August 30, 2014
   
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Pediatricians Come Out in Favor of Emergency Contraception for Teens
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Pediatricians Come Out in Favor of Emergency Contraception for Teens

 

In a move sure to provoke controversy among some, the American Academy of Pediatrics has come out in favor of strengthening the role of pediatricians in helping to reduce adolescent pregnancy in the United States. The group recommends that pediatricians provide birth control and now, emergency contraception (EC) counseling, to all adolescents, males and females, and to families of disabled adolescents as part of routine preventive care.

The Academy wants pediatricians to take a more active role in prescribing the medication.

The reasons for the newly-released updated Policy Statement on Emergency Contraception are straightforward. The birth rate among girls aged 15 to 19 in the U.S. remains a very high 34.3 per 1000 and 80% of these are unintended and result from contraceptive failure or non-use. In addition, 10% of sexually active teens may be victims of sexual assault or date rape.

Why Adolescents Need Access to Emergency Contraception

Emergency contraception can prevent pregnancy in cases of sexual assault, unprotected intercourse, condom breakage or slippage, and missed or late doses of hormonal contraceptives, including the pill, patch, ring, or injection. The AAP wants to be sure that pediatricians let girls and their parents know that EC is available to help in these types of circumstances.

Emergency contraception, contraception designed for prevention of pregnancy after intercourse, is most effective within the first 24 hours, but can reduce the risk of pregnancy up to 120 hours after unprotected intercourse. At present, females 17 years or older and males 18 years or older can obtain emergency contraception without a prescription, but in most states adolescents younger than 17 years are required to have a prescription. Studies have shown that adolescents are more likely to use emergency contraception if it has been prescribed in advance of need, rather having to obtain it after failed or not used contraception. The Academy wants pediatricians to take a more active role in prescribing the medication.

The Varieties, Risks, and Benefits of EC

There are several emergency contraception regimens available. The most popular, Plan B, Plan B One Step and Next Choice contain levonorgestrel that acts hormonally to prevent pregnancy, but do not interrupt pregnancies that are already established and do not cause birth defects in already growing fetuses. This is the preferred emergency contraception for teenagers because there are fewer adverse effects and a physical exam and pregnancy test are not required prior to administration. The rate of nausea and vomiting is lowest of the available options.

Levonorgestrel acts hormonally to prevent pregnancy, but does not interrupt pregnancies that are already established and does not cause birth defects in already growing fetuses.

A recently approved product, ulipristal acetate, is very effective but has the disadvantage that it may cause miscarriage if the user is already in the first trimester of a pregnancy. Therefore, a pregnancy test must be taken prior to starting this treatment.

There are other possibilities including physician-prescribed, short-term increased doses of standard contraceptive pills. Although less effective than the Plan B products, this strategy can be helpful when there is limited access to emergency contraceptive products. No form of emergency contraception prevents sexually transmitted diseases, and none is recommended for use as ongoing birth control.

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