September 29, 2014 — The American Academy of Pediatrics for the first time has recommended that long-acting reversible contraceptives be considered as a first choice for adolescents seeking contraceptives, according to a policy statement published in Pediatrics, the Pittsburgh Post-Gazette reports (Carpenter, Pittsburgh Post-Gazette, 9/29).
The guidance updates AAP's birth control policy from 2007, which did not recommend any specific contraceptive methods besides using condoms. It also brings AAP's position in line with recommendations issued in 2012 by the American College of Obstetricians and Gynecologists.
Benefits of LARC
AAP said that LARC, including intrauterine devices and hormonal implants, are safe, easy to use and nearly 100% effective, with lower failure rates than oral contraceptives, patches, injections and condoms used alone. IUDs are effective for three to 10 years post-insertion, while hormonal implants typically work for three years.
Although IUDs and implants can have higher upfront costs than other methods -- in part because they must be inserted at a doctor's office -- they are more cost-effective in the long run than birth control pills or condoms, according to Mary Ott, lead author of the AAP policy statement and an adolescent medicine specialist and associate pediatrics professor at Indiana University (Tanner, AP/Sacramento Bee, 9/29).
Federal guidance on the contraceptive coverage rules under the Affordable Care Act (PL 111-148) states that insurers must cover the full range of FDA-approved methods without cost sharing (Women's Health Policy Report, 9/19). However, out-of-pocket costs for those without insurance can be $800, according to the Post-Gazette.
Details of AAP Policy, Other Recommendations
The policy said, "The past decade has demonstrated that LARCs ... are safe for adolescents. Pediatricians should be familiar with counseling, insertion and/or referral for LARCs" (Pittsburgh Post-Gazette, 9/29). It added, "Given the efficacy, safety, and ease of use, LARC methods should be considered first-line contraceptive choices for adolescents" (AAP policy statement, 9/24).
AAP recommended that sexually active adolescents also use condoms to protect against sexually transmitted infections and further reduce the chance of pregnancy.
In addition, AAP noted that abstinence is 100% effective at preventing STIs and pregnancy and that pediatricians should counsel adolescents to wait to be sexually active "until they are ready." However, the group noted that many teens will not remain abstinent, so pediatricians should provide adolescents with contraceptive information.
Ott said, "All methods of hormonal birth control," including injections, patches and oral contraceptives, "are safer than pregnancy."
AAP also provided additional information to pediatricians for discussing contraceptive options with obese adolescents, noting that hormonal patches might be less effective in girls who weigh more than 198 pounds and that obese women have a higher likelihood of gaining weight with hormonal injections than with oral contraceptives (AP/Sacramento Bee, 9/29).
Guttmacher Institute Director of Public Policy Heather Boonstra said, "The AAP's recommendations will be a great help," adding, "This is about trying to change the minds of the provider community, more of who are recognizing that adolescents are appropriate users for the IUD."
Ana Radovic -- a physician at the Center for Adolescent and Young Adult Health, a family planning clinic -- added that the new policy "will give primary care physicians and pediatricians the much needed information that this is a safe procedure, even for young girls who have never had intercourse" (Pittsburgh Post-Gazette, 9/29).