Teenage Pregnancy
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Study: Free IUDs, implants cut teen pregnancies

Kim Painter, Special for USA TODAY 8:10 a.m. EDT October 2, 2014


(Photo: Duramed Pharmaceuticals Inc)

Teenage girls given free birth control and encouraged to use the most effective methods ended up getting pregnant, having abortions and giving birth at rates dramatically lower than usually seen in sexually active teens, a new study shows.

The study, published Wednesday in the New England Journal of Medicine, comes just after the nation's leading pediatricians group said doctors should counsel more sexually active teens to do exactly what many of the study participants did – get a hormonal implant or an intrauterine device (IUD).

Those methods are much more effective than more commonly used condoms and pills and they are safe, even for teens, the American Academy of Pediatrics said in its new policy statement Monday.
The statement relied on past research, including earlier reports from the St. Louis, Mo., project featured in the new study.

The latest information is from 1,404 girls ages 14 to 19. Most, 97%, were already sexually active; the rest said they planned to have sex soon. Researchers at Washington University School of Medicine offered participants any form of birth control but explained that IUDs and implants work best – largely because they don't require users to do anything once they are in place.

More than 70% of the teens chose the IUDS and implants and two-thirds of them kept the devices in place for at least two years. IUDs, T-shaped devices containing hormones or copper, can be left in the uterus for three to 10 years. Hormone implants, placed in the arm, are good for three years.

Before the study began, half of the teens already had been pregnant and 18% had had abortions. The group was at a high risk for more pregnancies, says researcher Gina Secura. Yet after two to three years of follow-up, teens in the study had:
• An annual pregnancy rate of 34 per 1,000, compared with 158.5 per 1,000 for sexually active teens nationwide.
• An annual birth rate of 19.4 per 1,000, compared with 94 per 1,000 nationwide.
• An annual abortion rate of 9.7 per 1,000, compared with 41.5 per 1,000 nationwide.

"These are stark differences," Secura says. The study shows that "when teens are informed about (effective) methods, they choose them. And they actually use them."

The study is "a landmark," says Gina Sucato, a pediatrician with Group Health in Seattle who co-wrote the academy statement but was not involved in the St. Louis study. It supports the pediatricians' view that the benefits of long-acting methods outweigh the downsides, she says.
For IUDs, downsides for teens include an often-painful insertion process and a greater than 5% chance the device will be unintentionally expelled, the academy statement says. Hormone implants can cause unpredictable bleeding and spotting. Neither method prevents sexually transmitted diseases, so they should be paired with condoms, the group says.

Contrary to common belief, modern IUDs do not pose a long-term risk of pelvic infection, Sucato says.

"Any of the currently available birth control methods are all safer for young women than pregnancy," she says.

Many social conservatives oppose promoting or providing birth control for teens, favoring abstinence-only education. "We don't sell kids filters because we assume they're going to smoke; we teach them not to smoke, period," says Arina Grossu, director of the Center for Human Dignity at the Family Research Council, D.C. "The same approach should be applied to sex education."

Pediatricians should talk to teens about abstinence, Sucato says. "Abstinence is the only method that's 100% effective, period." But contraception needs to be discussed too, she says, because half of high school students have sex anyway and 750,000 teens get pregnant each year.


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