By Jeanne Whalen
Doctors prescribing contraception to teenage girls who are
sexually active should recommend long-acting, implantable devices
as a first choice due to their high efficacy rates, the American
Academy of Pediatrics said in an updated policy statement.
The AAP also backed abstinence counseling, saying "adolescents
should be encouraged to delay sexual onset until they are ready."
But because adherence to abstinence is low in many teens, all
adolescents should be counseled about birth-control options, the
AAP said.
Intrauterine devices, or IUDs, and a separate type of device
that is implanted in the upper arm are safe for teens to use and
are more effective than birth-control pills or condoms at
preventing pregnancy, the AAP said. It added that all sexually
active teens should use condoms, as well, to prevent sexually
transmitted infections.
Hormone-containing devices that are implanted in the arm,
including the brands Implanon and Nexplanon from Merck & Co.,
have failure rates of less than 1% and can remain in place for
three years, the AAP said in a policy statement published in the
journal Pediatrics. IUDs, which are inserted in the uterus, also
have failure rates under 1% and can remain in place for between
three and 10 years.
If birth-control pills are used perfectly they also have failure
rates under 1%, but many women forget to take the pills, resulting
in a real-world failure rate of about 9%, the AAP said. Condoms
fail in less than 2% of cases if used perfectly, but in 18% of
cases if used typically.
"Implants are ideal for adolescents who prefer a method that
does not require regularly scheduled adherence and who desire an
extended length of protection," the AAP said. It noted that IUDs,
while not widely used in the U.S., are used "extensively world-wide
because they are safe and effective." The devices got a bad
reputation in the U.S. after a safety scandal in the 1970s
involving the Dalkon Shield brand, but IUDs available today are
much safer.
The AAP recommended that pediatricians discuss "the most
effective contraception methods first" with teens.
The new policy statement updates one published in 2007, which
advised pediatricians to discuss "abstinence, appropriate
contraceptive use and protection from STIs" with teens but didn't
rank contraception in order of effectiveness.
Nearly half of U.S. high-school students report ever having had
sexual intercourse, and each year, roughly 750,000 U.S. adolescents
become pregnant, the AAP said.
Write to Jeanne Whalen at jeanne.whalen@wsj.com
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