Most teenage girls choose condoms or birth control pills for contraception. The American Academy of Pediatrics (AAP) now recommends intrauterine devices and other implants as more reliable for preventing teen pregnancy.
In a new policy statement published in Pediatrics, the AAP is recommending for the first time that sexually active teens use a Long Acting Reversible Contraceptive (LARC).
Intrauterine devices (IUDs) and small implants placed underneath the skin are both LARCs. IUDs are inserted into the uterus by a healthcare professional. There are two levonorgestrel-releasing T-shaped IUDs on the market, as well as a copper-containing T-shaped IUD. Under-the-skin implants are inserted in the inside of the upper arm by a doctor or nurse.
The last time the AAP issued contraception recommendations was in 2007. According to the AAP, in the past decade, LARCs, which provide three to 10 years of continuous birth control coverage, have been shown to be safe for teens and young adults.
Nearly half of U.S. high school students report having had sex at least once, the AAP says. Each year, about 750,000 young people get pregnant, and more than 80 percent of those pregnancies are unplanned.
Condoms are the most frequently used form of contraception (52 percent of girls reported condom use at last sex). Use of more effective hormonal methods, including oral contraceptives, was lower, at 31 percent for birth control pills in 2011. Use of highly effective, long-acting, reversible contraceptives, such as implants or IUDs, was much lower still.
Dr. Anne T. Nucci-Sack, a pediatrician and medical director of the Mount Sinai Adolescent Health Center in New York City, told Healthline, “The AAP policy statement is totally groundbreaking. The long-acting reversible methods, whether an IUD or implant, seem to be more effective in terms of pregnancy prevention because you don’t have to worry about taking them. Having something that is consistent, where you don’t have to rely so much on schedules, getting refills, and remembering to take things, is very important in terms of making sure your contraceptive method is as effective as it could be.”
Women who choose a birth control pill, patch, or ring may do well using these birth control methods, but because they have to return for office visits and pharmacy refills, these options may be less reliable than an IUD or implant that remains in place for years.
IUDs and implants “are almost impossible to override, and they are the only two methods shown to be highly effective in terms of reducing unwanted and unintended pregnancy,” Nucci-Sack said.
The AAP statement also says that pediatricians should recommend the use of condoms to prevent sexually transmitted diseases (STDs).
Nucci-Sack said, “The prevalence and rate of transmission of STIs in adolescents is much higher than in the general population. It is really important to emphasize that not only are condoms protecting you against STIs, but sometimes you have failures of [birth control] methods. Sometimes IUDs can wiggle out or they can be [expelled from the body] … This happens in a small percentage of cases, but you still want to have a condom as back-up birth control.”
Will parents be happy or dismayed by the AAPs recommendation that pediatricians talk to their kids about sex and birth control? Nucci-Sack said that according to the Youth Risk Behavior Survey, 5.6 percent of high school students say they’ve had sex before the age of 13.
“If you say your kid is not sexually active, there is a 50/50 chance you could be wrong,” she said. “Teens are sexually active. It’s part of adolescent development. The reality of teen pregnancy has to hit home. Pediatricians should start having conversations with parents when their child becomes a preteen or a teen. These are the issues that are going to come up.”