New Recommendations on LARCs

LARCs = Long Acting Reversible ContraceptivesThe times they are surely changing. And so are the American Academy of Pediatrics guidelines on teenage pregnancy prevention. In the October issue of Pediatrics, AAP published a policy statement and accompanying technical report featuring their latest guidelines for teen pregnancy prevention, reflecting a big change from their previously published guidelines in 2007. New in this report is the recommendation that the first-line contraceptive choice for sexually active adolescents is a Long Acting Reversible Contraceptive (LARC).

What is a LARC? Examples of LARCs are intrauterine devices (IUDs) or implants. IUDs are small, T-shaped devices that, once inserted into the uterus by a doctor, can prevent pregnancy for up to 10 years with a failure rate of about 0.8 percent, according to the CDC. Implants, thin rods inserted under the skin on the upper arm, release progestin and last for about three years, with a failure rate of 0.05 percent.

A great deal of research has been conducted over the past decade demonstrating that LARCs are safe for adolescents and greatly reduce the risk of unintended pregnancy. When used accurately, LARCS have an unintended pregnancy rate less than one percent. AAP joins the American College of Obstetricians and Gynecologists and the Centers for Disease Control and Prevention in backing long-acting birth control as the preferred contraceptive method for adolescents and teens.
“Each year, approximately 750,000 adolescents become pregnant, with more than 80% of these pregnancies unplanned, indicating an unmet need for effective contraception in this population,” says Mary Anne Ott, MD, contributor to the AAP guidelines.

SBHC professionals play a critical role, not only as health care providers, but as trusted advisors and sources of accurate sexual and reproductive health information that can support adolescents and their families in discussing and asking questions about sensitive issues. These new guidelines from AAP provide critical support for school-based and other adolescent health care providers who want to offer this effective option to their patients.

With the recent national spotlight on LARCs, we mustn’t lose sight of the fact that LARCs and other hormonal contraceptives do not protect against sexually transmitted infections. Providers should stress that LARCs be used in combination with condoms to prevent HIV and STI transmission.

Additionally, the AAP guidelines advise pediatricians to conduct developmentally-targeted sexual histories, assess risk for sexually transmitted infections, and provide appropriate screening and/or education about safe and effective contraceptive methods. According to the AAP, regardless of which method of contraception is chosen, pediatricians should stress that all methods of hormonal birth control are safer than pregnancy, allow adolescents to consent to contraceptive care, and become familiar with state and federal laws regarding disclosure of confidential information in minors.

Click here for more information and to read the full policy statement and accompanying technical report released by AAP.

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