Executive Summary
Although adolescent use of long-acting reversible contraceptives (LARCs) remains low nationwide, efforts to improve access to LARC among teens seeking contraception at Title X service sites have increased use of these methods, according to research released by the Centers for Disease Control and Prevention.
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When looking at type of LARC, use of intrauterine devices (IUDs) for teens ages 15-19 increased from 3,685 (0.4%) to 17,349 (2.8%), and use of implants increased from 427 (0.04%) to 26,347 (4.3%).
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Use of IUDs was more prevalent than use of implants during 2005-2011 but was surpassed by implants in 2012 and 2013.
Although adolescent use of long-acting reversible contraceptives (LARCs) remains low nationwide, efforts to improve access to LARC among teens seeking contraception at Title X service sites have increased use of these methods, according to research released by the Centers for Disease Control and Prevention (CDC).1
The teen birth rate in the United States has continued to decline during the past two decades, from 61.8 births per 1,000 ages 15-19 in 1991 to an all-time low of 26.5 births per 1,000 ages 15-19 in 2013. However, the U.S. teen pregnancy rate remains up to seven times higher than in some developed countries.2,3 While improved contraceptive use has contributed substantially to the decline in U.S. teen births, data indicate there were approximately 273,000 births to teens in 2013.2
The U.S. Selected Practice Recommendations for Contraceptive Use and an American College of Obstetricians and Gynecologists committee opinion state that LARC methods such as intrauterine contraception and the contraceptive implant are safe, effective, and appropriate options for adolescents.4,5 (To read more on the guidance, see the Contraceptive Technology Update article, “What does the US SPR mean for adolescents?” September 2013.)
Healthcare professionals have a powerful role to play in reducing teen pregnancy, noted CDC Principal Deputy Director Ileana Arias, PhD, in a released statement accompanying the agency research. Clinicians can encourage teens not to have sex and discuss the use of intrauterine devices and implants as contraceptive options available to teens who choose to be sexually active.
“Long-acting reversible contraception is safe for teens, easy to use, and very effective,” stated Arias. “We need to remove barriers and increase awareness, access, and availability of long-acting reversible contraception such as IUDs and implants.”
Reported barriers to LARC use prompted the CDC and the Office of Population Affairs (OPA) to analyze patterns in LARC use among teens ages 15-19 seeking contraceptive services, using 2005-2013 data from the Title X National Family Planning program. The program supports confidential family planning and related preventive services with priority for low-income clients and teens.
The Title X National Family Planning program helps to increase teens’ access to long-acting reversible contraception, explained Susan Moskosky, the OPA’s acting director. It provides comprehensive information to teens, including advice that avoiding sex is the most effective way to prevent pregnancy and sexually transmitted infections. The Title X also applies the latest clinical guidelines on long-acting reversible contraception and other forms of birth control, offers training to providers on intrauterine devices (IUDs) and implant insertion and removal, and provides low- or no-cost options for birth control, she stated.
Analysis of the data indicates that use of LARC methods among teens seeking birth control services increased from less than 1% to 7% from 2005-2013.
When looking at type of LARC, use of IUDs for teens ages 15-19 increased from 3,685 to 17,349, and use of implants increased from 427 to 26,347. Use of IUDs was more prevalent than use of implants during 2005-2011 but was surpassed by implants in 2012 and 2013.1
Use of LARC methods increased from 0.6% to 7.6% among teens ages 18-19, and from 0.3% to 6.5% among teens ages 15-17. For both age groups, the increase in use of implants exceeded the increase in use of IUDs. For teens ages 15-17, usage changed from 0.05% to 4.5% for implants, and it changed from 0.2% to 2.0% for IUDs. For teens ages 18-19, usage changed from 0.04% to 4.1% for implants and from 0.5% to 3.4% for IUDs.1
Use of LARC methods differed by regions. In 2013, among the 616,148 adolescent female clients ages 15-19 seeking contraception at Title X service sites, usage was highest in the West (9.5%), followed by the Northeast and Midwest (both 6.4%), and lowest in the South (5.3%) (p<0.001).1 When analyzed by state, Colorado had the highest percentage of teen clients using LARC (25.8%), followed by Alaska (19.6%), District of Columbia (17.9%), Iowa (16.6%), Hawaii (14.4%), and Vermont (13.8%). The lowest percentage of teen clients using LARC methods was in West Virginia (2.0%), Indiana (1.5%), and Mississippi (0.7%).1
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Romero L, Pazol K, Warner L, et al. Vital signs: Trends in use of long-acting reversible contraception among teens aged 15-19 years seeking contraceptive services — United States, 2005-2013. Morb Mortal Wkly Rep 2015; 64(13):363-369.
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Martin JA, Hamilton BE, Osterman MJK, et al. Births: Final data for 2013. Natl Vital Stat Rep 2015; 64:1-65.
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Sedgh G, Finer LB, Bankole A, et al. Adolescent pregnancy, birth, and abortion rates across countries: Levels and recent trends. J Adolesc Health 2015; 56:223-230.
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Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion. U.S. Selected Practice Recommendations for Contraceptive Use, 2013: Adapted from the World Health Organization Selected Practice Recommendations for Contraceptive Use, second edition. Morbidity Mortality Week Rep 2013; 62(RR-05):1-60.
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American College of Obstetricians and Gynecologists. Committee Opinion #539. Adolescents and long-acting reversible contraception: Implants and intrauterine devices. Obstet Gynecol 2012; 120(4):983-988.
