Helping Teens Think about
Using Long-Acting Reversible Contraceptives

Over 80% of all teen pregnancies in the United States are unplanned. Yet teens typically use methods like the pill, which needs to be taken every day; or the male condom, which needs to be used with every act of intercourse. While excellent methods, they depend on the user to not make mistakes. Missing a pill or two, or not storing a condom properly can lead to an unintended pregnancy.

There are 3 methods that do not require regular maintenance. Each has a very high efficacy rate and that efficacy rate does not depend at all on how well the person uses it. These are:

• Birth Control Implant (Implanon)
• Progestin IUS (Mirena)
• Copper T IUD (ParaGard)

Collectively, these methods are referred to as LARCs (long-acting reversible contraceptives). All of these methods can be safely used by teens and all of these methods have less than a 1% failure rate for typical users. Once these methods are in place, the user does not have to do anything else to ensure its proper use.

Amazingly, there is little or no use of these 3 methods among teens and young adults. But you can change all that. You can share these basic facts with your teen clients and with your fellow staff members.

Teens can now get IUDS.

Until recently, teens were not really allowed to get the IUD here in the United States.

Over 40 years ago, there were problems with certain IUDs which are no longer used, like the infamous Dalkon Shield. These problems formed the basis of contraindications that today no longer apply. Based on years of research and overwhelmingly clear evidence, current IUDs have been proven to be safe for women of any age.

So, in 2004, the World Health Organization (WHO) issued updated guidelines which reflected this research. The following year, in 2005, the United States Preventative Task Force changed its guidelines as well. Since then, the American College of Obstetricians and Gynecologists has changed its criteria regarding IUD use. The most current edition of Contraceptive Technology also highlights these changes.

What this overall change in guidelines means is:

• Teens and other young women can get an IUD.
• Women with multiple sex partners can get an IUD.
• Women who have never had a pregnancy can get an IUD.

Many health care providers do not know about these changes, so they are not offering IUDs to teens. You can help advocate for these changes by sharing this article and the resources at the end of this article with your Medical Director and other fellow staff members.

Using LARCs is a great way to prevent pregnancy for years at a time.

It’s likely that teens who become sexually active may not want to have a baby for many years to come. Many would like to delay pregnancy until they are out of school or established in their career. They may want to wait until they are in a stable relationship or have a steady income.

Long-acting reversible contraceptives are the perfect option for teens in this transitional time of their lives.

At CFHC, we believe family planning providers are in a great position to help teens learn about implants and IUDs and to consider using them. We think family planning providers should actively encourage teens to consider using LARCs.

Here is a conversation you can have with sexually active teens and young women to help bring LARCs into their awareness:

• Do you want to have a baby? If so, when?
• If you don’t want to have a baby now, how would you go about preventing pregnancy?
• What do you think about a method that will help you prevent a pregnancy, but that you don’t have to think about and that you can safely use for years at a time?
• What do you think about a method where there is no way to use it wrong?

Give teens the information they need to make an informed decision.

Make sure they have the basic information all clients need about their chosen method of birth control:

• What it is and how it works to prevent pregnancy
• How well it works and how long it lasts
• How it is inserted and what the client can expect
• Side effects that could happen
• Complications and warning signs that she should be aware of
• Advantages and disadvantages of using the method
• What to do if she wants to stop using the method

Ask your client if she has any concerns about using one of these methods. Talk to her about her concerns. If she is interested in a LARC, help her think through how to solve any problems she might have while using one of these methods.
And remember, these methods are not for everyone.

Some teens may simply not feel comfortable with the idea of something being placed under the skin of their arm or in their uterus. But many teens will want to use these methods if they know about them and if they are properly prepared for what to expect. You are an important part of making these excellent methods available to teens.

Resources you may find helpful

If you want to learn more about counseling teens about using LARCs, there are two trainings coming up soon.

• A webcast on March 16 for Family PACT providers
• A face-to-face training in Los Angeles for health care providers

Want to learn more about informed consent and birth control method counseling?

• Take the Family Planning Health Worker training course.
• Review the previously recorded webcast on Making LARCs Available in Your Practice

Want more information about the current guidelines for LARC use?

• World Health Orgnization’s (WHO) Medical Eligibility Criteria for Contraceptive Use
• Helpful appendix from WHO
• American College of Obstetricians and Gynecologists (ACOG) Committee Opinion: Intrauterine device and adolescents. ACOG Committee Opinion No. 392. American College of Obstetricians and Gynecologists. Obstet Gynecol 2007; 110: 1493-5.