CONTRACEPTION AND ADOLESCENCE

 

It is general knowledge that most adolescents are embracing contraception as an alternative way of preventing pregnancy. This they do with or without their parents’ or guardians’ knowledge. Furthermore, majority of these adolescents are not fully informed about the types of contraceptives and the risk involved. The most common problem associated with contraception among adolescents is the failure to adhere to the guidelines of the preferred birth control method.

Therefore, many adolescent girls are more likely to stop using a contraceptive completely without going for an alternative method or forget to take their daily oral contraceptive pills. Although male condoms are the most frequently used among adolescents, there are myths and misconceptions surrounding it. These may include the perception that it lowers libido, decreases sexual pleasure and interferes with the partners’ romantic relationships. Consequently, these perceptions may inhibit consistent use of this method.

Moreover, adolescents face unique barriers in accessing contraceptive services. These encompass stigma concerns about client confidentiality and cost. Adolescents’ legal rights to confidential contraceptive services vary from one state to another. They also change over time. In a country where such legal rights are provided for, obstetrician-gynaecologists should consequently give adolescents an opportunity to discuss their reproductive goals, views and contraceptive needs without a parent or guardian being present.

 

Research also proves that adolescents who freely share their feelings and views regarding sex and contraception with a parent or guardian are more likely to use contraception consistently. This therefore means that they are less likely to become pregnant. It is therefore prudent that parental involvement should be encouraged when a supportive parent or guardian is available since this will help the adolescent make an informed choice.

 

The fear of a pelvic examination is a key factor which hinders adolescents from seeking contraception services. This examination is mandatory for some birth control methods especially the famous Intra Uterine Device (IUD). The examination helps determine whether the patient is fit for the IUD or not. As a result, most adolescents seeking contraception would prefer alternative contraceptives such as oral pills and implants for they preserve their privacy.

 

In addition to this, Injectable contraception (DMPA) has a convenient dosage schedule. This factor thus makes it attractive for many adolescents. Adolescents who receive repeated injections of DMPA within the recommended 3-month period have very low pregnancy rates. They should however pay attention to the “black box” warning on DMPA, cautioning patients against use of this birth control method beyond 2 years unless no other contraceptive methods. However, evidence suggests that DMPA may be used as long as there is need by adolescents or older women.

 

Lastly, owing to unnecessary delays in contraceptive method initiation among adolescents, same day initiation (“quick start”) should be considered when appropriate. This is because all contraceptive methods, whether hormonal or non-hormonal can be started at any time, including on the day of the visit, so long there is reasonable proof that the adolescent is not pregnant. It is thus advisable for the obstetrician-gynecologist to conduct a pregnancy test before initiating the whole process.