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  • Title: Contraceptive choices for adolescents.
    Author: Woods ER.
    Journal: Pediatr Ann; 1991 Jun; 20(6):313-21. PubMed ID: 1861894.
    Abstract:
    Because unintended pregnancy rates are 50-85% lower in European countries than in the US, there is great need to provide contraceptive choices to adolescents. In this context, there is discussion of confidential and comprehensive service requirements, the recommended medical care of the sexually active adolescent, the most effective protection with hormonal agents, the importance of barrier methods for sexually transmitted disease (STD) protection, and other choices for special groups. It is concluded that providers must obtain a confidential sexual history and discuss birth control and STD protection with adolescent patients: 50% of the 15-19 year old population are sexually active. Emphasis should be on the safety of the preventive methods available and the benefit of reducing the morbidity and mortality associated with early pregnancy. Abstinence and delay in sexual activity as the only complete protection needs to be communicated. Families need to be reassured that contraceptive counseling does not increase sexual activity or the number of partners, but education and comprehensive services reduce the adolescent pregnancy rate. Sociodemographic inequalities need attention also, but service providers are not able to do whole life counseling. Continuation of chosen methods is linked to frequent follow up, involvement of both partners, reducing barriers to appointments and information seeking, and personalized anticipatory guidance. Pediatricians can identify high risk patients. Rapid screening tests are important in early identification of pregnancy and patients need to know nonjudgementally the options available. Oral pills provide the most effective contraception, and latex condoms are needed to reduce exposure to viral and bacterial infections. However, with pill use there is still a 6-12/100 women years pregnancy rate for adolescents. Low-dose combined pills have the least reported side effects and their use may help the discontinuation rate due to side effects. In the future, the female condom with a spermicide may provide the simplest and most effective contraception and STD protection. For those who have difficulty with compliance, progesterone implants may be helpful. The life-long repercussions of early pregnancy and STDs required the involvement of providers, teachers, peers, and families.
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