Emergency contraception and adolescents

Emergency Contraception For Adolescents: Updates And Recommendations

The United States continues to have teen birth rates at significantly higher levels than other industrialized nations. Though there have been significant declines over the past two decades, the most recent birth data shows a rate of 34.3 per 1000 among 15- to 19-year-olds.

The most current data shows that 57 percent of teen pregnancies ended in live births, 27 percent ended in induced abortion, and 16 percent ended in miscarriage or stillbirth. Pediatricians play an important role through their interactions with adolescents to address the public health objective of continuing to reduce adolescent pregnancy in the US.

Use of emergency contraception can reduce the risk of pregnancy if used up to 120 hours after unprotected sex or contraceptive failure. Emergency contraceptives are most effective if used in the first 24 hours. Whether or not to use emergency contraceptives can be a touchy subject, but most indications for their use include sexual assault, unprotected intercourse, condom breakage or slippage, and missed or late doses of hormonal contraceptives (pill, patch, or ring).

Adolescents under 17 years of age need a prescription from a physician to get emergency contraception in most states, and they are more likely to use it if it has been prescribed before it is needed. An updated policy statement detailing recommendations regarding the use and prescription of emergency contraceptives to adolescents is available in the latest issue of Pediatrics.

The updated policy focuses on pharmacologic methods of emergency contraception used within 120 hours of unprotected or underprotected sex for the prevention of unintended pregnancy.

Lead authors Krishna K. Upadhya, MD, MPH and Cora C. Breuner, MD, MPH recommend Progestin-only regimens (Plan B, Plan B One Step) be taken as a single dose within 72 hours of contraception failure, with 120 hours the maximum. Ulipristal Acetate Progesterone
Agonist/Antagonist should be taken within 120 hours, and patient should seek follow-up if severe abdominal pain is experienced. Combined Hormonal Regimens (also called the “Yuzpe Method”) is safe for emergency contraception with adverse side-effects including nausea and vomiting.

There are some ethical concerns to offering adolescents emergency contraception. Some physicians refuse to provide teenagers with emergency contraception regardless of circumstance, while many will only offer it in special circumstances such as sexual assault. Despite the personal beliefs of some pediatricians, an updated policy from the American Academy of Pediatrics holds that practicing physicians have a duty to inform their patients of relevant, legally available treatments regardless of conscientious or moral objection. Otherwise, a pediatrician is required to refer their patient to a colleague who will provide this information lest they be in violation of the policy.

The authors also make a few recommendations based on the updated policy. Pediatricians should be aware of the prevalence of sexual behavior among teenagers and adolescents and encourage dual methods of contraception (condoms and hormonal contraception) while the emergency contraception provides a third option. Pediatricians should provide levonorgestrel 1.5 mg (Plan B, Plan B One Step, or Next Choice) on hand to teenagers in immediate need.

Finally, the authors recommend:

“At the policy level, pediatricians should advocate for increased non-prescription access to emergency contraception for teenagers regardless of age and for insurance coverage of emergency contraception to reduce cost barriers.”

The updated policy and recommendations are part of an effort to further decrease teen pregnancy rates in the US, while the authors maintain that the use of condoms in addition to hormonal contraception/intrauterine device or abstinence are the best ways for teenagers to avoid pregnancy.