Much of what gets reported today about American teens is negative, so let’s address something that’s getting better. Teenage pregnancy rates in the U.S. have been declining over the past 20 years. In 2014, they reached a historic low, down more than 50 percent from their 1991 peak. This has meant teen birth rates and abortion rates have also reached historic lows, all of which should come as welcome news.
More good news: Teen pregnancies are decreasing because teens are making better decisions. One-fourth of the decrease comes from teenagers waiting longer before becoming sexually active. The remaining 75 percent of the decline comes from the use of more effective birth control methods.
Now, the bad news: Every year about 750,000 teens become pregnant, and the vast majority of these pregnancies are unplanned.
How do we continue to decrease teen pregnancy? One key element is sex education, and in this, communities, parents and mentors can play a vital role. Our schools could help with this, but only 22 states require sex education, and unfortunately, Florida is not one of them. Astonishingly, only 13 of those states also mandate that the information provided to students be medically accurate. This is shameful and harmful, because well-rounded sex education can have a significant impact on teens’ behavior.
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Sex education programs that encourage abstinence, while providing comprehensive education about different forms of contraception, actually delay the initiation of sexual activity and increase teens’ use of effective birth control. This is opposed to abstinence-only education, which has been shown in multiple studies to have no effect on teens’ behavior. Encouraging abstinence is fine, but it is effective only when coupled with comprehensive education about birth control.
Of the many types of birth control, the two most recommended by the American Academy of Pediatrics are intrauterine devices (IUDs) and contraceptive implants, sometimes called long-acting reversible contraception (LARC). These can be used by teenagers of any age, even if they have never been pregnant, and even if they are virgins.
These two methods are recommended based on their effectiveness. Without birth control, in a one-year period almost 90 percent of sexually active teens will become pregnant. If they use condoms, 18 percent will become pregnant. With the birth control shot known as Depo-Provera and birth control pills, 6 percent and 9 percent of teens, respectively, will become pregnant. However, of women using an IUD or the implant, less than 1 percent will become pregnant. Even better, once the IUD or implant is placed, it lasts for three to 10 years depending on the type.
While condoms are an ineffective method of birth control, especially when compared with LARC, they are still the only method available to help prevent the spread of sexually transmitted diseases (STDs). Therefore, we recommend using both — LARC for birth control and condoms for STDs. This is especially important in South Florida, as Miami has more new cases of HIV, syphilis and chlamydia than any other city in the U.S.
We realize many parents have concerns about LARC. You may be worried about your child’s ability to have babies in the future, even after it’s removed. This fear stems mostly from an IUD used in the 1980s that did contribute to infertility. That device is no longer used and the newer devices are safe. Within the first year of removing a LARC, almost all women who are trying to become pregnant are successful. For other concerns, we encourage you to speak with your doctor, but remember, pregnancy is far more dangerous than any of the contraceptive options we use today.
A key barrier to the use of LARC is its cost, about $600 to $1,000 for insertion. It isn’t much compared to the $9 billion of taxpayer money going to teen pregnancy each year. However, it is likely more than a teenager can pay upfront. Realizing this, from 2009 to 2015 the Colorado Family Planning Initiative provided 30,000 females in the state with IUDs at little or no cost. During that time, teenage birth rates decreased 40 percent and abortions decreased 35 percent.
Other studies have shown similar results, suggesting that the Colorado model could be adopted nationwide. Fortunately, the Affordable Care Act, also known as Obamacare, now covers LARC.
By encouraging sex education, including accurate information about different kinds of birth control and supporting improved access to LARC, we encourage teens to make decisions that positively impact their lives, their families, their communities and ultimately the country as a whole.
Ashley Deboeuf, M.D., is a first-year pediatric resident, Muneera Shaikh, M.D., is a second-year pediatric resident, and J. Grey Faulkenberry, M.D., is a specialist in pediatrics and internal medicine at UHealth — the University of Miami Health System. For more information, visit UHealth