It wasn’t long ago Delaware led the nation in the number of women who got pregnant by accident, in particular teenagers. Today, the state’s teen pregnancy rate is the lowest it’s been in three decades. Eileen Dallabrida examine the role long-acting, reversible contraception - or LARC - is playing in that decline.
In the not-too-distant past, Delaware led the nation in the number of women who got pregnant by accident, especially teenagers.
Today, the teen pregnancy rate is the lowest in three decades in the First State, a trend mirrored across the United States.
The decline is attributed to multiple factors. First, fewer teens are having sex, according to government surveys and analysis. Young people also are better educated about the reproductive process and how to prevent unintended pregnancy. And long-acting, reversible contraception—known as LARC—is revolutionizing birth control with almost fail-proof methods that last as long as 10 years.
“We have really good choices now and LARC is something that patients want,” says Krishna White, M.D., head of Adolescent Medicine at Nemours/A.I. du Pont Hospital for Children in Wilmington.
LARC methods include intrauterine devices (IUDs) and hormone implants. Essentially, they are set-it-and-forget-it methods, with no pills to take or devices to introduce before intercourse. Because it lasts for years, LARC makes sense for adolescents who want to delay childbearing and has been endorsed by the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics as a first-line contraceptive choice for teens.
At Nemours, a gynecologist has trained two pediatricians and a nurse practitioner to insert LARC devices to keep up with increased demand. It’s part of Delaware CAN (Contraceptive Access Now), a public/private partnership launched earlier this year to ensure same-day low-cost or no-cost access to birth control.
Colorado rolled out a similar initiative seven years ago, with impressive results. The number of babies born to girls ages 15 to 19 fell nearly 50 percent. The teen abortion rate declined the same amount while repeat teenage births dropped 58 percent. The state reports Medicaid savings of about $5.85 for every $1 invested in the program.
White says providers are embracing a comprehensive approach to family planning. Teens are routinely screened for sexually transmitted diseases (STDs) when they seek contraception. They also are counseled on what LARC cannot do for them.
“LARC will not protect a girl from getting an STD; only a condom can do that,” she says. “It also won’t keep her from damaging her reputation or getting her parents upset or being embarrassed on social media.”
Sometimes, girls come in on their own to obtain LARC. More often, a parent will accompany a teen.
“They have had a conversation at home and the parents are requesting LARC for their daughters,” White says.
Across the United States, the teen birth rate is at an historic low, from 61.8 births per 1,000 teens aged 15–19 years in 1991 to 24.2 births per 1,000 teens in 2014. In Delaware, the rate is 20.4, according to the Centers for Disease Control and Prevention (CDC).
There also has been a dramatic decrease in abortions, says Ruth Lytle-Barnaby, president and CEO of Planned Parenthood of Delaware. So far in 2016, abortions for teens and young adults are down 23 percent in the state.
With the uptick in LARC use, Lytle-Barnaby expects the abortion rate to continue to decline. Currently, nearly one in five—17 percent—of teen and young adult women having an abortion in Delaware are opting for LARC, having an IUD inserted immediately after the procedure to prevent a subsequent unintended pregnancy.
Even with advances, about half of all pregnancies are unplanned for women of childbearing age. In Delaware, it’s nearly 60 percent, the highest rate of unintended pregnancies in America, according to a 2013 study by the Guttmacher Institute, a research and policy organization focused on sexual and reproductive health.
Further, Delaware ranks second in the nation in the percentage of teens who are sexually active. According to the CDC, 46 percent of high school students in the First State have engaged in intercourse, compared to the national average of 41.2 percent. Delaware teens also start having sex younger, with 6.8 percent having an encounter before age 13. The national average is 3.9 percent.
Still, that is a steep decline in the number of teens who are sexually active. In 2015, 28 percent more adolescents are chose not to have sex compared to 1991, the year the CDC initiated its Youth Risk Behavior Surveillance (YRBS) survey, which measures activities that can result in harm ranging from smoking to skipping breakfast.
The survey didn’t ask teens why they chose to abstain but the numbers suggest that many adolescents are waiting until they are older; 46 percent of 12th graders report having sex, compared to 16 percent of 9th graders. Teens engaged in a steady relationship also are more likely to have sex.
White attributes the decline in to the uptick in other activities.
“More kids are playing sports or are interested in social media,” she said. “They also are better educated and more aware of their choices so when young people do have sex more of them are using contraception.”
Indeed, nearly 90 percent of sexually active teens say they use contraception, according to the CDC. The problem is adolescents are more likely to be inconsistent.
“With the pill you have to take it every day and should take it at the same time,” notes Lytle-Barnaby “A teenager might think you can miss three days and then take three on one day. Or she might forget that the pill is not as effective if she is taking certain other medications.”
When taken as directed, the pill is about 99-percent effective. But in reality, about 9 percent of users wind up getting pregnant, says Noel Anupol, MD, of the Delaware Center of Excellence in Obstetrics and Gynecology in Milford.
“LARC is extremely effective because it doesn’t require any action on the part of the user,” he says. “Plus, it’s long lasting, at least three years. Women can go to school, go on with their life, and when they are ready for pregnancy it’s reversible.”
Anupol says a number of his patients had not heard of LARC until he described various alternatives for contraception. While its benefits for adolescents are getting most of the attention, he says it’s a viable option for more mature women, all the way up to menopause.
“It’s our responsibility to make woman aware of their choices so they can make the best decision for them and their families,” he says. “If we aren’t talking about all the options for birth control, we aren’t doing our job.”
LONG-ACTING REVERSIBLE CONTRACEPTION (LARC):
THE METHOD: Hormonal Intrauterine Device (IUD), a T-shape device inserted in the uterus.
BENEFITS: Depending on brand, the IUD is approved for up to three years or up to five years and is 99-percent effective in preventing pregnancy. The hormone, progestin, often results in lighter menstrual periods and reduces risk of endometrial cancer. Can be reversed at any time.
DRAWBACKS: Does not protect against sexually transmitted diseases. Cramping for a few days after insertion.
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THE METHOD: Copper IUD.
BENEFITS: Approved for up to 10 years and is 99-percent effective in preventing pregnancy. Can be reversed at any time.
DRAWBACKS: Does not protect against sexually transmitted diseases. Cramping for a few days after insertion.
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THE METHOD: Hormonal implant, a matchstick-sized rod inserted beneath the skin of the arm.
BENEFITS: Prevents pregnancy for up to three years. May reduce menstrual cramps. Can be reversed at any time.
DRAWBACKS: Does not protect against sexually transmitted diseases. Unpredictable bleeding, which usually improves over time. Side effects may include mood changes, headaches, acne, depression and weight gain.
