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Contraception for adolescents (American Academy of Pediatrics)
  1. K E MacGregor,
  2. S N Khadr
  1. Population, Policy and Practice Programme, Institute of Child Health, University College London, London, UK
  1. Correspondence to Dr Kirsten MacGregor, General and Adolescent Paediatrics Unit, Population, Policy and Practice Programme, UCL Institute of Child Health, 30 Guilford Street, London WC1N 3EH, UK; k.macgregor{at}ucl.ac.uk

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Introduction

Choosing the right contraceptive and getting reliable sexual health advice is important for adolescents as they have their first sexual experiences and their attitudes towards sex begin to form. In the UK, the average age of first heterosexual intercourse is 16 years, with around 30% of young people reporting first sex before the age of 16.1 Despite reductions over the last 10 years, the UK 15–17 and 15–19 years birth rates remain the highest in western Europe.2

In September 2014, the American Academy of Pediatrics (AAP) published an updated policy statement on ‘Contraception for Adolescents’ in the Pediatrics journal. The AAP recommends that paediatricians are knowledgeable about contraception to help adolescents ‘reduce risks of and negative health consequences related to unintended pregnancy’. Adolescents may also be prescribed contraception for medical reasons, such as management of menorrhagia.

Previous guidelines

The previous AAP policy statement on adolescent contraception was published in 2007. In the UK, the Faculty of Sexual and Reproductive Healthcare (FSRH) published guidance in 2010 on ‘Contraceptive choices for young people’. This guideline is due for review. The National Institute for Health and Care Excellence (NICE) published guidance entitled ‘Contraceptive services with a focus on young people up to the age of 25’ in March 2014.

Key issues

  • Confidentiality and consent: Adolescent contraception should be provided as a confidential service, as permitted by law, with adolescents encouraged to involve parents or trusted adults, as they are able.

  • Abstinence: Adolescents should be encouraged to delay first sexual intercourse until they are ready. However, over time, adherence to abstinence is low; therefore, paediatricians should also provide access to comprehensive sexual health information to all adolescents.

  • Contraceptive choices: Paediatricians are encouraged to counsel adolescents in order of the most to least effective contraceptives (table 1). Counselling should discuss effectiveness based on typical, rather than perfect …

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