How to talk to your teenaged patient about pregnancy and contraception

Teen Pregnancy and Contraception: A Report on Initiating Discussions and Promoting Optimal Outcomes

How to talk to your teenaged patient about pregnancy and contraception | Image Credit: © JPC-PROD – © JPC-PROD – stock.adobe.com.

Here is some sobering news: Teenaged mothers are twice as likely to experience postpartum depression (PPD) as adults.¹ For this population who are still maturing on a cognitive level and have not yet fully developed their basic coping skills, the impact of PPD can be crippling. Additionally, the stress that a pregnancy adds to this population group can lead to other increased mental health concerns, including severe depression and anxiety.² Furthermore, parenthood is the leading reason why teenaged girls drop out of school, with more than half of teenaged mothers never graduating from high school.³

Although the national teen pregnancy rates for girls aged 15 to 17 years and 18 to 19 years (the number of pregnancies per 1000 females in the specified age group) have declined almost continuously for the past 30 years,⁴ the teen birth rate in the United States is still higher than in many developed countries, including Canada and the United Kingdom.⁵ At the same time, sexual intercourse among adolescents has become the norm: by age 19, approximately 70% of teenagers have had sexual intercourse at least once.⁶

Initiating the discussion

As the Nike ad says, just do it. Jessica Peck, DNP, APRN, CPNP-PC, CNE, CNL, FAANP, FAAN, clinical professor of nursing at Baylor University Louise Herrington School of Nursing in Dallas, Texas, says to simply start a discussion, honestly and plainly. “Having an established relationship with a primary care provider makes it easier to initiate conversation on both sides. As girls progress into the teen years, it’s important to give anticipatory guidance before any risk-taking behaviors occur.”

Additionally, with the current laws on abortion having changed dramatically, Peck notes, “It is critical to know your state laws and your scope of practice according to your education, training, licensure, and certification, and providers should adhere to those boundaries, referring when necessary.” She adds, “It’s important to emphasize regular well childcare, where questions about reproductive health are easier to ask in the context of health promotion.”

What the discussion should include
The authors developed several recommendations for health care providers in terms of discussing pregnancy and contraception with their teenaged patients and educating them about it (Table). “Key elements that impact on the quality and effectiveness of service provisions are, among others, easy access to health services, including sexual and reproductive health (SRH); confidential, respectful empathetic care; communication and counseling skills; [and] easy link with specialized colleagues and the community,” the investigators note.⁸

Birth control recommendations
When it comes to counseling teenagers on methods of birth control, the AAP continues to recommend long-acting reversible contraceptives (LARCs), which include contraceptive implants and intrauterine devices, as the most effective contraceptives to prevent pregnancy. They also recommend that teenagers who use LARCs should also use a condom “or other type of barrier protection during sexual activity to prevent sexually transmitted infections (STIs).”

Additionally, the AAP notes that hormonal contraceptives—combined oral contraception pills, progestin-only contraception pills, patches, injections, and vaginal rings—are more than 90% effective in preventing infection. They recommend use of a condom here as well to prevent STIs.

The progestin-only pill containing norgestrel (Opill) is the first nonprescription birth control approved by the FDA and is now being sold over the counter (OTC).

Finally, should a teenager decide they want to see their pregnancy through and become a parent, the AAP affirms that “all pregnant adolescents should be counseled in a nonjudgmental, developmentally appropriate manner about their full range of pregnancy options.”⁹

Click here for more from the May issue of Contemporary Pediatrics.

References

1. Ladores S, Corcoran J. Investigating postpartum depression in the adolescent mother using 3 potential qualitative approaches. Clin Med Insights Pediatr. 2019;13:1179556519884042. doi:10.1177/1179556519884042
2. Hodgkinson S, Beers L, Southammakosane C, Lewin A. Addressing the mental health needs of pregnant and parenting adolescents. Pediatrics. 2014;133(1):114-122. doi:10.1542/peds.2013-0927
3. Teen moms. American Society for the Positive Care of Children. 2024. Accessed March 26, 2024. https://americanspcc.org/teen-moms/
4. About teen pregnancy. CDC. November 15, 2021. Accessed March 26, 2024. https://www.cdc.gov/teenpregnancy/about/index.htm
5. About teen pregnancy and childbearing. US Department of Health and Human Services. Accessed March 27, 2024. https://opa.hhs.gov/adoles
   

   SDGs, Targets, and Indicators Relevant to the Article

   1. Which SDGs are addressed or connected to the issues highlighted in the article?

   • SDG 3: Good Health and Well-being
   • SDG 4: Quality Education
   • SDG 5: Gender Equality
   • SDG 10: Reduced Inequalities

   2. What specific targets under those SDGs can be identified based on the article’s content?

   • SDG 3.7: By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programs.
   • SDG 4.7: By 2030, ensure that all learners acquire the knowledge and skills needed to promote sustainable development, including, among others, through education for sustainable development and sustainable lifestyles, human rights, gender equality, promotion of a culture of peace and non-violence, global citizenship, and appreciation of cultural diversity and of culture’s contribution to sustainable development.
   • SDG 5.6: Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Program of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences.
   • SDG 10.2: By 2030, empower and promote the social, economic, and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.

   3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

   • Indicator for SDG 3.7: Proportion of women of reproductive age (15-49 years) who have their need for family planning satisfied with modern methods
   • Indicator for SDG 4.7: Percentage of students who have achieved at least a minimum proficiency level in knowledge of sexual and reproductive health
   • Indicator for SDG 5.6: Proportion of women aged 15-49 years who make their own informed decisions regarding sexual relations, contraceptive use, and reproductive health care
   • Indicator for SDG 10.2: Proportion of population reporting having felt discriminated against or harassed in the previous 12 months on the basis of a ground of discrimination prohibited under international human rights law

   Table: SDGs, Targets, and Indicators

   SDGs	Targets	Indicators
   SDG 3: Good Health and Well-being	Target 3.7: By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programs.	Indicator: Proportion of women of reproductive age (15-49 years) who have their need for family planning satisfied with modern methods
   SDG 4: Quality Education	Target 4.7: By 2030, ensure that all learners acquire the knowledge and skills needed to promote sustainable development, including, among others, through education for sustainable development and sustainable lifestyles, human rights, gender equality, promotion of a culture of peace and non-violence, global citizenship, and appreciation of cultural diversity and of culture’s contribution to sustainable development.	Indicator: Percentage of students who have achieved at least a minimum proficiency level in knowledge of sexual and reproductive health
   SDG 5: Gender Equality	Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Program of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences.	Indicator: Proportion of women aged 15-49 years who make their own informed decisions regarding sexual relations, contraceptive use, and reproductive health care
   SDG 10: Reduced Inequalities	Target 10.2: By 2030, empower and promote the social, economic, and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.	Indicator: Proportion of population reporting having felt discriminated against or harassed in the previous 12 months on the basis of a ground of discrimination prohibited under international human rights law

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   Fuente: contemporarypediatrics.com

    

   

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