Every year more than 750,000 American teens become pregnant, and over 80 percent of these pregnancies are unplanned. That may be about to change. If teens take to the latest wave of birth control technologies the way they’ve taken to cell phones, unplanned pregnancy could go the way of landlines and stretchy handset cords.
On October 2, the American Academy of Pediatrics published updated practice guidelines for medical providers serving adolescent patients. The new guidelines endorse three kinds of long acting reversible contraceptives (LARCs) including state-of-the-art IUDs and implants that are total game changers when it comes to unintended teen pregnancy.
These methods have been slow to arrive in the United States, largely because of an early defective IUD that caused infection and injury during the 1970’s, traumatizing women, doctors, and regulators. But since that time, later generations of long acting contraceptives have become the norm in other countries. No one method works for everyone, and any contraceptive decision requires that a young woman and her medical provider weigh any risks of a given method against other methods or none at all, meaning the health and life risks of pregnancy. Nevertheless, in 2012, the American Congress of Obstetricians and Gynecologists finally gave long acting contraceptives a strong endorsement for Americans including young single women. Since then research has been piling up, confirming that LARC methods are safe and effective for teens.
In St. Louis between 2008 and 2013, 9000 women including 1400 teens were offered the contraceptive of their choice at no cost, and 72 percent chose a LARC. Teen pregnancy and abortion rates plummeted. This summer a teen pregnancy prevention program in Colorado announced equally impressive results. Between 2009 and 2013, Colorado’s teen pregnancy rate dropped 40 percent, with 75 percent of the decrease coming from areas in which low- or no-cost LARCS had been made available through public clinics. The program, funded by a $23 million grant from an anonymous donor, saved the state $42 million in teen-pregnancy related health care costs in 2010 alone, including a decrease of 35% in abortion procedures. And whether we measure the benefits in terms of flourishing families or state budgets, that’s just the beginning.
Here is why a little bit of “intrauterine bling” or “bicep bling” can make such a difference:
Think of fertility as an on/off switch. When a female hits adolescence, her defaut setting toggles to ON. For the next four decades, over 400 cycles, if she doesn’t want to get pregnant she will have to keep switching it back off or else use some kind of sperm barrier whenever she has sex. Pills and condoms work pretty well if they’re used perfectly—but who’s perfect? In the real world, 1 in 11 women relying on the Pill gets pregnant each year, and 1 in 8 couples counting on condoms ends up facing a big surprise. For sexually active teens the statistics are worse.
Don’t go looking down your nose or wagging your finger. Condoms may be a decent fit for the average penis, but every-day and every-time contraceptives are a rotten fit for the human brain. In technical terms, they get a big fat “D” on human factors engineering. To be sure, condoms are the best thing we have going to prevent sexually transmitted infections, and they’re way, way better than nothing when it comes to preventing pregnancy. But people wait too long or leave them on too long, or stretch them too tight, and they sometimes slip; and then, to quote Lena Dunham’s hilarious scene in Girls, there’s “the stuff that gets up around the sides of condoms.”
As for the Pill, it’s almost impossible for ordinary imperfect human beings to take any medication at the same time every day for weeks and months and years and decades on end. Forgetfulness, fights, finances—you name it—life provides an endless grab bag of distractions and barriers, to the point that only fifteen percent of women miss three or fewer pills each month. (It’s not just you, and like I said before, teens are even worse at it.)
Again, in the real world, pills are far more effective at reducing pregnancy and STI’s than alternatives like withdrawal, barriers, fertility monitoring, or abstinence commitments. But, Pills simply don’t compare to “set and forget” methods like IUD’s and implants that toggle the fertility switch to OFF for 3-12 years at a time, or until a woman feels ready for a baby.
No one method works for everyone, and each LARC has an adjustment phase, but once things are settled into place, the annual pregnancy rate drops below 1 in 500 for the least effective, the copper IUD. For the most effective, the implant, that number is one in 2000. Compare that to the 1 in 5 annual pregnancy rate for young couples using withdrawal or the 4 in 5 pregnancy rate for those counting on crossed fingers. The difference means young women (and young men!) can dream big and then put their energy into pursuing those dreams rather than angsting about missed periods.
Speaking of Aunt Flo, shorter, lighter, fewer periods is one of the reasons that some teens are opting for a LARC even before they become sexually active. Heavy cramps and bleeding are a top reason teen girls miss school, but a hormonal IUD reduces cramps and bleeding by, on average, 90 percent by the end of the first year. For a girl with problem periods that can make the difference between regular attendance and chronic absenteeism. For a young athlete it can be a literal game changer. And given that most youth are sexually active for six months before seeking birth control, non-contraceptive benefits like these can open up timely conversations about reproductive health before the first scare or accidental pregnancy.
Today even teens who do use birth control rely mostly on older, less effective methods; only 4.5 percent have a LARC. But health providers and even schools are working to get out the word about new options and to make better birth control accessible for all. If they succeed, more young women will be using their cell phones to text friends about homework assignments instead of abortion services or maternity care. Having a big thumbs up—and some actual practice guidelines—from the top professional organization of U.S. pediatricians can only help.
Valerie Tarico is a psychologist and writer in Seattle, Washington. She is the author of Trusting Doubt: A Former Evangelical Looks at Old Beliefs in a New Light and Deas and Other Imaginings, and the founder of www.WisdomCommons.org. Subscribe to her articles at Awaypoint.Wordpress.com.
Back to the Future — Modernizing Sexual Health Care, Regulations, and Reimbursement for Teens
Where the Wild Things Are–Family Planning Conversations on Teen Turf
Say Anything — A Powerful New Approach to Family Planning Conversations
Bring It On! — Why It’s Tme For Over the Counter Oral Contraceptives.
Dazed and Confused — The Case for Comprehensive Sexual Education
Party Time! Excellent! Educators and Health Professionals Celebrate a Drop in Teen Pregnancy.
Great article. Keep up the good fight
Thank you Valerie, as usual, great work. I realized the difference between North America and Europe when I married a wonderful European women, 31 years ago. There, IUDs were already a way of life (safe, efficient, non-cumbersome (according to my wife:-), etc). We got our three children exactly when we wanted them, I mean exactly. We have lived in Europe, Africa and Canada each one for several years and it really made life simple. An interesting anecdote is that when sharing that knowledge with the African community there was complete amazement from the women part of course (price, safety, efficiency). Things are not always straight forward though… for a while some men felt that their manliness had been stolen, to pinpoint the importance of dialogue and lots and lots of patience :-)
Did I mention patience….?