Twenty-six-year-old “Hannah” participated as a teenager in a St. Louis study that provided 14- to-19 year-olds with free birth control, including long-acting reversible contraception (LARC). She told the New York Times that, “Having an IUD … I think it's empowering.” Now married, she said she enrolled in the study to “break the cycle of poverty in my family.” Published this October in the New England Journal of Medicine, the study found that teenagers involved in the free contraception program (72 percent chose LARC) “had lower annual pregnancy, birth and abortion rates than teenage girls nationwide.” The findings are being used to strengthen the push for LARC as a “first line” of defense against early pregnancy for adolescents.
The American Academy of Pediatrics (AAP) recently joined the chorus of voices promoting LARC for adolescent girls by issuing an updated policy statement, encouraging doctors to recommend IUDs and hormonal implants as the “first line contraceptive choices for adolescents.” Those advocating LARC for adolescents note that the methods are safer than in years past, long-lasting (three to five years for hormonal IUDs and about 10 years for copper IUDs), and are more effective than birth control pills. Advocates argue that LARC offers teens an “easy” form of contraception that does not require remembering to take a pill.
While LARC sounds like an easy fix for the nation’s teen pregnancy problem, this risk-reduction approach minimizes the importance of abstinence as the most complete protector of overall adolescent wellbeing, and marginalizes parents who remain the best line of defense against early sexual activity and teen pregnancy. It also ignores recent improvements in teen sexual behavior and pregnancy rates, and the support for abstinence that most teens say they want.
Diminishing the importance of abstinence. The AAP’s updated policy, “Contraception for Teens,” gives a brief nod to abstinence, stating that, “counseling about abstinence and postponement of sexual intercourse is an important aspect of adolescent sexual health care.” But abstinence is not mentioned in the 11 specific recommendations, and when it is addressed, doctors are advised to encourage teens to “delay sexual onset until they are ready,” not specifically until they are married, or older, or even out of high school.
The push for LARC as the “first line” contraceptive choice for teens is part of a prevention strategy that is primarily focused on reducing but not eliminating the negative outcomes of adolescent sexual activity. But this approach ignores the root cause of teen pregnancy, which is the behavior that puts young women at risk for getting pregnant in the first place—an early sexual debut. A legitimate concern about promoting LARC for adolescents is that it could lead to increased sexual activity. Planned Parenthood acknowledges as much in its promotion of IUDs on its website: “IUDs may improve your sex life,” and “some women say they feel free to be more spontaneous.” Do we really want teenagers having more “spontaneous” sex? A teenage girl with an IUD might have a significantly reduced risk of pregnancy, but it will not protect her from sexually transmitted infections (STIs).
Adolescent sexual activity is associated with a number of negative lifetime outcomes beyond pregnancy that no pill, implant/IUD, or condom can completely protect against. As the pro-abstinence American College of Pediatricians explains in its response to the AAP, “Even when contraception is used, early sexual debut has been associated with negative consequences including multiple sexual partners, sexually transmitted infections (STI), increased likelihood of psychological injury (feelings of regret, depression, suicidal attempts), greater substance abuse, and lower academic achievement.”
Sexual abstinence is the only 100 percent effective method for avoiding all of the negative effects associated with teen sexuality. Unlike a condom or IUD, abstinence carries no risk of pregnancy or STIs, while also protecting the mental and emotional health of teens. Delaying sexual activity also provides benefits for future marriages. In fact, research shows that couples that wait to have sex until they are married report more satisfying marriage relationships, better communication, better sex, and “less consideration of divorce.” Conversely, as Scott Stanley pointed out in a recent IFS post “Having a greater number of sexual partners before marriage is associated with greater odds of divorce and greater odds of marital infidelity.”
Marginalizing parents. Boston pediatrician Dr. Eileen Costello told the New York Times that “most of our kids coming in don’t want their parents to know” they are using LARC. She said teens are less willing to use IUDs because they may cause prolonged bleeding, which might be noticed by their mothers.
In addition to minimizing abstinence, the promotion of LARC for adolescents excludes parents from the process of contraceptive counseling, including for invasive birth control methods such as IUDs and implants. According to the AAP, pediatricians “should allow the adolescent to consent to contraceptive care and to control the disclosure of this information within the limits of state and federal laws.”
Aside from parental rights concerns, it is unwise to push parents out of the process of contraceptive counseling, when they remain the biggest influence on teen decisions about sex, and are associated with reduced rates of early sexual activity and teen pregnancy. According to the National Campaign to Prevent Teen and Unplanned Pregnancy (National Campaign), “Teens who are close to their parents and feel supported by them are more likely to abstain from sex, wait until they are older to begin having sex, have fewer sexual partners, and use contraception more consistently.” Parents not only have the right to be involved in adolescent sexual health care and treatment, but they also are a key component of any pregnancy prevention effort.
Finally, the push for LARC for adolescents seems extreme in light of teen sexual behavior, and what teens say they want. Nationally, more teens are delaying sexual activity, and teen pregnancy and birth rates are at historic lows. According to the National Campaign, since the early 1990s, the teen pregnancy rate has dropped 44 percent, and the teen birth rate has declined 52 percent. While experts are mixed on the reasons for the decline, most acknowledge delayed sexual activity among teenagers as at least part of the equation. The Centers for Disease Control and Prevention (CDC) states that, “While the reasons for the declines are not clear, teens seem to be less sexually active and more of those who are sexually active seem to be using birth control than in previous years.”
Furthermore, a June 2014 survey from the National Campaign found “tremendous support among young adults for waiting longer to have sex.” According to the report:
- Most high school students (53 percent) have not had sex.
- 69 percent of young adults say it is “acceptable for someone their age to be a virgin.”
- 86 percent of young adults say it is important for young teens to know “it’s okay to be a virgin when you graduate from high school.”
- 66 percent of young adults think it would help teens wait longer if they knew less than half of their peers were sexually active.
“Making virginity more realistic and relatable is what young people want to see in their media, and what those who care about young people—like parents and health care providers—can offer elsewhere,” the report concludes. “Despite young adults’ confidence and openness about virginity and waiting, they could use more support on this front early on. As they navigate the teen years, young people want to know that waiting to have sex is, in fact, quite normal.”
We can all agree that teen pregnancy is a serious concern, and some populations are more at risk than others. But preventing teen pregnancy requires more than reliance on long-acting birth control methods that may encourage more risky sexual behavior, while leaving teenage girls vulnerable to the other consequences of adolescent sexual activity.
We live in a culture where teens are bombarded with sexual messages and images, especially online, and where they face tremendous pressure to become sexually active too soon. Instead of attempting to treat the symptoms of adolescent sexual activity (i.e., pregnancy, STIs), perhaps our efforts should be more focused on treating the cause of the problem by promoting sexual restraint as normal and healthy, and helping teens learn how to make the truly empowering decision to postpone sex. Rather than pushing invasive birth control methods on teens and marginalizing parents in the process, let’s give young people more of the support for abstinence they say they want, starting with the facts about the harms of becoming sexually active too soon, and the benefits of waiting to have sex for as long as possible, ideally until marriage.