Contraception and Pregnancy in Adolescents

Any of the contraceptive methods that are used by adults may be used by adolescents. The most common obstacles are access, correct use, and adherence (eg, forgetting to take daily oral contraceptives or stopping them entirely—often without substituting another form of birth control). Although male (external) condoms are the most frequently used form of reversible contraception in adolescents (1), there are still perceptions that may inhibit consistent use (eg, that condom use decreases pleasure). Some adolescents may not feel able to discuss condom use with a sexual partner or may not insist on condom use during oral, vaginal, or anal intercourse.

Adolescents should be counseled by their primary care clinician about contraception and about safer sex practices to decrease the risk of acquiring STIs. Some schools and public health organizations also provide counseling and/or various types of contraceptives. Primary care clinicians in the United States who provide counseling about contraception and STI testing and treatment should be familiar with state laws related to confidentiality and other pertinent legal issues related to consent (2, 3, 4).

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 (1, 2, 3), thus worsening their economic status and potentially impacting self-esteem and social relationships. Adolescents should be counseled about options, including parenting, adoption, and pregnancy termination(4, 5). According to an American Academy of Pediatrics policy statement, the majority of available evidence does not support concerns about a long-term increase in mental health issues associated with induced abortion. Clinicians should provide counseling and education about contraceptive methods to adolescents (and all patients) as part of the pregnancy termination process.

Pregnant adolescents are less likely than adults to receive prenatal care and more likely to have poorer obstetric and neonatal outcomes. In the pregnant patient, outcomes include increased risk of anemia, preterm labor, and preeclampsia. In the neonate, outcomes include increased risk of prematurity, low birth weight, infection, and sudden infant death syndrome (6, 7, 8). Risks seem to increase in younger adolescents; for example, one study found that the risk of preterm delivery was significantly higher in pregnant adolescents age 10 to 13 compared with those age 14 or older (9).

Parents and caregivers may have different reactions when their adolescent becomes pregnant or is in a relationship with someone who is pregnant. Some parents are pleased and others are distressed; emotions may range from excitement to apathy, disappointment, or even anger. It is important for parents to express their support and willingness to help adolescents sort through their choices. Parents and adolescents need to communicate openly about abortion, adoption, and parenthood—all tough options for adolescents to evaluate alone. However, before revealing a pregnancy to parents, clinicians should screen for the possibility of abuse of the pregnant adolescent by a parent, because revealing the pregnancy may put vulnerable adolescents at greater risk (10).