Long-Acting Reversible Contraception (IUD): It's Recommended for Teens

LARC includes intrauterine devices (IUDs) and implants, which are safe, effective, and appropriate for use in teens.

A recent CDC Vital Signs report shows that nearly 90% of teens used birth control the last time they had sex.[1] That's the good news.

However, less than 5% of teens used LARC,[2,3] the most effective type of birth control.[1] Teens most often used condoms and birth control pills, which are less effective at preventing pregnancy when not used consistently and correctly.

LARC does not require taking a pill each day or doing something each time before having sex, and it can prevent pregnancy for 3-10 years, depending on the method. Less than 1% of LARC users would become pregnant during the first year of use. This compares with 9% of birth control pill users and 18% of condom users.[4]

Several barriers may discourage teens from using LARC. Teens may know very little about LARC, or they don't think they can use it because of their age.[5,6]

It is important to offer your teen patients a broad range of birth control options, including LARC. Also, discuss the pros and cons of each method during client-centered counseling, which includes discussing the most effective contraceptive methods first.[7] This approach has been shown to improve continuation of contraception.[8,9]

The Affordable Care Act requires plans to cover all US Food and Drug Administration-approved methods of contraception without cost sharing, which generally includes LARC, although there are some exceptions. Providers or their staff should discuss cost concerns with their patients and explore funding options to reduce cost. Providers should also be mindful of how insurance filing might affect a teens' privacy and provide such options as paying out of pocket.

Studies show that when barriers are addressed and teens are educated about LARC, they choose it over other contraceptive methods. Title X clinics have seen LARC use increase from less than 1% in 2005 to 7% in 2013 by addressing some of these barriers.[10]

Another study shows when women were offered both long- and short-acting methods at no cost, more than 72% of adolescents chose LARC.[8] More than 66% of those adolescents were still using LARC after 2 years, compared with only 37% of adolescents using non-LARC methods.[9]

Teens appreciate the advantages of using IUDs and implants because they are "forgettable" by not requiring attention for many years after insertion.They also can have positive benefits, such as lighter or no menstrual periods.[5]

There are also barriers that prevent providers from offering LARC as a contraceptive choice. Providers may lack awareness of the safety and effectiveness of LARC in teens, or may think LARC is not appropriate for a young woman or woman who has never given birth.[6] Providers may not be trained in LARC insertion and removal, and cost may also be of concern.[6]

Recognizing the safety, effectiveness, and appropriate use of LARC in teens, LARC is recommended by the American Academy of Pediatrics[7] and the American College of Obstetricians and Gynecologists[8]as a first-line contraceptive choice for teens.[11,12] LARC does not increase risk for infection or infertility. The US Medical Eligibility Criteria for contraceptive use also support the safety of LARC use among teens, because the risk for any complication is very low.[13]

Providers can seek training in LARC insertion and removal and have supplies readily available to increase LARC use in their clinics.

LARC is also cost-effective. A study of Medicaid clients in California shows that more than $5 are saved for every $1 spent on LARC.[14]

This Vital Signs report is a reminder of the important role that health professionals have in preventing teen pregnancy. Although births to teens have declined, we still need to help teens delay having sex or make informed choices about birth control if they are sexually active.

Providers can do this by removing barriers and providing confidential, respectful, and culturally appropriate services that encourage teens not to have sex. Providers can also offer a broad range of birth control options for teens, including LARC, and discuss the advantages and disadvantages of each method.[10]

Providers should also remind teens that LARC by itself does not protect against sexually transmitted diseases, including HIV, and that condoms should also be used every time they have sex. Increasing awareness, access, and availability of LARC will help teens make the best-informed decision they can about their reproductive health.