IUDs) and contraceptive implants over other pregnancy prevention methods for sexually active teenage girls.
The policy statement, which was published in the October issue of Pediatrics and replaces a statement written in 2007, notes that pediatricians have an important role to play in reducing teen pregnancy and promoting contraceptive use.
The AAP has made recommendations on contraception to its members since 1980 and suggested that pediatricians become familiar with all contraceptive methods as well as the negative consequences of unintended teen pregnancy. This is the first time, however, that the organization has recommended that pediatricians consider long-acting reversible contraceptive methods (LARCs), including IUDs and implants, for their patients before other methods.
The recommendations note that pediatricians should encourage correct use of condoms for every sexual act, even for those adolescents using a LARC method. This is particularly important because neither the IUD nor the implant prevent the transmission of sexually transmitted infections, including HIV.
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IUDs are small, T-shape devices that are inserted into the uterus by a physician. They prevent pregnancy primarily by interfering with the path of the sperm toward the egg.
Two of the IUDs on the market—Mirena and Skyla—release hormones similar to those in some birth control pills, which thickens the cervical mucus (creating a barrier to sperm) and may also prevent ovulation. The other type of IUD, called ParaGard, releases copper, which is thought to create an environment that is toxic to sperm.
ParaGard lasts for ten years, Mirena for five, and Skyla for three years, but any of them can be removed if a user wishes to become pregnant.
Contraceptive implants, sold under the brand name Nexplanon, are flexible plastic devices about the size of a matchstick that are inserted under the skin on a woman’s upper arm.
LARC methods are highly effective in large part because users can “set them and forget them.”
All contraceptive methods have two efficacy rates: the perfect use rate, which shows how well they can work if used consistently and correctly, and the typical use rate, which shows how well they do work for average couples during the first year.
The typical use rate for most contraceptive methods is lower than the perfect use rate because people make mistakes, from forgetting to refill a pill prescription to leaving the condom in the night table drawer. For LARC methods, however, the perfect use rate and the typical use rate are essentially the same; if the method is properly inserted by a physician, users can’t make mistakes.
IUDs have a failure rate of less than 1 percent. Implants have a failure rate of 0.05 percent, meaning that out of 100 couples who use these methods as their primary form of birth control, fewer than one couple will experience an unintended pregnancy in the first year of use.
Though IUDs were once thought to be safe only for older women or women who had already had children, research in the past decade has found that they are safe for women of all ages, including adolescents. Implants have also been found to be safe for women of all ages.
Given the safety and efficacy of these devices, many experts believe that they are the ideal birth control method for young women.
In 2012, the American Congress of Obstetricians and Gynecologists recommended that LARCs be considered the first-line contraceptive method for adolescents. That opinion read, in part:
When choosing contraceptive methods, adolescents should be encouraged to consider LARC methods. Intrauterine devices and the contraceptive implant are the best reversible methods for preventing unintended pregnancy, rapid repeat pregnancy, and abortion in young women.
The AAP recommendations released this week are similar but focus more on the role the pediatrician should play.
Pediatricians should be able to educate adolescent patients about LARC methods including progestin implants and IUDs. Given the efficacy, safety, and ease of use, LARC methods should be considered first-line contraceptive choices for adolescents. Some pediatricians will choose to acquire the skills to provide these methods to adolescents. Those who do not should identify health care providers in their communities to whom patients can be referred.