The pregnancy and abortion rates among adolescents in the United States are higher than in other industrialized nations as a result of intermittent, improper, and lack of use of contraception [1,2].
This topic review will provide an overview of issues related to the provision of contraceptive services to adolescent females. The various types of hormonal contraception and the risks and benefits of these methods are discussed separately. (See "Emergency contraception" and "Risks and side effects associated with estrogen-progestin contraceptives" and "Overview of contraception", section on 'Issues to consider when beginning hormonal contraception'.)
NATIONAL DATA ON CONTRACEPTION IN TEENAGERS
According to the National Survey of Family Growth (2006-2008), among never-married teenagers, 79 percent of females and 87 percent of males used a method of contraception at first sex, and 96 percent reported ever using a contraceptive method . With a few exceptions, teenagers' use of contraceptives has changed little since 2002. The condom remained the most commonly used method (95 percent), followed by the withdrawal method (58 percent) and the oral contraceptive pill (55 percent). The use of highly effective hormonal injectables, mainly depot medroxyprogesterone, remained stable (17 percent). One exception was an increase in the use of condoms and the use of a condom combined with a hormonal contraceptive (dual method use) reported by males. Another exception was an increase in the percent of female teenagers who had ever used periodic abstinence, or the "calendar rhythm" method. In addition, female teenagers reported using a wider array of hormonal methods than was reported in previous years (17 percent had ever used emergency contraception, 11 percent the contraceptive patch, and 7 percent the vaginal ring).
Adolescents vary in their ability to implement various types of contraception. From a developmental perspective, sexually active girls in early adolescence have difficulty planning events and activities; they often have an idealistic point of view, think about situations in a concrete or literal way, and live in the moment. Thus, implementing a contraceptive method that requires planning and forethought to prevent the “possibility” of pregnancy is difficult at this age without monitoring and adult support. Girls in middle and late adolescence are more capable of higher-level planning, decision making, and problem solving, skills essential to effective contraceptive behavior [4,5]. (See "Adolescent sexuality", section on 'Adolescent development' and "Overview of contraception".)
The sexually active adolescent is more likely to seek contraception if she [2,5]: