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Contraception and Adolescent Pregnancy

by Sharon Levy, MD, MPH

Many adolescents engage in sexual activity but may not be fully informed about contraception, pregnancy, and sexually transmitted diseases, including human immunodeficiency virus (HIV) infection. Impulsivity, lack of planning, and concurrent drug and alcohol use decrease the likelihood that adolescents will use birth control and barrier protection (such as condoms).

Contraception

Any of the adult contraceptive methods may be used by adolescents (see Overview of Contraception), but the most common problem is adherence. For example, many adolescent girls forget to take daily oral contraceptives or stop using them entirely, often without substituting another form of birth control. Although male condoms are the most frequently used form of contraception, there are still perceptions that may inhibit consistent use (for example, that condom use decreases pleasure and interferes with “romantic love”). Some girls also are shy about asking male partners to use condoms during sex.

Pregnancy

Pregnancy can be a source of significant emotional stress for adolescents.

Pregnant adolescents and their partners tend to drop out of school or job training, thus worsening their economic status, lowering their self-esteem, and straining personal relationships. Pregnant adolescents (who account for 13% of all pregnancies in the United States) are less likely than adults to get prenatal care, resulting in poorer pregnancy outcomes, such as higher rates of premature birth. Pregnant adolescents, particularly the very young and those who are not receiving prenatal care, are more likely than women in their 20s to have medical problems such as anemia (when the body does not have enough healthy red blood cells—see Anemia During Pregnancy) and preeclampsia (high blood pressure and protein in the urine that can stress the fetus—see Preeclampsia and Eclampsia).

Infants of young mothers (especially mothers younger than 15 years) are more likely to be born prematurely and to have a low birth weight. However, with proper prenatal care, older adolescents have no higher risk of pregnancy problems than adults from similar backgrounds.

The adolescent may decide to terminate the pregnancy. Having an abortion (see Abortion) does not remove the psychologic problems of an unwanted pregnancy—either for the adolescent girl or her partner. Emotional crises may occur

  • When pregnancy is diagnosed

  • When the decision to have an abortion is made

  • Immediately after the abortion is done

  • When the baby would have been born

  • When the anniversaries of that date occur

A pregnant adolescent may choose to give up a child voluntarily (adoption—see Adoption) or raise the child herself or together with the child's father, often with support of family members.

All of the options cause emotional stress. Family counseling and education about contraceptive methods, for both the girl and her partner, can be very helpful.

Parents may have different reactions when their daughter says she is pregnant or their son says he has impregnated someone. Emotions may range from apathy to disappointment and anger. It is important for parents to express their support and willingness to help the adolescent sort through his or her choices. Parents and adolescents need to communicate openly about abortion, adoption, and parenthood—all tough options for the adolescent to struggle with alone.