Your child’s doctor probably asks a lot of questions during a routine checkup.
Does your child eat a heathy diet, do they sleep enough hours, what kind of physical activity do they get?
All of these are fairly standard lines of inquiry at a general health visit.
But as your child grows into their teens, some in the medical profession are calling for one more question to be directed at your daughter.
Do you plan to become pregnant in the next year?
According to experts, that one simple question can facilitate a much-needed conversation that teens and their parents should have about sexual health and contraception.
What’s more, they say, it can ultimately prevent an unplanned pregnancy.
“Pediatricians certainly have varying degrees of comfort when talking about sexual health,” Dr. Elise Devore Berlan of the Nationwide Children’s Hospital in Ohio, told Healthline. “We should think about asking the question, ‘Do you want to become pregnant next year?’”
Teens and birth control
Berlan is also the founder and director of Birth Control for Teens, also known as BC4Teens.
The program gets teenagers and parents to talk about sex, birth control, and sexually transmitted diseases. Access to contraception is also a major focus of the program.
Since it opened in June 2014, BC4Teens has provided care and contraception counseling for approximately 1,200 people in the two clinics it operates.
The organization also educates and trains medical professionals on how to talk to teens about pregnancy and contraception.
Obstetricians routinely ask patients about their intentions of getting pregnant. But usually those women are older.
The American Academy of Pediatrics (AAP) recommends that teenagers receive appropriate education about sexual health and contraception from their doctors.
But when the question of pregnancy intention is posed to a teenage girl, what tends to transpire is a more involved line of inquiry, according to Berlan.
She said doctors need to be trained on how to ask this question. That’s because any dialogue with teens about sex and contraception will include a discussion about family values, cultural expectations, religious beliefs, and socioeconomic capabilities.
“It’s not as easy as it sounds,” she said. “Patients may challenge your paradigm of what you think is right for them.”
Yes, and no
It’s fair to say that most teens don’t want to become pregnant, Berlan noted. But a small percentage does. And others haven’t given the idea much thought.
She said regardless of the answer, it’s up to the doctor to “meet the patient where they are.”
A “No” answer from her patients will lead Berlan to a discussion about options for contraception. This includes forms that include the pill, condoms, IUDs, and abstinence.
A “Yes” answer prompts Berlan to find out how long her patient has felt this way. She makes every effort to get to the heart of why a teenager would want to get pregnant.
“A lot of times it’s ‘I want someone to love me,’” Berlan said.
When a teen does express interest in getting pregnant, doctors must take a measured approach when following up. Berlan said, she still has to remind herself to check her own value systems at the door.
“Not tell her anything, but ask questions. Not judge her, show her that I’m going to respect her,” she said. “[Me] being open, and inquiring about pregnancy intention can yield a lot of fruit.”
It may seem surprising that some teens don’t have any feelings around pregnancy, or at the very least they haven’t given it much thought.
‘No opinion’ most concerning
It’s this middle-of-the-road response that can end up being the most problematic, according to Bill Albert, chief program officer of the National Campaign to Prevent Teen and Unplanned Pregnancies (NCPTUP).
“Ambivalence about pregnancy is a huge risk factor,” he said.
Albert noted that the pregnancy rate for teens who haven’t given much thought about becoming pregnant is about as high as it is for girls who want to get pregnant.
So that simple question from a doctor can help to “attack that ambivalence,” and ignite a conversation about pregnancy prevention, according to Albert.
“Those in the middle are very much at risk because they are less likely to use a condom,” she said.
Teen pregnancies on the decline
In 2015, nearly 230,000 teens in the United States gave birth. That’s about 22 births per every 1,000 girls.
That number may seem high, but the teenage pregnancy and birth rates across the United States have dropped significantly since the early 1990s. That’s when birth rates peaked, according to NCPTUP.
Teen pregnancy and teen births have declined as much as 50 percent and 64 percent, respectively. This is across all 50 states, and all races and ethnicities, according to NCPTUP.
Albert said the decline is due to a number of factors. Teens are having less sex, which he attributed in some cases to HIV and AIDS awareness. He also credits more choices in contraception and quick access to contraception.
Berlan said it’s unclear if that easy access will continue now that Congress is intent on repealing the Affordable Care Act (ACA). The program’s birth control mandate is why medical professionals are able to provide contraception so readily.
“We don’t have to provide prior authorization for birth control because of ACA,” she said. “I tell people that it’s good you’re getting it now because it’s not clear that you'll be getting it in the future.”
Albert applauds programs such as BC4Teens for its role in bringing together teens and their parents. Any opportunity for a parent to have an open conversation with their child about sexual health is a step in the right direction, he added.
Albert said parents tend to have a “crisis in confidence” when it comes to advising their child about sex. But they shouldn’t. According to NCPTUP surveys, teens say that parents do influence their views on sex.
It’s fitting, he added. Parents have a say in what their children eat, when they go to sleep, if and where they go to college. Why wouldn’t they have the same influence when it comes to sexual health?
Albert added that any parent who feels insecure in talking about sexual health with their child should cast aside those doubts and take the first step.
“You can’t wait around and have your kid ask you about sex,” he said. “It’s 2017. Do any of us think anyone at the age of 17 is ready to take on the lifelong challenges of becoming a lifelong parent?”