American Academy of Pediatrics Updated Recommendations on Contraception and Adolescents

Pediatricians can help ensure teens have accurate information and counseling on their contraceptive options to avoid unintended pregnancies and sexually transmitted disease

While rates of sexual activity, pregnancies, and births among adolescents have declined to historic lows, many teens remain unsure about how to avoid unintended pregnancy and prevent sexually transmitted infections. Pediatricians, building on their trusting relationship with patients, can provide guidance and counseling to help teens reduce their risks.

The American Academy of Pediatrics provides health care providers with tools for counseling teens within a revised policy statement, “Barrier Protection Use by Adolescents During Sexual Activity” and an accompanying technical report, in the August 2020 Pediatrics (published online July 20).

A new clinical report, “Long-Acting Reversible Contraception,” will be published in the same issue (published online July 20). The AAP Committee on Adolescence wrote these 3 documents, which draw on the most recent research for safe and effective use of contraception.

“It’s important for us as pediatricians to help families encourage teens to take responsibility for their own health,” said Laura Grubb, MD, MPH, FAAP, author of the policy statement and technical report on barrier protection and Director of Adolescent Medicine at the Floating Hospital for Children at Tufts Medical Center.  “Discussions about sexuality are important for all children throughout development, and the physician is in a unique position to provide information in a nonjudgmental, safe environment.”

The policy statement, which updates a 2013 statement on condoms, discusses barrier methods and updates descriptions, effectiveness data and proper use of products. The products include the external condom (previously known as male condom), internal condom (previously known as female condom) and other barrier methods. When used consistently and correctly, latex and synthetic barrier methods reduce the risk of many sexually transmitted infections, including HIV, as well as pregnancy.

Barrier protection use by adolescents has declined while STIs have increased significantly over the past decade.

AAP recommends that pediatricians:

• Discuss abstaining from sexual intercourse as the most effective way to prevent genital STIs, as well as HIV infection, and unintended pregnancy.
• Support and encourage the consistent and correct use of barrier methods, as well as other reliable contraception, as part of anticipatory guidance during visits with adolescents who are sexually active or contemplating sexual activity.
• Support the provision of free or low-cost barrier methods within communities, including providing barrier methods within clinics.
• Promote communication between parents and adolescents about healthy sexual development, sexuality, prevention of STIs and pregnancies, and proper use of barrier methods

In a separate and new clinical report, AAP describes the efficacy and long-term cost-benefit of long-acting reversible contraception, also known as LARC.  Available long-acting reversible contraception methods include a progestin subdermal implant and various intrauterine devices (IUDs), all of which are appropriate for use in the adolescent population and are the most effective methods to prevent pregnancy and also offer non-contraceptive benefits such as reducing menstrual blood flow and dysmenorrhea.

The clinical report serves as a supporting document to a policy statement and technical report on contraception previously published by AAP.

While the long-acting reversible methods of contraception are very effective, few teens use them, possibly because they aren’t aware of the options or are concerned about cost or confidentiality, according to research. The report provides pediatricians with a framework to discuss the options, safety and availability of the contraceptives.

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.