Adolescent and Contraception

Adolescent And Contraception

Adolescents (10–19 years) represent a critical group for targeted contraceptive education and access due to their increased vulnerability to unintended pregnancies, STIs, and social stigma. Effective contraceptive counseling and method availability are key to protecting their reproductive health.

Why contraception matters for adolescents?

1. Prevent unintended pregnancies: Adolescents have higher unmet contraceptive needs, leading to a higher risk of unsafe abortions and school dropouts.

2. Protection from STIs: Barrier methods help reduce the risk of sexually transmitted infections.

3. Empowerment and autonomy: Contraceptive access supports informed reproductive choices and autonomy.

WHO recommendations for adolescent contraception

The WHO Medical Eligibility Criteria (MEC) guidelines affirm that most contraceptive methods are safe for adolescents, with proper counseling and support. Key consideration should include:

1. Confidentiality

2. Nonjudgmental and age-appropriate counseling

3. Dual protection (for both pregnancy and STI prevention)

CONTRACEPTIVE OPTIONS FOR ADOLESCENTS

A. Barrier Methods

Male/Female Condoms

Advantages:

1. Dual protection - Barrier contraceptive provide protection against unwanted pregnancy and also prevent spread of STI (sexually transmitted infections).

2. Hormone free method - Hence no side effects and will not effect hormonal system which is still developing in adolescents.

Challenges:

1. Proper use required- high rates of failure when not used properly.

2. May interrupt spontaneity which becomes a road block to use.

Availability: Over the counter

B. Hormonal Methods

Progestin-Only Pills (POPs)

1. Safe in adolescents, particularly if estrogen is contraindicated (eg - women with clotting disorders, Autoimmune diseases).

Challenges

1. Requires daily compliance and missed pill reduces efficacy of protection and can lead to spotting or irregular bleed.

Combined Oral Contraceptives (COCs)

1. Provides an added benefit of regulating cycles and treat hormonal acne.

2. Useful in adolescents with hormonal disorders like PCOS.

Challenges

1. Requires daily compliance and missed pill reduces efficacy of protection and can lead to spotting or irregular bleed.

Injectables (e.g., DMPA)

1. Intramuscular or self administered subcutaneous injections given once in 3 months.

2. Prolonged use can cause amenorrhea and increase risk of bone mineral density.

3. This should be offered only if the compliance to other daily use methods are poor.

Challenges

1. Prolonged use can cause amenorrhea and effect long term bone health.

2. Regular clinic visits for administration of shots.

Implants (e.g., etonogestrel) (not commonly available in India)

1. Long-acting (3–5 years), effective and discreet

Challenges

1. Requires trained provider for insertion/removal

2. High cost

C. Intrauterine Devices (IUDs)

Copper IUD (Cu-IUD)

1. Hormone-free, long-acting

2. Safe in nulliparous adolescents as per WHO MEC

Challenges

1. Insertion to be done at a clinical setup

D. Emergency Contraception

1. Levonorgestrel (within 72 hours) or Ulipristal (within 120 hours)

2. Not for routine use, but important for unprotected sex or contraceptive failure

Considerations in Choosing Contraceptives for Adolescents

Factor	Consideration
Medical history	Check for contraindications (eg-Migraines, clotting disorders)
Menstrual issues	If irregular cycles or sign of hormonal imbalance - consider non hormonal methods IF heavy bleeding, painful periods or severe PMS - consider hormonal contraceptives
STI risk	Emphasize barrier contraception and STI screening
Compliance	Long acting reversible contraceptives (LARCs) preferred over daily methods
Confidentiality	Crucial for uptake and continuation
Cultural and parental influence	Address misconception and involve trusted adults when appropriate

Barriers to Access in India

1. Social stigma and judgment from providers.

2. Lack of privacy and adolescent-friendly services.

3. Misinformation about safety and fertility impacts.

4. Limited access to long-acting reversible contraceptives (LARCs).

Parental consent is not required for providing contraceptive services to adolescents

Strategies to Improve Uptake

1. Training healthcare providers in adolescent-friendly services.

2. School and community-based awareness programs.

3. Integrating contraception into general adolescent health check-ups.

4. Ensuring free or subsidized contraception through public health systems.

References

1. Youth friendly services for sexual and reproductive health:A hand book for service providers : http://india.unfpa.org

1. Consent and Confidentiality :Increasing Adolscents' Access to health services for HIV and Sexual and Reproductive health : iris.who.int/bitstream/handle/10665/204910/B0456.pdf