SAN DIEGO – Counseling adolescent females about the use of long-acting reversible contraceptives can be tricky business because not all of them will be forthright with clinicians about their reproductive life needs during office visits.
At the annual meeting of the North American Society for Pediatric and Adolescent Gynecology, Dr. Aparna Sridhar emphasized the four key components of LARC use in teens: counseling, confidentiality, consent, and cost.
Dr. Aparna Sridhar
She highlighted the importance of establishing confidentiality before counseling teens on the use of LARCs. Start the dialogue by informing the patient that "all services are provided to you in confidence. Our discussion about birth control methods will remain private unless you give me written permission to share it with someone else," she recommended.
Before discussing LARCs specifically, Dr. Sridhar asks the patient about her readiness for pregnancy, as birth control methods work best when integrated with a reproductive life plan. Sample questions may include: How old do you want to be when you have your first/next child? Why then and not now? How would it be for you if you got pregnant by accident right now? How would your partner feel?
Next, ask specific questions to assess the patient’s fears, worries, and negative information they may have about LARC options. "Do not wait for the adolescent patient to raise concerns," said Dr. Sridhar, a clinical fellow in family planning in the department of obstetrics and gynecology at the University of California, Los Angeles. "Explain in nontechnical terms how each long-acting method works to prevent pregnancy, and assure patients that they can always share concerns and worries."
She also recommends that clinicians elicit what the patient knows about contraceptive methods, ask permission before providing information, and elicit the patient’s reaction to information or advice by asking a question such as, "How would you feel about using this method?" Dr. Sridhar also makes it a point to offer condoms to teen women seeking advice about LARCs and counsels them about the correct way to use them for protection against sexually transmitted infections.
Currently, no state or federal laws require minors to obtain parental consent to get contraception. "Two federal programs – Title X and Medicaid – protect teens’ privacy and prohibit parental consent requirements for teens seeking contraception," she said. "Teens and minors have a right to privacy that includes their ability to use contraception."
Dr. Sridhar said that she had no relevant financial disclosures.