Long-acting reversible contraceptive devices (LARCs) should be the first choice of birth control for teenage girls, according to new recommendations from the American Academy of Pediatrics (AAP). In a policy statement published in the Sept. 29 online journal Pediatrics, the AAP called on pediatricians to discuss LARCs such as IUDs and progestin implants before other birth control methods with their teenage patients who do not practice abstinence.
The majority of teens who are sexually active use condoms – still recommended to prevent sexually transmitted diseases – or birth control pills. A 2006 to 2010 Health and Human Services survey on teen sexuality and contraceptive use found that 52 percent of teen girls said condoms were used the last time they had sex and 31 percent said they used birth control pills.
At issue is the effectiveness of these birth control methods and their reliance on “in-the-moment” use or remembering to take a daily pill. The Centers for Disease Control and Prevention (CDC) reports condoms have an 18 percent failure rate, and birth control pills have a failure rate of 9 percent.
In a Washington Post interview, Mary A. Ott, MD, an associate professor of pediatrics at the Indiana University School of Medicine and a lead author of the AAP guidelines, said that many major health organizations and agencies are suggesting long-acting contraceptives for teens, in part due to a “decade of data suggesting that LARC [methods] are safe in teenagers and they are the most effective tools we have to prevent pregnancy.”
Inserted in the uterus, IUDs release small amounts of either copper or the hormone progestin and can prevent pregnancy for up to 10 years. These devices have a failure rate of about 0.8 percent. The contraceptive implant is a thin, flexible rod about the size of a match stick and is inserted under the skin of the upper arm, where it releases controlled amounts of progestin. Implants last about 3 years and have a failure rate of 0.05 percent.
Ott admits that barriers to LARC use among teens include cost and access to healthcare providers. The devices must be implanted by a physician and an IUD can cost $500 to $1,000. However, said Ott, LARCs can be more cost-effective over time.
And to parents and teens who have concerns about the safety of IUDs, Ott pointed to 20 years of accumulated data attesting to the safety and efficacy of the devices. Added Ott in the Washington Post, “I always remind families when I’m counseling them that all methods of contraceptives are safer than pregnancy.”