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INTRODUCTION

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Contraception is a health behavior that often begins during adolescence and evolves throughout reproductive life. Approximately 80% of pregnancies in adolescents between 15 and 19 years of age in the United States are unintended. The Youth Risk Behavior Survey (2015) found that 30% of high school students had had sex within the last 3 months, and of those, 13.8% did not use a condom or any other form of contraception. This is significant in that more sexually active teens are utilizing contraceptive methods. Meanwhile, there was a decline in teen births in the United States to women between 15 and 19 years of age: 229,888 births in 2015 compared to 553,000 in 2011. This may be due in part to more teens remaining abstinent longer; more effective means of contraception, particularly long-acting reversible contraception (LARC); and the use of emergency contraception.

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Discussions of sexual decision-making, abstinence, sexual activity, reproduction, and contraception occur frequently as a normal part of the well-adolescent visit for female adolescents. Females are more likely to seek out a contraceptive method if they perceive getting pregnant to be negative; they have long-term educational goals; and/or they have friends, family, and clinicians who promote the use of contraception. In contrast, male adolescents, who are not at risk for pregnancy and do not require prescriptive contraceptives, may have clinician contact only during a sports physical or treatment of an injury or acute illness. Although sexuality and contraceptives are not traditionally discussed during “the sports check,” which often substitutes for the annual examination for male adolescents, clinicians should emphasize the need for such discussions because this visit may be the only contact between the male adolescent and a clinician.

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TYPE OF CONTRACEPTIVE

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Common methods of contraception for male and female adolescents are reviewed in Table 80-1. Providers are encouraged to use an efficacy-based approach to discussing contraceptive options, starting with LARC methods, which have the highest efficacy for pregnancy prevention. Efficacy-based charts, such as those available from the CDC (https://www.cdc.gov/reproductivehealth/unintendedpregnancy/pdf/contraceptive_methods_508.pdf) or Bedsider (htpp://www.bedsider.org) can help providers explain and adolescents understand the effectiveness of different methods. Adolescents should be encouraged to choose a contraceptive method that they feel comfortable with, that they believe they can use successfully, and that meets their needs related to both pregnancy and sexually transmitted infection (STI) risk reduction. For some, the choice is condoms, which are relatively inexpensive, easily obtained, and highly effective for protection from pregnancy and STIs, but only when used consistently and correctly. For adolescents who choose to use a contraceptive method (LARC, Depo-Provera, or a combined hormonal method), it should be emphasized that when used correctly the methods are effective against pregnancy but do not protect against STIs. Counseling regarding emergency contraception and its effectiveness is imperative for individuals not using a LARC method in anticipation of method failure or lapse in contraceptive use. Heterosexual adolescents, like adults, tend ...

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