“Would you like to become pregnant in the next year?” Asking teenage girls that question is one simple way to prevent unplanned pregnancies.
The remarkable drop in birth rates among teenagers hides a large gap between urban and rural teens. Between 2007 and 2015, teen birth rates dropped 50 percent in large urban counties and just 37 percent in rural counties. We can do better.
Most teen pregnancies are unplanned and unwanted. Increased use of birth control is the primary driver of fewer teenage pregnancies in urban and rural areas. So what explains the demographic difference? Formal sex education for teen boys and girls has fallen off since 2006, more in rural than urban areas. Participants in comprehensive sexuality education programs are more likely to delay starting to have sex, have fewer unprotected sexual encounters, and are more likely to use condoms and contraception. In addition, teenage girls and young women in rural areas may have reduced access to medical care and pharmacies compared to their urban peers.
Here are a few things that health care organizations and communities can do to help young women make good choices for their sexual and reproductive health.
Ask the question
Primary providers, obstetricians, and gynecologists routinely ask their adult female patients, “Would you like to become pregnant in the next year?” The Oregon Foundation for Reproductive Health has helped popularize that question through its One Key Question Initiative. Pediatricians rarely ask it. But they should.
Most teens who are sexually active don’t want to become pregnant. Most have plans to finish school, perhaps attend college, and find a career and a partner before starting a family. Before we started asking teens that question, our county, Franklin County in central Ohio, had high rates of premature births and infant mortality. Teen pregnancies contribute to both. That was the driving force behind an idea for an outpatient birth control clinic that would offer comprehensive, teen-friendly contraceptive counseling that focused on improving access to the most effective birth control methods.
In 2014, we launched the Young Women’s Contraceptive Services Program, also known as BC4Teens, at Nationwide Children’s Hospital in Columbus, Ohio. It provides a place for young women to talk about sex, birth control, sexually transmitted diseases, and more with medical experts, and get access to contraception. Because many clinicians do not have the knowledge and skills to provide teens with the most effective methods of contraception in their offices, our program also focuses efforts on educating and training medical professionals.
Listen to the answer
The question “Would you like to become pregnant in the next year?” is part of reproductive life planning. For women who answer “No,” the ensuing conversation, often called contraceptive counseling, has become the standard for guiding a discussion of lifestyle, future plans, and birth control options. A health professional trained to provide contraceptive counseling can help a woman choose the birth control method that is right for her.
In the BC4Teens program, we don’t presume to know how our patients will answer the question. We encourage open discussion among our teen and young adult patients, their parents or guardians (if they are minors), and health care providers. With the use of supportive education, myth busting, teen-friendly educational materials, parental support, and more, this “difficult” discussion has become much less awkward.
Engage the community
Many teens and young adults don’t routinely see a doctor. That’s why meeting adolescents where they are is an important part of the effort to reduce unplanned pregnancies. Our team uses community engagement as a platform to educate young men and women about preventing teen pregnancy while also encouraging young women to discuss birth control options with their partners. Offering training and online education for health care providers, holding education sessions for schools and community groups, and being a presence at local events and activities provides the opportunity to deliver the most accurate information to young people.
Offer effective options and make it easy
The medical community must move beyond simply offering teens the option of oral contraceptives and condoms to prevent unplanned pregnancy. The American Academy of Pediatrics recommends that sexually active teens be counseled about the full spectrum of essential contraceptives.
BC4Teens follows that advice, and provides information about, and immediate access to, all available types of prescription birth control methods, starting with the most effective ones — intrauterine devices (IUDs) and the contraceptive implant (Nexplanon). These methods are highly effective at preventing pregnancy in part because they eliminate the potential for human error, like missing a dose of an oral contraceptive or properly using a condom.
We also provide counseling on the correct use of condoms for prevention of sexually transmitted infections, and provide condoms to our patients.
Because we know it’s difficult for many teens to get an appointment with a family planning provider, we make available same-day appointments and evening appointments. In most cases, teens in the program are able to start their chosen contraceptive method, including IUDs and implants, on the day of their appointment.
The BC4Teens program has helped us more than double the birth control outreach at sites across the Nationwide Children’s Hospital system. One signal that it may be working is a decline in infant mortality, which is related to teen pregnancy, in Franklin County, where most of our patients live.
More than 200,000 American teenagers become pregnant each year. Most of these pregnancies are unplanned and unwanted. Unwanted pregnancy is a leading cause of girls dropping out of school and may perpetuate generational poverty. Better sex education and access to contraception can improve the lives of teens and the overall health of communities.
Elise DeVore Berlan, MD, is a physician in the Section of Adolescent Medicine at Nationwide Children’s Hospital and an associate professor of clinical pediatrics at The Ohio State University College of Medicine. She has received payments from Merck Sharpe and Dohme.
This article was edited to update the author’s disclosures.