“The American Academy of Pediatrics has come out with a recommendation for sexually active teenage girls. The organization says the first choice should be long-acting contraception such as IUDS and contraceptive implants. But, condoms and birth control pills seem to be the first choices for teenage girls in the U.S. Is this just a matter of money or is there more going on here?”
Dr. Theresa Rohr-Kirchgraber: I think initially when the mothers of these teenage girls were young, IUDs were kind of a forbidden area. There was concern at the time that there was an increased risk of infertility later on and there were some complications with the IUDs back in the 70s. The IUDS now are completely different, the way they are made, the way they are used. When there was a study that specifically looked at taking away any financial burden and giving all the information for free, doing it right then and there when the teen walked into the office, they actually found that the long-acting IUDs were better tolerated, were easier to put in and gave the teen the best protection against unwanted pregnancies. So, maybe part of it is getting past that hurdle. The other is that, for most teens, when they come into the office, in order to get birth control, it’s often a 2 or 3 visit process. Most providers are able to do birth control pills right then and there. For many, to be able to walk in and to get a long-acting mechanism like an IUD, is not something that’s going to happen that day. So, I think, just that delay of onset is probably what is the biggest impediment to getting it done.
Lewis: One more question about the money, though. According to Planned Parenthood, IUDs can run $500-$1,000; contraceptive implants, $400-$800. That does seem way too expensive for your average teenager.
Dr. Rohr-Kirchgraber: That is absolutely true. We usually check first to see if they are covered by their insurance plan. If so, that’s an easy thing. But if you have pay for it out of pocket, even if you calculate the costs of birth control pills over a five-year span, it’s much more expensive than an IUD. Still it’s hard to have that amount of cash upfront.
Lewis: Can these girls get IUDs and contraceptive implants without telling their parents?
Dr. Rohr-Kirchgraber: Yes.
Lewis: But if you have to have insurance coverage, your parents would know.
Dr. Rohr-Kirchgraber: They probably would know, depending on the insurance plan and what is being given and done. Every plan is a little bit different. In general, yeah, they would know. But they would also know too if you were going to an OBGYN office, because you would get the bill for that. There are ways of being able to get it in a confidential manner, either through your primary care provider or through the number of family planning programs throughout the state. There are definitely ways for you to get it without your parents knowing. Those federal guidelines were put into place specifically so that teens could get contraception and avoid unwanted pregnancies. If they are the ones that are deciding to have sexual intercourse, they need to have that protection. One of the other concerns from some parents and teens is the long-acting nature of this. But I would counter that: that is exactly what you need at this age. You need something that’s going to be covering you for a good five years like the IUDs do, either for five or ten years. That gets the kid out of high school. It gets them out of college, before they have to consider starting a family. So my bias as a parent would be to consider something like this, where then you don’t have to worry so much every day. “Is she taking her pill?” Also, for the kid, too, you don’t have to remember something every day. It’s really a nice option.
