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 All methods of hormonal birth control, including contraceptive
pills, are safer than pregnancy, Dr. Mary A. Ott from the Indiana
University School of Medicine in Indianapolis, Indiana told Reuters
Health by email.
But long acting reversible contraceptive (LARC) methods, including
the contraceptive implant and the intrauterine device (IUD), should
be the first-choice contraceptive methods for adolescents who choose
not to be abstinent, she added.
Today in the medical journal Pediatrics, Ott and colleagues on the
AAP’s Committee on Adolescence updated the organization’s 2007
policy statement on prescribing contraception for adolescents.
After reviewing such issues as confidentiality, discussing a teen’s
sexual history, and counseling about abstinence and contraception,
the policy statement advises pediatricians to counsel teens about a
broad range of contraceptive services, with a special focus on
long-acting reversible contraceptives.
The policy statement also urges pediatricians to ensure that
adolescents have access to these methods. In order to do so, they
must be familiar not only with national best practice
recommendations for confidential care, but also with state and
federal laws regarding consent to contraceptive care and information
disclosure, the paper notes.
Once an appropriate contraceptive method has been selected, the
pediatrician should encourage its consistent use along with
consistent and correct use of condoms with every act of sexual
intercourse.
These principles should also apply to the care of adolescents with
chronic illnesses and disabilities, while recognizing that those
illnesses may complicate the contraceptive choices.
Finally, the AAP says, pediatricians must recognize that the
contraceptives discussion is ongoing, and this requires time for
their adolescent patients to have their needs addressed in a
“developmentally appropriate” way.
“The Bright Futures best practice guidelines from the American
Academy of Pediatrics and the Maternal and Child Health Bureau
recommend starting to speak to adolescents confidentially about
puberty, relationships, and sexual behaviors starting in early
adolescence,” at ages 11 to 14, Ott explained.
“Bright Futures recommends that counseling be developmentally
tailored to the adolescent, with a stronger focus on abstinence in
early adolescence gradually focusing more on healthy relationships
and sexually transmitted infection prevention and contraception by
late adolescence,” or ages 18 to 21, she continued.
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“Adolescents are capable of understanding complex messages about
sexual health,” Ott said. “Adolescents trust pediatricians and
understand that their pediatricians can simultaneously encourage
abstinence and provide non-judgmental contraceptive information and
care.”
Dr. Hatim Omar, Division of Adolescent Medicine chief at the
University of Kentucky in Lexington, told Reuters Health, “Teens are
less likely to be compliant and because of their development are not
fully aware about consequences (‘it won’t happen to me’), so proper
counseling and using long-acting reversible contraceptives are the
most effective means of preventing unwanted pregnancy.”
“Counseling should always include abstinence, STIs, and condom use,”
Omar concluded.
Not all parents will welcome the interventions, however.
Eric Scheidler, executive director of the Chicago-based Pro-Life
Action League, told Reuters Health that as a father of daughters he
finds it “horrifying” that their pediatrician would promote
contraception.
“I’d prefer for this discussion about teen sexuality to be a
discussion between parents and children and not a girl and her
doctors,” he said in a phone call. “It’s not just a medical
decision, it’s a moral decision. It ties into a girl’s aspirations,
her personality, her state of mind” – things a parent knows better
than the child’s doctor, he added.
“The recommendation from the APP can’t replace the parental
relationship,” Scheidler said.
SOURCES: http://bit.ly/1u6tgVw
and http://bit.ly/1wRJnFM
Pediatrics, online September 29, 2014.
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reserved.] Copyright 2014 Reuters. All rights reserved. This material may not be published,
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