Adolescent Contraception

Abstract

Many adolescents in the United States remain at risk for an unplanned pregnancy despite advances in contraceptive technology and increased availability of birth control methods. Physicians who care for adolescents need to be familiar with the various contraceptive measures and their appropriateness for adolescents. A health professional must also be prepared to participate in sex education and to counsel or refer individual teenage patients when sexual problems occur. Attention in this discussion of adolescent contraception is directed to the following: reasons for nonuse of contraception, postcoital contraception, oral contraception (contraindications, side effects, guidelines for use in adolescents, and the mini-pill (progestogen only), IUDs, diaphragms, vaginal chemical contraceptives, condoms, withdrawal or rhythm, intervention techniques, and selection of the proper method. The average adolescent is exposed to unprotected intercourse for a year or longer before requesting contraception. Available evidence suggests that teenagers today may be using contraceptives more than ever before, yet a significant number fail to use a method for a variety of reasons. Most reasons reflect lack of knowledge; some reflect nonavailability. The reasons include ignorance of fertile periods, a belief that their age is protective, infrequent or unanticipated intercourse, and strong guilt feelings evoked by the idea of being prepared for the possibility of sexual intercourse. Many adolescents are hesitant to ask for contraceptive advice or prescriptions from private physicians because they fear lectures on morality and refusal of their requests. There is evidence in at least 1 study that locating the family planning clinic within the school is effective in lowering pregnancy rates and ensuring high continuation rates after 36 months of followup. Intervention techniques that might be effective include providing a method immediately following an event (abortion, birth, rape) when motivation is highest and tailoring the method to the individual life style and preference. If no contraindications exist, the teenager should be given the method preferred and a method that is geared to frequency of intercourse. A backup method should also be provided if the preferred method is not tolerated or never started. To maximize continuation rates, frequent followup is essential.