AAP policy update recommends first-line contraceptives, addresses special populations

1. The American Academy of Pediatricians (AAP) recommends that pediatricians offer long-acting reversible contraceptives (LARC) such as the IUD or progestin implants as first line contraceptive methods, given their efficacy and safety.

2. The APP continues to encourage physicians to consistently address sexual health and behavior with their patients and to encourage contraceptive education, use, and compliance. In addition, it is highlighted that patients within “special populations,” such as those with chronic illnesses, have similar contraceptive needs and these illnesses should be addressed in the context of recommending contraception.

Policy Rundown: Greater than 80% of the annual 750 000 pregnancies among U.S. adolescents are unplanned. The AAP recognizes and addresses the need for effective contraception among these adolescents in an effort to decrease unplanned pregnancies and the spread of sexually transmitted infections (STI). In this AAP policy statement, pediatricians are urged to educate themselves on the state laws regarding adolescent consent and confidentiality as well as have an understanding of the efficacy of the available contraceptive methods and their role in the management of certain medical conditions. Pediatricians are encouraged to educate their patients about available contraceptive methods, especially LARC methods, which are most effective at preventing unplanned pregnancy when used in typical manner. The most commonly used methods among US adolescents include condoms, withdrawal, and hormonal birth control pills while the most effective and some of the least utilized methods are LARCs and DMPA injections. This policy statement also highlights the lack of necessity of a pelvic exam prior to prescribing contraceptive methods apart from IUDs. It is recommended that physicians unable to place IUDs be familiar with area providers for easy referral. Pediatricians are encouraged to screen for STIs before prescribing contraception. In addition, patients should be encouraged to regularly use latex condoms with other forms of contraception to prevent STI transmission in addition to pregnancy. Detailed information about specific contraceptive methods including their contraindications, benefits, and side effects can be found in the accompanying technical report.  The AAP recognizes recent attention to the adverse effects of the progestin-only injectable and transdermal patch; however, continues to support their use as these contraceptive methods are safer than pregnancy itself. The APP emphasizes that special populations, such as obese patients and those with chronic medical conditions, have the same sexual health needs as typical adolescents but may require condition-specific consideration when making contraceptive recommendations. Pediatricians are encouraged to regularly follow up with patients with regards to their sexual history and practices in a way that facilitates trust, disclosure, and ultimately safer sex practices.

Click to read the policy statement published today in Pediatrics

Click to read the accompanying technical report in Pediatrics

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