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The Kids Will Be All Right

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October 2, 2014

Earlier this week, the American Academy of Pediatrics (AAP) approved for the first time the use of long-acting contraceptive methods (LARCs) as the first recommended choice for teens. These devices, the intrauterine device (IUD) and the implant, offer the best of protection against unwanted pregnancies for at least three and up to twelve years (ten FDA-approved). This is especially good news considering that Skyla, the newest IUD on the market, was designed explicitly for young people and/or those who haven’t given birth.  Two of the biggest reasons why it’s been difficult for those groups to find a gynecologist who would be willing to prescribe them IUDs were the slight risk of expulsion from the uterus before pregnancy has occurred, it was something that doctors used to discourage or outright deny young people as a contraceptive method.

And that’s a problem. The AAP correctly addressed teens’ unique needs when caring for their sexual health. They’re more vulnerable to sexually-transmitted diseases and continue to constitute over half of new cases ever year, for instance. Yet, isn’t this more a failure due to substandard sex education and inaccessible health care? In any case, where the AAP went wrong was its particular wording when referring to pediatricians and other doctors counseling teens about the decisions they make about sex: “Adolescents should be encouraged to delay sexual onset until they are ready. However, existing data suggest that, over time, perfect adherence to abstinence is low” (ie, many adolescents planning on abstinence do not remain abstinent).

Well, of course not: teens are sexual beings, so it makes sense that they will be generally less willing as they age to abstain from it. Certainly, I’m not arguing that teens shouldn’t be strongly encouraged to be considerably more cautious than adults about sex, but the language the AAP uses discredits teens’ capacity to be responsible. Yes, teens are less developed emotionally and mentally, which means they are likelier to make unhealthy decisions in general, including sex. However, that does not mean that being likelier to make unsafe sexual decisions equates to a total lack of capability. There’s actually hard evidence of the opposite: when the state of Colorado started providing free birth control to teens, the teen pregnancy rate dropped 40% within four years. (Not) coincidentally, the methods provided under this policy were the aforementioned LARCs, especially helpful because they don’t require people to remember to maintain them. Multiple studies have also shown that when given a comprehensive sex education versus abstinence-only, teens are far likelier to practice safer sex with condoms and contraception, and/or take fewer partners. Teens today are also much more likely to use contraception than they were twenty years ago and use it more often.

So then, why do doctors continue to fall back onto ageism when a young person requests a LARC? In my Alabama college town, for instance, it’s impossible to find a gynecologist willing to prescribe and/or insert one. The most common reply from doctors is that “they’re young and will soon regret or change their minds about something so long-term.” Why do we force parental notification or consent for teens to receive abortion care, when the three most common reasons given by teens seeking abortions are (a) they can’t afford to raise a child, (b) they are wary about how a child would change their lives, and (c) they don’t feel mature enough to raise one – all reasons that indicate that teens are not only responsible about reproductive decisions, but possess incredible amounts of self-awareness about what they can and can’t handle. Why do we actively prevent teens from making these decisions?

I honestly understand the worry and concern. My sister will be thirteen soon and I worry all of the time about her. I’d rather she not be able to easily tell me what Nicki Minaj means about tossing salads. Thirteen is young, as are they high school kids sneaking away from their parents during guided tours to hastily grab condoms when my organization is giving them away in the student union. But personal discomfort shouldn’t get in the way of comprehensive sex education and full access to resources that help them make healthy decisions about sex.  Pretending that teen sex isn’t happening has never helped anyone. Teens can handle themselves, and they’ve already shown that they can.

 

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