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HOW TO TALK TO YOUR TEENAGED PATIENT ABOUT PREGNANCY AND CONTRACEPTION

May 10, 2024
Lois Levine, MA
News
Article
Contemporary PEDS JournalMay 2024
Volume 40
Issue 04



As teenagers become sexually active, are they fully educated on contraception
and pregnancy?

How to talk to your teenaged patient about pregnancy and contraception | Image
Credit: © JPC-PROD - © JPC-PROD - stock.adobe.com.



Here is some sobering news: Teenaged mothers are twice as likely to experience
postpartum depression (PPD) as adults.1 For this population who are still
maturing on a cognitive level and have not yet fully developed their basic
coping skills, the impact of PPD can be crippling. Additionally, the stress that
a pregnancy adds to this population group can lead to other increased mental
health concerns, including severe depression and anxiety.2 Furthermore,
parenthood is the leading reason why teenaged girls drop out of school, with
more than half of teenaged mothers never graduating from high school.3

Although the national teen pregnancy rates for girls aged 15 to 17 years and 18
to 19 years (the number of pregnancies per 1000 females in the specified age
group) have declined almost continuously for the past 30 years,4 the teen birth
rate in the United States is still higher than in many developed countries,
including Canada and the United Kingdom.5 At the same time, sexual intercourse
among adolescents has become the norm: by age 19, approximately 70% of teenagers
have had sexual intercourse at least once.6

For these and other reasons surrounding sexual health, initiating discussion of
sexual activity, pregnancy, and contraception is a necessity for health care
providers. According to the American Academy of Pediatrics (AAP), “Pediatricians
[should] spend one-on-one time with adolescents starting at the 11- to
13-year-old checkups. The pediatrician will ask about sexual behaviors and, if
indicated, talk with the young person about birth control and ways to prevent
sexually transmitted infections [STIs].”7 The question is how to broach issues
of pregnancy and contraception with this patient population to produce optimal
outcomes.

Initiating the discussion
As the Nike ad says, just do it. Jessica Peck, DNP, APRN, CPNP-PC, CNE, CNL,
FAANP, FAAN, clinical professor of nursing at Baylor University Louise
Herrington School of Nursing in Dallas, Texas, says to simply start a
discussion, honestly and plainly. “Having an established relationship with a
primary care provider makes it easier to initiate conversation on both sides. As
girls progress into the teen years, it’s important to give anticipatory guidance
before any risk-taking behaviors occur.”

Additionally, with the current laws on abortion having changed dramatically,
Peck notes, “It is critical to know your state laws and your scope of practice
according to your education, training, licensure, and certification, and
providers should adhere to those boundaries, referring when necessary.” She
adds, “It’s important to emphasize regular well childcare, where questions about
reproductive health are easier to ask in the context of health promotion.”

A recent paper published in Frontiers in Pediatrics8 discusses the actions that
health care providers can take in the prevention of unplanned pregnancy. Study
authors note it is crucial to be “empowering young adolescents to become more
aware and capable of making informed decisions about their sexual life, health,
and future.”8

The paper cites several factors contributing to adolescent pregnancy, including
personal vulnerability, family context, lack of information, poor access to
contraception, and religious and cultural background. “Adolescents, especially
under the age of 16 or 17 years, lack a long-term vision of the consequences of
their behavior and are driven by experimentation and emotions. Therefore,
although they cognitively know about contraception and the risk of pregnancy,
they may choose to ignore these aspects of their behavior as a kind of denial
(‘it cannot happen to me’). This explains why, even in high-income countries
with a good coverage of health care needs, some adolescents find themselves
pregnant,” the authors state.8



What the discussion should include
The authors developed several recommendations for health care providers in terms
of discussing pregnancy and contraception with their teenaged patients and
educating them about it (Table). “Key elements that impact on the quality and
effectiveness of service provisions are, among others, easy access to health
services, including sexual and reproductive health (SRH); confidential,
respectful empathetic care; communication and counseling skills; [and] easy link
with specialized colleagues and the community,” the investigators note.8

Birth control recommendations
When it comes to counseling teenagers on methods of birth control, the AAP
continues to recommend long-acting reversible contraceptives (LARCs), which
include contraceptive implants and intrauterine devices, as the most effective
contraceptives to prevent pregnancy. They also recommend that teenagers who use
LARCs should also use a condom “or other type of barrier protection during
sexual activity to prevent sexually transmitted infections (STIs).”

Additionally, the AAP notes that hormonal contraceptives—combined oral
contraception pills, progestin-only contraception pills, patches, injections,
and vaginal rings—are more than 90% effective in preventing infection. They
recommend use of a condom here as well to prevent STIs.

The progestin-only pill containing norgestrel (Opill) is the first
nonprescription birth control approved by the FDA and is now being sold over the
counter (OTC).

Finally, should a teenager decide they want to see their pregnancy through and
become a parent, the AAP affirms that “all pregnant adolescents should be
counseled in a nonjudgmental, developmentally appropriate manner about their
full range of pregnancy options.”9

Click here for more from the May issue of Contemporary Pediatrics.

References:

1. Ladores S, Corcoran J. Investigating postpartum depression in the adolescent
mother using 3 potential qualitative approaches. Clin Med Insights Pediatr.
2019;13:1179556519884042. doi:10.1177/1179556519884042

2. Hodgkinson S, Beers L, Southammakosane C, Lewin A. Addressing the mental
health needs of pregnant and parenting adolescents. Pediatrics.
2014;133(1):114-122. doi:10.1542/peds.2013-0927

3. Teen moms. American Society for the Positive Care of Children. 2024. Accessed
March 26, 2024. https://americanspcc.org/teen-moms/

4. About teen pregnancy. CDC. November 15, 2021. Accessed March 26, 2024.
https://www.cdc.gov/teenpregnancy/about/index.htm

5. About teen pregnancy and childbearing. US Department of Health and Human
Services. Accessed March 27, 2024.
https://opa.hhs.gov/adolescent-health/reproductive-health-and-teen-pregnancy/about-teen-pregnancy-and-childbearing

6. Lindner J. Sexually Active Teen Statistics: Market Report & Data. Gitnux.
Updated December 20, 2023. Accessed March 27, 2024.
https://gitnux.org/sexually-active-teen-statistics/

7. Ott MA, Alderman EM. Contraception explained: birth control options for teens
& adolescents. HealthyChildren.org. Updated March 8, 2024. Accessed March 26,
2024.
https://www.healthychildren.org/English/ages-stages/teen/dating-sex/Pages/Birth-Control-for-Sexually-Active-Teens.aspx

8. Martins MV, Karara N, Dembiński L, et al. Adolescent pregnancy: an important
issue for paediatricians and primary care providers-a position paper from the
European Academy of Paediatrics. Front Pediatr. 2023;11:1119500.
doi:10.3389/fped.2023.1119500

9. American Academy of Pediatrics; Committee on Adolescence. Options counseling
for the pregnant adolescent patient. Pediatrics. 2022;150(3):e2022058781.
doi:10.1542/peds.2022-058781

Download Issue PDF
Articles in this issue

--------------------------------------------------------------------------------

How to talk to your teenaged patient about pregnancy and contraception

HCPs can play an important role in addressing the US infant formula shortage

Sun-safe practices in different pediatric patients

Child welfare: Now that we know better, let’s do better

Measles increase: Discussing vaccination with vaccine-hesitant parents

Highlights of the May 2024 issue of Contemporary Pediatrics

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Highlights of the May 2024 issue of Contemporary Pediatrics


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Editor-in-chief Tina Tan, MD, FAAP, FIDSA, FPIDS, highlights the April 2024
issue of Contemporary Pediatrics.




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Having "the talk" with teen patients


June 17th 2022
Podcast



A visit with a pediatric clinician is an ideal time to ensure that a teenager
knows the correct information, has the opportunity to make certain contraceptive
choices, and instill the knowledge that the pediatric office is a safe place to
come for help.




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April 29th 2024
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properly.




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April 29th 2024
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A decision from the federal agency is expected in the fourth quarter of 2024.




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FDA approves diazepam for seizure clusters in patients 2 to 5 years


April 29th 2024
Article



With the approval comes the immediate availability of 5 mg, 7.5 mg, 10 mg, 12.5
mg, and 15 mg doses for patients between 2 to 5 years of age.




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Study: Neonatal outcomes not associated with hyperoxygenation use


April 25th 2024
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Research in AJOG: Maternal hyperoxygenation doesn't boost neonatal Apgar scores
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Highlights of the May 2024 issue of Contemporary Pediatrics


May 6th 2024
Article



Editor-in-chief Tina Tan, MD, FAAP, FIDSA, FPIDS, highlights the April 2024
issue of Contemporary Pediatrics.




--------------------------------------------------------------------------------

Having "the talk" with teen patients


June 17th 2022
Podcast



A visit with a pediatric clinician is an ideal time to ensure that a teenager
knows the correct information, has the opportunity to make certain contraceptive
choices, and instill the knowledge that the pediatric office is a safe place to
come for help.




--------------------------------------------------------------------------------



FDA approves mavorixafor as first drug for WHIM syndrome


April 29th 2024
Article



The rare genetic disease causes the body's immune system to not function
properly.




--------------------------------------------------------------------------------

FDA accepts sNDA for tapinarof cream, 1% to treat AD in children 2 years and up


April 29th 2024
Article



A decision from the federal agency is expected in the fourth quarter of 2024.




--------------------------------------------------------------------------------

FDA approves diazepam for seizure clusters in patients 2 to 5 years


April 29th 2024
Article



With the approval comes the immediate availability of 5 mg, 7.5 mg, 10 mg, 12.5
mg, and 15 mg doses for patients between 2 to 5 years of age.




--------------------------------------------------------------------------------

Study: Neonatal outcomes not associated with hyperoxygenation use


April 25th 2024
Article



Research in AJOG: Maternal hyperoxygenation doesn't boost neonatal Apgar scores
in pathologic fetal heart rate tracing, showing no FiO2 benefit.




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