October 30, 2014 – Earlier this month, the American Academy of Pediatrics (AAP) recommended that the first-line contraceptive choice for sexually active adolescents is a long-acting reversible contraceptive (LARC). This is a new recommendation for the APP, which is an organization of 62,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.
Also published earlier this month was an article entitled “Provision of No-Cost, Long-Acting Contraception and Teenage Pregnancy” in the New England Journal of Medicine. This article noted that each year, more than 600,000 U.S. teens become pregnant, and that three of every 10 U.S. teens will become pregnant before they reach the age of 20. This comes at a very high cost, both socially and financially: In addition to the negative health and social consequences experienced by teenage mothers and their children, births involving teenage mothers cost the United States nearly $10 billion in increased public assistance, health care and other factors in 2010 alone.
What are LARCs?
LARCs are birth control methods that provide effective contraception for an extended time period without requiring user action. They include intrauterine devices (IUDs) and implantable subdermal rods. Their advantages are that they are cost-effective relative to condoms and birth control pills, long-lasting, safe, convenient and well-liked by users. LARCs can also be used by women of any age no matter how many times they have given birth. LARCs are also highly effective: Partly because they do not depend on patient compliance, their failure rates are less than 1% per year. The New England Journal of Medicine article states that LARC methods have higher continuation rates than shorter-acting methods and reduce the likelihood of pregnancy and of repeat pregnancy among adolescents.
In addition to low cost and high efficacy, LARCs are also preferred by young women. In a large study that removed cost and other common barriers to LARC methods, and included counseling on the full range of birth control options, more than two-thirds of females aged 14-20 years chose LARC methods. Despite these facts, LARCs are under-utilized: Less than 5% of U.S. teens report using LARC methods (usually an IUD).
What we think
We are very excited about the AAP’s recommendation, and we agree that increased use of LARCs among sexually active adolescent girls can reduce the likelihood of unwanted pregnancies. We believe that LARCs are a safe and highly effective form of birth control as there is no risk for user error and therefore less of a chance of pregnancy; we don’t have to worry about a girl forgetting to take her pill, taking out her ring or failing to get her injection on time.
We offer several LARC options for women of all ages, including subdermal implants and IUDs. And although in the past some women were hesitant to use IUDs due to fear of an increased risk of pelvic inflammatory disease, we have found that this is not an issue. One thing to remember: because LARCs do not protect against sexually transmitted infections, condoms should ALWAYS be used in addition to a LARC. We are skilled and experienced in inserting these forms of contraception and we look forward to providing our patients with the most effective forms of reversible contraception available.
Additional information on LARCs
Additional information on LARCs can be found at:
About the practice
Dr. John Garofalo, M.D., is a gynecologist located in Fairfield County, Connecticut. He has more than 20 years of practice and surgical experience covering many facets of obstetrics and gynecology.
Laury Berwitt, APRN, is a nurse practitioner specializing in women’s health in Fairfield County, Connecticut. Laury has a passion for providing quality women’s health care in a safe and comfortable manner by creating a trusting patient-practitioner relationship. She has been in practice for 10 years, caring for women of all ages.
For more information, go to www.garofaloobgyn.com. John Garofalo, MD and Laury Berkwitt, APRN can be reached for personal consultations by calling 203.855.3535.