Contraception For Adolescents Research Articles

Examining Permanent Contraception for Children, Adolescents, and Young Adults With Intellectual Developmental Disorder: Ethical, Legal, and Medical Considerations: Clinical Report.

There have been significant advances in the medical and surgical options available for contraception and management of menses for individuals, including those with intellectual developmental disorder. This new statement frames the ethical, legal, and medical issues of permanent contraception in children, adolescents, and young adults with intellectual developmental disorder, emphasizing the importance of utilizing long-acting reversible and minimally invasive treatments, whenever possible. The historical use and abuse of permanent contraception is briefly reviewed, providing the foundation for ongoing ethical and legal considerations, including issues of informed consent. The authors then discuss medical decision-making and patient preferences that should be considered and make recommendations to providers who are contemplating permanent contraception therapies in this population.

Contraception options during pubertal transition: Risks, benefits and considerations.

The age of puberty and sexual maturation has been decreasing, highlighting the importance of providing appropriate contraception to girls and adolescents. However, challenges remain, including legal implications and understanding the effects of hormonal methods on pubertal development. This article aims to equip general practitioners with theknowledge of options, as well as their use and limitations, in young people seeking contraception. No one-size-fits-all approach exists for adolescent contraception. Long-acting reversible contraceptives offer superior contraceptive efficacy, with subdermal implants being the most acceptable regarding the insertion procedure. Condoms should be recommended for protection against sexually transmissible infections. Bone health and mood disorders should be considered when prescribing hormonal contraceptives. Despite the lack of robust evidence regarding harm caused by contraception in adolescents, preventing unintended pregnancies should take precedence, with theoretical risks guiding tailored options for individuals.

Intrauterine device use in adolescence: a narrative review.

Contraceptive use in adolescence remains a challenging issue. Adolescents are at high risk of unintended pregnancies and sexual transmitted infections. During the past few decades intrauterine devices are recommended from global health organization, including the American Academy of Pediatrics, American College of Obstetricians and Gynecologists and World Health Organization as a method of contraception for adolescents. Intrauterine devices are part of the long-acting reversible contraceptives (LARCs) and include the copper bearing device (CU-IUD) and the levonorgestrel intrauterine system (LNG-IUS). IUDs are a safe and effective contraceptive method for adolescents with a failure rate less than 1%. Their use is not limited only in contraception. LNG-IUS 52 mg is approved for treating heavy menstrual bleeding and protection from endometrial hyperplasia in women receiving hormone replacement therapy. It can also be an effective tool in the management of dysmenorrhea, while CU-IUD can provide emergency contraception. Nevertheless, IUDs remain underutilized in this group of population. Adolescents' lack of proper education about contraception and sexual behavior creates myths and misconceptions about the possible side effects and the suitability of IUDs in this age group. Furthermore, health care providers remain skeptical and hesitate to suggest IUDs to adolescents. Other barriers including high cost, concern about confidentiality and difficulties in access contribute to its limited use. It is of high importance to eliminate barriers and offer more accessible contraceptive services to adolescents.

Mother-Daughter Dyads’ Perceptions of Contraception

In an increasing number of states, parents must provide permission for their daughters under 18-years-old to start contraception. We sought to understand perceptions among mother-daughter dyads about sources of information, and to describe dyadic interactions when discussing contraception. Dyads were recruited from an adolescent medicine clinic in Dallas, TX. A semi-structured joint interview was conducted with each dyad. Interviews were recorded, transcribed, and coded through an iterative approach. There were 11 dyadic interviews (22 participants). Sources of information about contraception included mothers, healthcare providers (HCPs), friends/family, school, and individualized learning. Dyads identified distinct purposes and limitations of each source. Mothers noted the importance of supporting their daughter's development and specific needs. Often these conversations began with a discussion of menstrual management. Information from friends/family was overwhelmingly anecdotal. Schools and HCPs were viewed as trusted sources, and the internet/social media as possibly inaccurate or misleading. Dyads described several risks and benefits of different methods. Minimal conflict was noted. These results provide rich information about how mother-daughter dyads view contraception in joint discussion. It is important to ensure that accurate stories about contraception are accessible and teaching health literacy would be helpful. Menstrual management appears to be an acceptable starting point to discuss contraception. Schools and HCPs are trusted sources and measures should be taken to ensure teaching is accurate, developmentally appropriate and teaches evaluation of online information. Regardless of parental consent laws for adolescent contraception, engaging caregivers in the process can help support adolescent contraceptive decision-making.

Contraception and Reproductive Health Measurement Instruments for Adolescents and Youth: A Scoping Review

Background The contraception and reproductive health of adolescents and youth is critical to their development and global public health. In order to provide useful references for choosing and optimizing adolescent contraception and reproductive health measurement instruments, the objective of this review is to summarize existing relevant measurement instruments and analyze them in terms of application characteristics, comparison of traditional and newly developed instruments, and psychometric properties. Methods A literature search was conducted of three databases (PubMed, Web of Science, and Embase Database) on articles published between database creation and March 2023, involving contraception and reproductive health measurement instruments for adolescents and youth. After critical appraisal, inductive content analysis was conducted. Results Eventually 14 measuring instruments that met the criteria were included. Most of these instruments have been developed for adolescents and youth and are reliable. Five of the instruments were developed specifically for females and none for male adolescents. In contrast to traditional instruments measuring adolescents’ contraceptive knowledge and contraceptive self-efficacy, newly developed instruments in recent years have focused on including the community and the family in their measurement. Conclusion This review systematically summarizes existing measurement instruments for contraception and reproductive health among adolescents and youth. It provides a solid basis for promoting the use of existing instruments and the development of new ones.

Expanding Access to Contraception for Adolescents—Reproductive Justice and the Emergency Department

Expanding Access to Contraception for Adolescents—Reproductive Justice and the Emergency Department

Feasibility of adolescent contraceptive care in the pediatric emergency department: A pilot randomized controlled trial.

This study assessed feasibility constructs of adolescent contraceptive care in the pediatric emergency department (PED), including contraception initiation. We conducted a randomized trial in two PEDs with pregnancy-capable adolescents aged 15-18 years who were assigned to enhanced usual care (usual) or same-day initiation (same day). All received counseling and clinic referral, but same-day participants could also receive contraception in the PED. We trained PED clinicians in counseling and prescribing. Adolescents and clinicians rated feasibility using five Likert-type items (1 = strongly disagree to 5 = strongly agree) after the session. We assessed PED medication initiation and appropriateness via medical record review and contraception use and side effects at 30 days via adolescent survey. To further explore feasibility, we conducted clinician interviews at study completion; these were audio-recorded, transcribed, and analyzed. We hypothesized contraceptive care would be feasible (defined as average score ≥ 4 across five survey items). We enrolled 37 adolescents (12 in usual and 25 in same-day), mean age was 16.6 years, 73% were Black, and 19% were Hispanic. We trained 27 clinicians. Average feasibility scores were 4.6 ± 0.4 (adolescents) and 4.1 ± 0.8 (clinicians). Eleven (44%) same-day participants initiated contraception in the PED. One adolescent with migraines initially received estrogen-containing pills; this was corrected after discharge. At 30 days, same-day participants were more likely to report contraception use (78% vs. 13%; p = 0.007). One adolescent reported bloating as a side effect. Clinicians enjoyed delivering contraceptive care, found study resource materials useful, and identified staffing shortages as a barrier to care delivery. We are among the first to report on PED-based adolescent contraception initiation to prevent unintended pregnancy. Adolescents and clinicians reported that contraceptive care was feasible. Initiation was common and medications were largely appropriate and tolerated. Future efforts should explore integrating contraceptive care into routine PED care.

Estrogen exposure and skeletal health: Special populations and considerations

Estrogen is critical for bone health from puberty onwards. Various clinical scenarios in adolescence can impact skeletal exposure to estrogen during this vulnerable time. Primary ovarian insufficiency, premature menopause, and anorexia nervosa necessitate prompt evaluation, treatment, and replacement of estrogen in order to optimize accrual of peak bone mass. We have much still to learn about the skeletal impact of delaying puberty and gender affirming hormones in gender diverse individuals. While the choice of hormonal contraception in adolescence is often driven by patient preference and concerns about adherence, providers and patients much take the long-term impact on bone health into consideration. Key Concepts(1)Delayed, diminished or absent estrogen during adolescence has a negative impact on peak bone mass accrual.(2)Hormone replacement therapy is essential for patients with primary ovarian insufficiency and premature menopause.(3)Recovery from anorexia nervosa does not lead to a complete catch-up of bone density lost/not gained.(4)Not all hormonal contraception methods are created equal for the adolescent skeleton.(5)Skeletal health of trans youth is an emerging focus.

Oral contraceptives in adolescents: a retrospective population-based study on blood pressure and metabolic dysregulation.

This study aimed to explore the relationship between oral contraceptive use and blood pressure values and in a national cohort of women adolescents and to investigate the level of coexistence of the high blood pressure levels, dyslipidemia or insulin resistance. This is a retrospective cohort study that evaluated data form 14,299 adolescents aged 14 to 17years. Crude and race-and age-adjusted analyses were performed using Poisson regression to estimate the prevalence ratios. Data clustering analysis was performed using machine learning approaches supported by an unsupervised neural network of self-organizing maps. We found that 14.5% (n = 2076) of the women adolescents use oral contraceptives. Moreover, an increased prevalence of high blood pressure, dyslipidemia, and insulin resistance (all P < 0.001) was observed among adolescents who use oral contraceptives as compared to those who do not. Our analysis also showed that 2.3% of adolescents using oral contraceptives had both high blood pressure levels and dyslipidemia, whereas 3.2% had high blood pressure levels combined with insulin resistance (all P < 0.001). The algorithmic investigative approach demonstrated that total cholesterol, LDLc, HDLc, insulin, and HOMA-IR were the most predicted variables to assist classificatory association in the context of oral contraceptive use among women adolescents with high blood pressure. These findings suggest that oral contraceptives were associated with an increased prevalence of high blood pressure, dyslipidemia, and insulin resistance among women adolescents. Although the indication of this therapy is adequate to avoid unintended pregnancies, their use must be based on rigorous individual evaluation and under constant control of the cardiometabolic risk factors.

Developing a theory of change - the importance of rich process data and authors' insights into context, implementation and mechanisms.

Theories of change explaining how interventions work are increasingly important, yet the methods/data to develop these are less advanced than for evaluating effects. We conducted a systematic evidence synthesis to develop a theory of change for structural adolescent contraception interventions. We reflect on the utility of the information provided in evaluation reports. Few of the included evaluations presented their theory of change, or included rich, qualitative process data. Authors' descriptions of context and implementation, typically in introduction and discussion sections, were very useful. These helped to understand the intervention's context, how it was experienced and why or how it had the effect that it did. We recommend incorporating rich process evaluations into studies, and reporting contextual insights into the intervention's development, implementation and experience. We also recommend including these data and insights within syntheses that aim to develop theories of change.

How do South African policies address provision of contraception among adolescents?

The South African government has pioneered several policy documents that emphasise the importance of sexual and reproductive health (SRH). We examined how national policies address access and provision of contraception to adolescents in South Africa. South African national policies. We systematically searched various academic databases such as EbscoHost, Science Direct, Google Scholar, PubMed and Scopus, and other relevant sources to obtain 854 policy documents. Using a set of explicit inclusion criteria, we screened and selected 11 South African policies for analysis. Next, we analysed three international policies and frameworks to extract the key elements from them. Thereafter, we used these key elements to develop an analytical framework for conducting the analysis of the South African national policies. We found that South Africa's SRH policies largely address the provision of contraception by following international guidelines. These policies recognise the value of providing contraception to adolescent girls. However, we also found gaps in some policies, which could impede how they are translated into practice. These include recognising that adolescent boys can play a role in contraception; adolescents have varying SRH needs and are a key stakeholder not only for policy development but also for monitoring and accountability. With a specific focus on South Africa's contraception services in the public sector, these findings are relevant to policymakers, providers and users of contraceptives.Contribution:This review proposes recommendations that will assist with strengthening health policy development and thus improve primary health care services related to contraception for adolescents.

75. Extreme Precipitation Events and Adolescent Contraception in Sub-Saharan Africa

75. Extreme Precipitation Events and Adolescent Contraception in Sub-Saharan Africa

Development of a serious game for learning about safe sex and contraception in adolescence

Objetivos: desenvolver um serious game em aplicativo mobile para aprendizagem sobre sexo seguro e contracepção com a participação ativa dos adolescentes; e avaliar conteúdo, aparência e usabilidade da tecnologia com adolescentes e experts . Método: trata-se de uma pesquisa aplicada, de produção tecnológica sobre o desenvolvimento de um serious game , realizada em duas etapas: desenvolvimento da tecnologia propriamente dita; e avaliação do conteúdo, aparência e usabilidade do aplicativo. Adolescentes de uma escola pública da cidade de São Paulo-Brasil participaram da etapa de desenvolvimento da tecnologia . A avaliação foi realizada pelos adolescentes e experts nas áreas de saúde coletiva e tecnologia em saúde. Seguiram-se os critérios: aspectos educacionais, interface do ambiente e recursos didáticos. Resultados: desenvolveu-se Prinventon App ® , um serious game ambientado em uma cidade virtual, projetado para abordar a sexualidade na adolescência. O aplicativo obteve 90% de respostas positivas e apresentou Índice de Validade de Conteúdo de 0,80, sendo considerado adequado. As sugestões e apontamentos foram acatados e implementados. O serious game foi considerado interessante e importante diante do tema abordado. Conclusão: a tecnologia desenvolvida pode auxiliar os adolescentes na aprendizagem sobre sexo seguro e contracepção, ao abordar, de maneira lúdica e realística, a sexualidade na adolescência.

Development of a serious game for learning about safe sex and contraception in adolescence

Objetivos: desarrollar un serious game en aplicación móvil para el aprendizaje sobre sexo seguro y anticoncepción con la participación activa de los adolescentes; y evaluar contenido, apariencia y usabilidad de la tecnología con adolescentes y expertos. Método: se trata de una investigación aplicada, de producción tecnológica acerca del desarrollo de un serious game , realizada en dos etapas: desarrollo de la tecnología propiamente dicha; y evaluación del contenido, apariencia y usabilidad de la aplicación. Adolescentes de una escuela pública de la ciudad de São Paulo-Brasil participaron en la etapa de desarrollo de la tecnología. Ya la evaluación fue hecha por los adolescentes y expertos en las áreas de salud colectiva y tecnología en salud. Se siguieron los criterios: aspectos educacionales, interfaz del ambiente y recursos didácticos. Resultados: se desarrolló Prinventon App ® , un serious game ambientado en una ciudad virtual, diseñado para abordar la sexualidad en la adolescencia. La aplicación obtuvo 90% de respuestas positivas y presentó Índice de Validez de Contenido de 0,80, siendo considerado adecuado. Las sugerencias y apuntes fueron acogidos e implementados. El serious game fue considerado interesante e importante ante el tema abordado. Conclusión: la tecnología desarrollada puede ayudar a los adolescentes en el aprendizaje sobre sexo seguro y anticoncepción, al apuntar abordar, de manera lúdica y realista, la sexualidad en la adolescencia.

Place de la santé sexuelle en médecine générale

ObjectiveAssessment of the practices and knowledge of general practitioners in Bouches-du-Rhône and Vaucluse regarding their patients's sexual health. MethodA descriptive cross-sectional study was conducted among general practitioners in Bouches-du-Rhône and Vaucluse from January 12, 2023 to February 9, 2023. A questionnaire was developed and sent to general practitioners practicing in Bouches-du-Rhône and Vaucluse. It was distributed by personal and professional emails and numbers, and Bouches-du-Rhône and Vaucluse's medical order. The questionnaire was divided into three parts: the first collected demographic and epidemiological data, the second assessed knowledge and practices of general practitioners regarding the sexual health, and the last evaluated practitioner's obstacles to talking about sexual health. ResultsNinety-nine general practitioners responded to the questionnaire (99/276, 35.9%). In all, 30.3% obtained a rate of correct answers>60%. The general practitioners with the best response rates had training in sexology or a degree in gynecology (P=0.0109). In their practices, some topics such as contraception for adolescents, the reassessment of contraception, the search for vulvuvaginal disorders in postmenopausal patients are more addressed by doctors and in particular those of the female sex. Other topics such as sexual violence, male sexual dysfunction and sexual health in patients over 70 are less discussed in consultation. ConclusionThe care of sexual health is an important part of global health, specific to the profession of general practitioner. The results of our study suggest that the knowledge and practices of general practitioners in Bouches-du-Rhône and Vaucluse, are perfectible. The establishment of professional training, consultation dedicated to prevention, or even better awareness of sexual health professionals would promote a better screening.

Can cash transfer interventions increase contraceptive use and reduce adolescent birth and pregnancy in low and middle income countries? A systematic review and meta-analysis

Becoming pregnant and giving birth under the age of 20 is associated with a range of adverse social, socioeconomic and health outcomes for adolescent girls and their children in Low and middle income countries. Cash transfers are an example of a structural intervention that can change the local social and economic environment, and have been linked with positive health and social outcomes across several domains. As part of a wider review of structural adolescent contraception interventions, we conducted a systematic review on the impact of cash transfers on adolescent contraception and fertility. Fifteen studies were included in the review with eleven studies providing evidence for meta-analyses on contraception use, pregnancy and childbearing. The evidence suggests that cash transfer interventions are generally ineffective in raising levels of contraceptive use. However, cash transfer interventions did reduce levels of early pregnancy (OR 0.90, 95% CI 0.81 to 1.00). There was suggestive evidence that conditional, but not unconditional, cash transfers reduce levels of early childbearing. Given that much of the evidence is drawn from interventions providing cash transfers conditional on school attendance, supporting school attendance may enable adolescent girls and young women to make life choices that do not involve early pregnancy.

Contraception in Adolescents with Complex Disease Entities

Contraception in Adolescents with Complex Disease Entities

Long-acting reversible contraception in gender-diverse adolescents and young adults: Outcomes from a multisite collaborative

ObjectivesThis study aimed to describe the clinical experience of gender-diverse adolescents and young adults receiving long-acting reversible contraception (LARC). Study designThis was a secondary analysis of prospectively collected quality improvement data among gender-diverse adolescents and young adults receiving LARC in four adolescent medicine clinics. ResultsMost attempted insertions (59/63) were successful. A majority (54%) chose LARC for both contraception and menstrual management. Pelvic pain/cramping and unsatisfactory bleeding were reported side effects. One known expulsion and six known LARC removals occurred. ConclusionsGender-diverse adolescents and young adults had high rates of successful LARC insertion and demonstrated a side effect profile similar to a broader adolescent and young adult population seeking LARC care. ImplicationsLARC is an important and well-tolerated method of menstrual management and contracention in gender-diverse adolescents and young adults, although more investigation is needed to understand how gender-affirming testosterone therapy may impact the LARC experience in this population.

Caregivers’ Perception on Adolescents’ Access on, Use of, and Support Required to Prevent Unwanted Pregnancies in Lesotho

Background: Usage of hormonal or barrier contraception by adolescents is challenging for most adolescents. The study revealed new evidence of caregivers’ support to adolescents on access and effective contraception use to prevent unwanted pregnancies in k.w. There is a need for adolescents’ user-friendly services, supportive supervision, accommodative cultural and religious practices, and the promotion of independent decisions. Objectives: To explore and describe caregivers’ perceptions of access (1) and the use of (2) contraception for adolescents in Lesotho and to explore and describe caregivers’ perception of types of support needed for adolescents to prevent unwanted pregnancies in Lesotho (3). Methods: A qualitative explorative, descriptive, and contextual design. Purposive sampling caregivers of adolescents in a government primary health care facility with the highest outpatient number in Maseru district, Lesotho. Five focus groups with six participants each, which included (N=30) participants, were conducted using an interview schedule. Data were analysed using Creswell’s six steps of data analysis with the assistance of a co-coder. Results: Three categories emerged, namely (1) access to contraception by adolescents, (2) use of contraception by adolescents, (3) and support to prevent unwanted pregnancies with respective themes and sub-themes emerged. Conclusion: Contraception use among adolescents is challenging. Adolescents’ caregivers disclosed being unskilled to discuss sexuality due to their cultural and religious background. Basic sexuality education has been included in the school curriculum. Service providers’ attitudes and rigid health services contribute to the limited access to contraception for adolescents.

The effect of depression and anxiety on nonbarrier contraception in adolescents and young adults: A scoping review.

The effect of depression and anxiety on nonbarrier contraception in adolescents and young adults: A scoping review.