There are many things that get blamed for teen pregnancy, from rap music to kids liking 16 and Pregnant a little too much, but the main cause is not actually that exciting: poor contraception use. Teenagers, even more than adults, need contraception that has little margin for error, but instead they are using condoms, mostly because they're easy to get. Condoms are great, don't get me wrong, but as the sole means for preventing pregnancy, they have a relatively high failure rate compared with other methods, with 18 percent of condom users experiencing an unintended pregnancy in the course of a year.
Enter the IUD, which is a nearly error-proof form of contraception that you insert once and forget about for the next 10 years, giving it a failure rate of .05 percent. Which means that 1 in 2,000 IUD users will get pregnant in a given year, compared with 18 out of 100 condom users. Which is why the American Academy of Pediatrics released new recommendations this week that advise doctors to prioritize IUDs over other forms of contraception for teenage patients. From the Washington Post:
For the first time, the organization recommends that pediatricians discuss long-acting reversible contraceptives before other birth control methods for teens, citing the "efficacy, safety and ease of use" of long-acting reversible contraception, such as IUDs and progestin implants.
In 2012, the American Congress of Obstetricians and Gynecologists made a similar recommendation, arguing that not only should the IUD and other long-acting reversible forms of contraception be made available to teens, but that they "should be first-line recommendations for all women and adolescents." (Both ACOG and the AAP hasten to add that doctors should also advise patients to use condoms to prevent STIs.)
The ACOG also noted in its report that research done in St. Louis found that teenagers themselves love long-acting reversible forms of contraception, such as the IUD. When given full counseling and offered their contraception of choice free of charge, more than two-thirds of the girls ages 14-20 chose an IUD or progestin implant.
While a lot of parents might be nervous about their teen daughters getting IUDs, it's actually a really great idea. Even if your daughter isn't having sex yet, odds are that she will be soon enough. The average age to first start having sex in the U.S. is 17, but most people don't want to start having kids until their mid-to-late 20s. Helping your daughter get an IUD into place before she goes off to college (or even earlier, to be safe) will cover that typical window. Now that Obamacare requires contraception to be covered without a copay, there's no charge if you're insured and don't work for Hobby Lobby.
For girls with parents who still cling to the fantasy that their daughters aren't having sex, however, getting an IUD is a problem. Twenty-one states have a law explicitly stating a teenager's right to contraceptive services without parental consent, and four more states have no policy at all. However, while a teenage girl might be able to pay for her own birth control pill if she doesn't want to alert her parents by going though their insurance, she likely cannot afford the out-of-pocket costs for an IUD, which can be more than $1,000. To deal with that problem, the ACOG recommends "referral to a publicly funded clinic" for those teenagers.
But ideally, parents will work with their teenage daughters to get an IUD or at least some form of contraception, and not just because going through the medical protocol alone can be a bit daunting for a teenager. By helping their daughters secure contraception, parents can show what responsible sexual health care looks like. Respecting her sexual health needs now might help her stay responsible and assured down the line, such as when a partner is trying to weasel out of a condom and she needs to stand up for herself.