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Contraception and Adolescent Pregnancy

By Sharon Levy, MD, MPH, Assistant Professor of Pediatrics; Director, Adolescent Substance Abuse Program, Harvard Medical School; Boston Children's Hospital

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

Any of the adult contraceptive methods may be used by adolescents. The most common problem is adherence (eg, forgetting to take daily oral contraceptives or stopping 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 (eg, that condom use decreases pleasure and interferes with “romantic love”). Some female adolescents also are shy about asking male partners to use condoms during sex.

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. Adolescents (who account for 13% of all pregnancies in the US) are less likely than adults to get prenatal care, resulting in poorer pregnancy outcomes (eg, higher rates of prematurity). 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 during pregnancy, such as anemia and preeclampsia. Infants of young mothers (especially mothers < 15 yr) 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.

Having an 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 infant would have been born, and when the anniversaries of that date occur. 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. However, before revealing a pregnancy to parents, practitioners should screen for domestic violence because revealing the pregnancy may put vulnerable adolescents at greater risk.