Unintended Pregnancies

When I was asked by my office manager to write a blog for our webpage, I knew the information I wanted to provide, but I wasn’t sure the best way to deliver the information. Today, after meeting a 16 year old high school student for the first time and having to break the news to her that she is pregnant, I realize how the message is delivered is irrelevant. It needs to get out and needs to be spread to as many teenagers and parents as quickly as possible. Prevention of unintended pregnancies is how I can have the greatest impact on our society and the lives of the young women of Arkansas.   Keeping them from having to face the decision that this 16 year old patient is faced with as of today is my motivation.   She has been changed by the choices she made and she will never be the same.

According to Up to Date: Approximately 80% of pregnancies that occurred between 15-19 year olds were unintended. In national surveys, approximately one-third of high school students reported themselves as being sexually active, one-third of them used an effective method of contraception (long-term reversible contraception or short-term hormonal contraception) and one-sixth did not use any method.

Among female high school students responding to the 2017 Youth Risk Behavior Survey

• 38 percent had ever had sexual intercourse
• 29 percent were currently sexually active; among these:
  • 47 percent used a condom during their last sexual intercourse
  • 22 percent used birth control pills
  • 7 percent used a shot, patch, or birth control ring
  • 5 percent used an intrauterine device (IUD) or contraceptive implant
  • 9 percent used a condom plus a highly effective/effective contraceptive method
  • 17 percent did not use any method to prevent pregnancy

As a father of two daughters, these statistics are frightening. As an OB/GYN they are not surprising at all, sad but not surprising. In my clinic, especially when discussing contraceptive options in the adolescent population, I give the same talk over and over again. I don’t encourage or condone risky sexual behavior. On the contrary, I try and educate them. More times than not, after dispelling myths they have heard from “a friend”, they are open to considering more effective forms of contraception.

 Prevention of pregnancy should be approached as we treat other conditions in medicine with the basic tenet of using the most effective means with the fewest side effects.   If we do this, especially in adolescents, we have to consider LARCs (IUD or Implant) as first line. Starting an adolescent on oral contraceptive pills, patch or ring is easier but relies too much on the user and the ramifications if the method fails are too great. Approximately 1 out of 11 oral contraceptive pill, patch or ring users gets pregnant within the first year even when thinking they are using them correctly compared to about 1 out of 500-2000 IUD or Implant users. The more the contraceptive option relies on the patient, the more likely it will fail due to human error.

According to ACOG Practice Bulletin #186: Intrauterine devices and the contraceptive implant should be offered routinely as safe and effective contraceptive options for nulliparous women and adolescents. The American Academy of Pediatrics and ACOG endorse the use of LARC, including IUDs, for adolescents.