A 16-year-old comes in for an annual well visit. During the confidential psychosocial assessment, she reports that she is in a relationship and has had vaginal sex. Her partner is using condoms, but she would like to use a contraceptive that is more effective at preventing pregnancy. How can the pediatrician counsel her?
Data from the 2023 Youth Risk Behavior Surveillance System showed that 48% of 12th-graders report sexually activity. Among those, 52% report condom use, and 33% report contraceptive use at last sex, leaving a high number at risk for pregnancy.
In addition, less than one-third of adolescents and young adults who responded to the National Survey of Family Growth (2011-2017) reported receiving comprehensive sex education in high school that included contraception.
As a trusted and accessible source of health information, pediatricians are well-positioned to provide adolescents with guidance about healthy relationships and contraception.
The updated AAP policy statement Contraception for Adolescents provides pediatricians with an evidence- and equity-informed approach to counseling adolescents and young adults about contraception. A companion clinical report Contraceptive Counseling and Methods for Adolescents outlines patient-centered counseling approaches and provides an update on contraceptive methods.
The policy statement is available at https://doi.org/10.1542/peds.2025-072217, and the clinical report can be found at https://doi.org/10.1542/peds.2025-072218. Both are from the Committee on Adolescence and will be published in the July issue of Pediatrics.
Confidentiality is key
The pediatrician previously talked to the adolescent and her parent about the importance of teens having time alone with their provider so they can take responsibility for their own health care and have another trusted adult with whom to disclose information and concerns.
A reproductive health equity framework emphasizes the importance of confidentiality and time alone with a provider. It recognizes the teen’s capacity for decision-making and the evolving role of parents and caregivers from making decisions for the younger child to providing a safe and supportive environment for teens to make autonomous decisions. The 2024 AAP policy statement Confidentiality in the Care of Adolescents provides additional support for pediatricians.
Many teens will want to involve a parent, guardian or other trusted adult in their decision-making, while other teens may not feel safe or comfortable doing so. Reproductive health equity is grounded in scientific evidence showing that the availability of confidential care increases disclosure, access and use of effective methods of contraception.
Start with the teen
The pediatrician spends a few minutes talking with the teen about what she wants in a birth control method. She says she is planning to attend college and feels strongly about preventing pregnancy. She also has heavy periods and would like a method that decreases bleeding. She is busy at school and is worried about forgetting to take pills, but is hesitant to have an injection because she knows people who have gained weight. She settles on the implant, a highly effective long-acting method that generally decreases total amounts of bleeding. The pediatrician is able to place the implant before she leaves the office.
The policy statement emphasizes an adolescent-centered approach to contraceptive counseling. Instead of counseling primarily on the effectiveness of various methods, the pediatrician is encouraged to understand the teen’s reproductive health goals and preferences as well as social and family contexts.
For this teen, counseling would focus on the intersection of highly effective methods to prevent pregnancy and methods that reduce menstrual bleeding. Other teens may want to have regular periods or no periods, may not want hormonal methods or may need a method that can be hidden from parents or a partner.
It also is important to consider a teen’s access to contraception and other reproductive health services such as abortion and who can support her in using various methods.
A pediatrician will need a working knowledge of the range of contraceptive methods and can consider using a decision aid, such as the one at www.bedsider.org, or a contraceptive effectiveness chart. To get a broader understanding of contraceptive methods, pediatricians are encouraged to reference the clinical report at https://bit.ly/3HjdNjn and method-specific policy statements and clinical reports from the Academy at https://bit.ly/44QOKy2.
Dr. Ott is a lead author of the policy statement and clinical report.
