The most effective contraceptive method for teens are IUDs and implants, according to a new CDC study released today. Yet, less than 5 percent of teens are currently using IUDs and implants to prevent unwanted pregnancies. So, the CDC is recommending a number of strategies to get that number up — strategies that include teaching health care providers that they’re safe for teens.
IUDs and hormonal implants don't require any effort to use
Although the number of teen births in the US has declined by 60 percent since 1991, the adolescent birth rate is still double that of Canada; children aged 15 to 19 gave birth to about 273,000 babies in 2013. But about 90 percent of teens who are sexually active say they use birth control. That's why the new report from the CDC about the best contraception for teenagers is so important: it's meant to ensure that teens don't have children at a time when childbearing carries important economic, health, and social costs for young mothers — and their kids.
Most teenagers use condoms and birth control pills, which are only effective when used correctly. IUDs and hormonal implants don't require any effort to use once implanted. About 18 percent of women who use condoms and 9 percent of women who use birth control pills will become pregnant during the first year of use; only 1 percent of women using IUDs and hormonal implants become pregnant the first year they use the contraception. But less than 5 percent of teenagers are using these more-effective methods.
To further reduce the number of teen births in the US, the CDC recommends that health care professionals increase access IUDs and hormonal implants. They are "safe and appropriate for teens," said Ileana Arias, CDC Principal Deputy Director, during a press briefing earlier today. And health care professionals play an important role in getting this message across.
Hormonal implants and IUDs fall into the "Long-Acting Reversible Contraception" (LARC) category of birth control. IUDs — also known as intrauterine devices — are implanted in the uterus, whereas implants are placed in the arm, under the skin, where they provide users with a contraceptive drug. Once in place, these contraceptive methods can be used for a period of three to 10 years without having to be removed.
A lower failure rate than condoms and birth control pills
There have been some improvements regarding IUD and implant use over the last 10 years. In 2013, the use of LARCs among female adolescents who sought contraceptive services at federally funded Family Planning centers was a little over 7 percent, compared with 0.4 percent in 2005. "The use of implants, rather than IUDs accounted for most of the increase in LARC use," Arias said. This might have something to do with the perception that a hormonal implant inserted under the skin is less invasive than an IUD.
"Health professionals can encourage teens to not have sex," Arias said. But they should also "recognize LARC as a safe, effective choice of birth control for teens." That means speaking with teenagers about the advantages and downsides of LARC use, seeking training in LARC insertion and removal, and having supplies of LARC available. Health care professionals should also "explore some of the options that exist to cover costs," Arias said.
Cost is a pretty large barrier to LARC use among teens. An IUD can costs between $500 and $900, and implants cost up to $800. "Although the costs are high, we are working with our [federally funded] services providers to work with this barrier," Arias said.
IUDs and implants are expensive, however
The cost of implants and IUDs isn't the only barrier, however — geography also appears to play a role. Colorado has the highest teen use of LARC in the country, with 26 percent of female teenagers relying on that method, according to the CDC's study. Yet less than 1 percent of female teenagers in Mississippi use IUDs and implants. This may be because health practitioners in states like Colorado appear to push LARC as a first option more often than other states, said Lee Warner, Associate Director for Science with CDC's Division of Reproductive Health. Colorado has also worked to ensure that doctors and nurses are trained in LARC insertion and removal. That’s why it’s important to get health practitioners in other states on board, Arias said.
The CDC isn't alone in its promotion of IUDs and implants among teens. Both the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists have endorsed their use among adolescents. That said, IUDs and implants don't protect against STIs — teenagers and adults alike still need to use a condom for that.