When teenagers think of birth control, the pill and condoms are likely the first to come to mind - and indeed the pill is the number one choice of contraceptive among adolescents. But according to Stanford ob/gyn expert Paula Hillard, MD, the IUD is a long-acting reversible contraception (LARC) excellently suited for adolescents. In an editorial published in the October issue of Journal of Adolescent Health, Hillard urges doctors to consider the benefits of LARCs for young women.
The IUD and other LARCs don't require consistent, correct daily use, so they're easier to use and less likely to fail. In addition to being extremely effective, IUDs have a high rate of satisfaction among adolescents. Some types of IUDs can also be used therapeutically for problems like heavy bleeding or cramping. LARCs are also cost-effective over time, and the initial investment is no longer a barrier in California due to the Family PACT program, which allows teens to confidentially access birth control at no cost. In addition, the Affordable Care Act mandates that contraceptive methods must be covered in most cases without a co-pay.
So what are the barriers to use? They include misconceptions and lack of information on the part of both teens and providers, as well as provider concerns about the insertion procedure in young women who haven't given birth.
In an email, Hillard told me:
Many physicians and most adolescents are unaware that modern IUDs provide contraception that is 20 times more effective than birth control pills, the patch or the ring. IUDs are a method of birth control that is very safe, very effective, and “forgettable”. IUDs are considered to be “top tier” contraceptive methods (along with subdermal implants and sterilization, which is not appropriate for typical adolescents) by the American Congress of Obstetricians and Gynecologists and the American Academy of Pediatrics.
IUD use has increased from 0.5 percent to 2.5 percent among teens 15-19 years old over the past decade. Still, around 50 percent of obstetrician-gynecologists don't consider an IUD as a first-line contraceptive for adolescents.
Hillard closes her piece with a discussion of the challenges and importance of counseling for adolescents. Proper counseling includes giving the most effective options priority, and discussing side-effects up front (which improves adherence to contraceptive regimens, including in adults). She writes:
It remains important for us as clinicians to fight for reproductive justice and contraceptive access for all women, with the elimination of barriers including costs. In our counseling, we need to honor principles of informed consent, be aware of power differences between ourselves and our patients, be certain that our counseling is not coercive, and carefully respect our patients' choices.
Previously: Research supports IUD use for teens, Will more women begin opting for an IUD?, Study shows women may overestimate the effectiveness of common contraceptives and Study: IUDs are a good contraceptive option for teens
Photo by Liz Henry