But Are LARCS the Only Way to Go?

Date: October 16th, 2014
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A new study from the University of St. Louis seems to put the final nail to close the LARCS (i.e., long-acting, reversible contraceptives) and teen pregnancy debate. Researchers found that LARCS are not only effective, they are super effective in reducing pregnancy rates, birth rates, and abortion rates among teens. Dr. Secura and her colleagues recruited 1,404 teenage girls (ages 14-17) to participate in the Contraceptive CHOICE project. Girls were provided a standardized contraceptive counseling that included a description of all commonly used birth control methods in order of effectiveness. Their birth control of choice was initiated immediately according to evidence-based clinical guidelines at no cost to them. If the method of choice was contraindicated at that time (i.e., a pregnancy could not be ruled out or if the participant had acute cervicitis) the participant received a Depo-Provera contraceptive shot or the oral contraceptive pill until her method of choice could be administered.

Participants were followed for 2-3 years, depending on enrollment date. They completed a baseline survey, a 3-month follow up, and then a survey every 6 months until the end of the study. Researchers were mainly interested in looking at pregnancy rates, live births, and abortion rates. Therefore, participants were asked whether they had become pregnant since the last survey. If there had been a pregnancy, they were asked about the outcome of the pregnancy (e.g., live birth, miscarriage, or induced abortion). Their responses were compared to national data sets of all teens 15 to 19 years old and to sexually experienced teens in the same age range.

The results were dramatic. First, let’s look at who participated in the study. Participants were mostly Black (62.5%), almost half had a previous unintended pregnancy (47.8%), and 18% had had an abortion. Participants overwhelmingly (70%) chose a LARC method over other hormonal birth control. Over one-third (36%) chose an IUD, and 34.5% chose the implant, followed by the Depo-Provera shot (9%), pills (12.5%), the NuvaRing (4.9%), and the patch (2.0%). This distribution in itself is impressive considering that only 4.5% of contracepting teens in the United States use some form of LARC. At the end of the study period, participants had significantly less number of pregnancies, live births, and abortions than other sexually experienced teens nationwide.

Pregnancy rate chart

* Pregnancy rates reported as number of pregnancies per 1,000 teens in the same age range.
** Original chart can be found in Secura, G., Madden, T., McNicholas, C., Mullersman, J. L., Buckel, C.M., Zhao, Q., & Peipert, J.F.  (2014). Provision of no-cost , long-acting contraception and teenage pregnancy. N Engl J Med, 371(14), 1316-1323.

Secura and colleagues are not alone in the push for more LARCs for teens who do not want to parent yet. Just last week, the American Association of Pediatrics published new guidelines promoting the use of LARCs among adolescents. ACOG (American Congress of Obstetricians and Gynecologists) has been advocating this practice for a while and has an entire section of their website devoted to guiding clinicians on the use of these methods. Their guidelines on LARC use for teens date back to 2007 and have recently been updated to reflect current evidence-based clinical practice.

What does that means for us? Is sex ed over? Should we table our beloved curricula and link teens to clinics to get LARCS? Hardly! This research tells us that when teens are given proper counseling and true power over their contraceptive choices, and you remove all access barriers, they will chose the LARC.

However, sex education does not stop at merely preventing a pregnancy. Sexuality is a complex aspect of our lives and affects everyone regardless of their sexual experience. Perhaps by promoting LARCs and effectively linking teens with clinical services, sex educators can spend more time on the subtleties of sexuality, helping youth foster healthy relationships, improving their communication, and achieving overall sexual health by protecting their bodies, their minds, and their souls. And don’t put away those woodies just yet. LARCS don’t protect from STIs, so condom demos will not go away anytime soon.

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About the Author

Dr. Genevieve Martínez-García, Director of Innovation and Research at Healthy Teen Network, is a health educator committed to bringing innovation to the field of sexual and reproductive health. She has over 14 years of experience researching adolescent sexual and reproductive health issues such as mHealth, fertility, social determinants of health, cultural and economic barriers to health care access among minority populations, health media literacy, characteristics of programs for pregnant and parenting teens, and Latino youth pregnancy intentions.

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