IUDs can help reduce the rate of teen pregnancies

As the Trump administration prepares to take office, GOP threats to defund Planned Parenthood continue, and rhetoric around women’s healthcare grows louder from both sides, it’s essential we rely on facts, and not anecdotal evidence, when talking about contraceptives, especially where teens are concerned.

In addition to caring for women during their pregnancy and labor, my job as a high-risk obstetrician involves helping women make good decisions to manage their fertility in the context of all of their health and life goals.

{mosads}Recently, I admitted a 15-year-old patient for a labor induction because her baby was not growing appropriately. Her naiveté during the entire process was distressing, though not atypical for a patient her age; she had to be taught what a cervix was and needed her mother to hold her hand during the pelvic exam she had to start her labor process.

She ultimately required an emergency cesarean delivery, which, to be sure, is a stressful situation for anyone. However, her lack of maturity made trying to help her appreciate the severity of the situation and understand the need to move quickly for her baby’s health even more challenging.

While at the beginning of her labor she had wanted an intrauterine device (IUD) placed immediately after delivery, she had changed her mind by the time she delivered. Simply, a family member had talked her out of it due to mistaken beliefs about the side effects — and thus inadvertently increased her chances of becoming pregnant again in the next year.

The need to decrease the rate of unintended pregnancy, particularly in teenagers, and especially in teenagers who have already been pregnant, seems to be something most people can agree on. While the rate of teenage pregnancy has been declining over the past few decades, nearly 20 percent of teenage births are repeat births. Further complicating the matter: Adolescents appear to be at increased risk for preterm birth, preeclampsia and low birth weight. Additionally, teenage mothers are less likely to receive a high school diploma and more likely to live in poverty.

Studies have shown that the rate of repeat pregnancy is significantly reduced in teenagers who receive long-acting reversible contraception (LARC) immediately after delivery. Teens who did not receive the implant were more than seven times more likely to be pregnant again with a year.

The reality is that these reductions are going to be achieved by making contraception easier to get and reducing misconceptions about forms of contraception; they will not happen because teenagers will suddenly stop having sex. In fact, while most teenagers would stop using sexual health services if parental notification were required, very few of them would stop having sex.

States have demonstrated the benefits of increasing access to obtaining effective contraception, particularly LARC methods, to adolescents. Colorado initiated a program that provided IUDs free of charge to teenagers and low-income women.

In return the state demonstrated a 40 percent reduction in its teenage pregnancy rate and a similar reduction in the rate of abortion. Similarly, the CHOICE project in St. Louis showed that providing no-cost contraception to adolescents dramatically reduced the teenage pregnancy rate. Nearly three-quarters of the teenagers enrolled chose a LARC method.

Misconceptions regarding the safety and side effects of LARCs have limited their utilization. IUDs were historically not considered appropriate for teenagers due to commonly held beliefs that they can result in infertility and cause pelvic infections. However, there is a large body of evidence demonstrating the inaccuracy of these beliefs. In fact, the American Academy of Pediatrics recommends IUDs as a first-line contraceptive option for teenagers, given their safety and efficacy.

Both President Trump and the Republican-controlled legislature have consistently and aggressively voiced their intent to repeal the Affordable Care Act. One key component of this act is that participating healthcare plans must include contraceptive coverage free of charge.

The legislature has also advocated for eliminating funding for Planned Parenthood, a move that has already proven to increase the number of low-income women without affordable access to contraception. While the exact effects the new administration will have on reproductive health are not yet known, it is highly likely that access to contraception, particularly for young people, will become more challenging.

Now that we have compelling evidence that LARCs are key to decreasing unintended adolescent pregnancies, a public health goal most can agree upon, we need to put greater efforts into increasing the availability and understanding these contraceptive methods.

Healthcare providers must take advantage of each interaction with sexually active adolescents to provide clear and consistent messaging regarding the value of contraceptive use. And legislators who are single-mindedly focused on taking away the Affordable Care Act must acknowledge the potential consequences of restricting, rather than expanding, access to contraceptive services, and ask themselves whether that is really what they, or their constituents, want.

Dr. Priya Rajan is a maternal-fetal medicine physician and an assistant professor at Northwestern University, and is a Public Voices Fellow.