"Always remember to use protection" is a fairly straightforward message for sexually active teens. But young women have a lot of options when it comes to the types of protection they can choose to use.
This week, the American Academy of Pediatricians recommended long-acting reversible contraceptives such as IUDs and contraceptive implants as the best line of defense against teen pregnancies. The American College of Obstetricians and Gynecologists has backed long-acting contraceptives for teens since 2012, as have various women's health groups, saying that these methods are safe and more effective than other forms of contraception.
The problem is, most teens don't know much about IUDs and implants, and doctors sometimes hesitate to prescribe these methods, says Gina Secura, an epidemiologist at Washington University in St. Louis. Besides using condoms, the majority of teens who use birth control use the pill.
But when practitioners told teen women about all their contraceptive options, from most effective to least effective, 72 percent chose long-acting options, according to a study by Secura and her colleagues published Wednesday in the New England Journal of Medicine.
The researchers enrolled more than 1,400 teens in the study, as part of the larger CHOICE study designed to promote the use of long-acting contraceptives.
All of the participants were given contraceptive counseling and provided whatever form of birth control they wanted for free. Over a three-year period, the pregnancy rate among the girls enrolled was much lower than the national average — 34 per 1,000, compared with the national rate of 158 per 1,000 sexually active teens. And the rate of abortion among the teens in the study was a quarter of the national rate.
"I think we thought we would see really low pregnancy and abortion rates, but this is startling," Secura says.
Moreover, whereas teen pregnancy rates tend to be higher among minority women, the pregnancy rates for white and black teenagers in this study were around the same. That, Secura says, suggests that providing all teens with access to good health care and free or affordable contraceptives is the best way to reduce racial disparities in contraceptive use.
The big hurdle, Secura says, is getting more doctors to suggest IUDs and other long-acting methods for teens. Some doctors are hesitant because older versions, like the Dalkon Shield IUD, which was marketed in the 1970s, were found to raise the risk of pelvic inflammatory disease.
And in some cases, providers don't trust teens to know what they want, Secura says. "We see things like providers saying, 'She's just going to change her mind and want the device removed,' " Secura says. "And it's a real bummer."
Teens tend to understand what's best for them, says Dr. Catherine Shubkin, a pediatrician at the Children's Hospital at Dartmouth-Hitchcock in Lebanon, N.H., who wasn't involved in the study.
She says she was a little surprised that so many teens opted for long-acting contraceptives. "I think many teenagers know their limitations pretty well," she says. "They know it's hard to take a birth control pill every single day."
Shubkin says she supports the pediatricians' new guidelines. "Now one of the biggest barriers to their use is getting the message out there," she says. Doctors, as well as teens and their parents, could use a bit more education about IUDs and other long-acting options, she says. "When a teenager makes the decision to have sex, we want her and her partner to know about all the contraceptive options."