Contraception and Adolescents

Although adolescent pregnancy rates in the United States have decreased significantly over the past decade, births to adolescents remain both an individual and public health issue. As advocates for the health and well-being of all young people, the American Academy of Pediatrics strongly supports the recommendation that adolescents postpone consensual sexual activity until they are fully ready for the emotional, physical, and financial consequences of sex. The academy recognizes, however, that some young people will choose not to postpone sexual activity, and as health care providers, the responsibility of pediatricians includes helping teens reduce risks and negative health consequences associated with adolescent sexual behaviors, including unintended pregnancies and sexually transmitted infections. This policy statement provides the pediatrician with updated information on contraception methods and guidelines for counseling adolescents. INTRODUCTION Pediatricians have an important role in adolescent reproductive health care. Their long-term relationships with patients and families allow them to help promote healthy decision-making around sexuality and include abstinence as a way to avoid the negative consequences associated with risky sexual behaviors. As advocates for the health and well-being of young people, pediatricians communicate their recommendation to adolescent patients to postpone sexual activity until they are ready, because any sexual activity for which the adolescent is ill prepared may have emotional, physical, and financial consequences. However, clinicians recognize that some of their adolescent patients are sexually active or will choose to become so. Recent studies indicate that, for some adolescents, even participating in formal programs that advocate abstinence and signing abstinence pledges do not result in abstinent behavior.1,2 Pediatricians can have an active role in encouraging their adolescent patients to use contraception to reduce the risk of unintended pregnancies and to prevent sexually transmitted infections (STIs). In previous publications, the American Academy of Pediatrics (AAP) has addressed issues of adolescent sexuality, unwanted pregnancy, STIs, and contraception.3 This policy statement provides the pediatrician with updated information on adolescent sexual behavior, which may lead to pregnancy, including guidelines for counseling adolescents about available methods of contraception. Current methods available are discussed, as are methods in development. ADOLESCENT SEXUAL BEHAVIOR AND USE OF CONTRACEPTION Reported contraceptive use by adolescents has increased in recent years. From 1991 to 2005, the percentage of sexually active high school students who reported using a condom the last time they had sexual intercourse increased from 46.2% to www.pediatrics.org/cgi/doi/10.1542/ peds.2007-2535 doi:10.1542/peds.2007-2535 All policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.