As adolescent medicine physicians based in the Bronx, which has one of the highest teen pregnancy rates in the nation, we frequently see how young patients become pregnant before they are ready to be parents.
While U.S. pregnancy rates among girls aged 15 to 19 years have been declining over the past two decades, still nearly 600,000 girls younger than 20 years old become pregnant each year with the majority of these being unintended pregnancies. Unplanned pregnancies and births can alter the life course of an adolescent mother and her partner, hindering their opportunities to complete high school, graduate from college, secure meaningful employment with a living wage, and raise their children in a nurturing home within a safe community. Moreover, the medical costs and increased public assistance expenditures due to adolescent pregnancy and childbirth are estimated to be $10 billion annually in the U.S.
As adolescent medicine specialists, it’s our responsibility to advise on and provide comprehensive contraceptive services to adolescent and young adult women. In our practice, in alignment with the American Academy of Pediatrics recommendations, we believe that long-acting reversible contraceptives (LARC), such as implants or intrauterine devices (IUDs), are a first-line option for adolescents and young adults. LARC methods have been shown to be highly effective and safe, yet their use in this population remains low. Increased use of condoms, birth control pills, and injection methods as well as two or more methods such as pills and condoms, has contributed to the declining adolescent pregnancy rate, yet further improvement is within reach.
With the implementation of the Affordable Care Act (ACA) many preventive health services, including LARCs, are available at no cost to the patient. Understandably, there may be some concern from providers since LARCs have high initial costs that are later reimbursed by insurance companies. We know from experience there may be some hesitation in paying for products upfront and relying on the reimbursement to come through later, however with the ACA mandate that all types of contraception are covered, we believe this will alleviate providers’ concerns. Furthermore, as these methods are much more effective in preventing adolescent pregnancy than other methods, it is a worthwhile investment to make.
By eliminating cost barriers, we are hopeful that adolescents and young adults will have improved access to and increased use of LARC methods, with the goal of ultimately even further decreasing unintended pregnancies and birth rates. We believe this will optimize the quality of life for this population and help to ensure they have the ability to pursue healthy and meaningful lives and achieve their academic, professional and personal goals.
Dr. Coupey’s article on the topic was published in the American Journal of Public Health.
Susan M. Coupey is chief, division of adolescent medicine, Children’s Hospital at Montefiore, Bronx, NY. Jennifer L. Northridge is a postdoctoral fellow, adolescent medicine.
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