Many adolescents engage in sexual activity but may not be fully informed about contraception, pregnancy, and sexually transmitted infections (STIs). Impulsivity, lack of planning, and concurrent substance and alcohol use decrease the likelihood that adolescents will use birth control and barrier protection (such as condoms) to prevent transmission of STIs.
(See also Introduction to Health Care Issues in Adolescents.)
Contraception in Adolescents
Any of the contraceptive measures that are used by adults may be used by adolescents, but the most common obstacle is access to contraception and correct and consistent use. Although male condoms are the most frequently used form of reversible contraception (tubal sterilization is the most common form of contraception overall), there are still perceptions that may inhibit consistent use. For example, adolescents may think condoms decrease pleasure. Some adolescents may not feel comfortable discussing condom use with a sexual partner or insisting on condom use during vaginal or anal sex. Adolescent girls may forget to take birth control pills every day or stop taking them entirely and may not substitute another form of birth control. Longer-term forms of contraception, such as intrauterine devices (IUDs), hormonal injections that last 3 months or longer, or implants under the skin that may be effective for several years, may be good options for some adolescent girls.
Adolescents should be counseled by a health care professional about contraception and about safe sex practices to prevent STIs, and some schools and public health organizations also provide counseling, various types of contraceptives, or both. Most adolescents can access contraception through their primary care clinician or through a specialist. In the United States, each state has different laws related to confidentiality for adolescents accessing this care.
Pregnancy in Adolescents
Pregnancy can be a source of significant emotional stress for adolescents.
Pregnant adolescents and their partners tend to drop out of school or job training, thus worsening their economic status, possibly lowering their self-esteem or straining personal relationships.
Pregnant adolescents are less likely than adults to receive prenatal care, resulting in poorer outcomes for the mother, such as an increased risk of preterm birth, anemia (when the body does not have enough healthy red blood cells), and preeclampsia (high blood pressure and protein in the urine that can stress the fetus), and for the baby, such as increased risk of low birth weight, infection, and sudden infant death syndrome (SIDS). Risks seem to increase further in pregnant adolescents who are very young, such as 10- to 13-year-olds.
A pregnant adolescent may choose to continue or terminate the pregnancy. An adolescent may raise the child herself or together with the child's father, possibly with support of family members, or may give up a child voluntarily (adoption).
All of the options may cause emotional stress. Counseling for both the adolescent and the involved partner can be very helpful. Counseling should also include education about use of contraception after the pregnancy.
An adolescent's parents may have different reactions when their adolescent becomes pregnant, impregnates someone, or is in a relationship with someone who is pregnant. Emotions may range from distress to excitement, apathy, disappointment, or anger. It is important for parents to express their support and willingness to help adolescents sort through their choices. Parents and adolescents need to communicate openly about abortion, adoption, and parenthood, which are all tough options for adolescents to struggle with alone.
