I just did an informal survey of pediatric residents and attendings: did you know that teen girls who identify as lesbian, gay, bisexual, or other (LGB+) are more likely to get pregnant than teen girls who are heterosexual?
The universal response was "WHAT? NO WAY! WHY?"
In answer to the last question, it is probably due to several factors:
- Earlier heterosexual sexual debut
- Higher numbers of sexual partners (both male and female)
- Higher risk of being forced to have sex with male partners
These girls may feel that the "usual" birth control education does not apply to them. It is thus important to develop materials tailored to them.
This week in Pediatrics (10.1542/peds.2020-013607), we are early releasing an article by Michele Ybarra et al that describes a randomized controlled trial in which girls who identified as LGB+ were recruited via Facebook and Instagram and randomized to receive an intervention delivered through text messages (as many as 4-12 texts per day) that specifically focused on sexual and reproductive health. The control group received information about general teen health. Each girl in the intervention group was also paired with a "text buddy," so that they could practice strategies with each other in a safe manner.
Did the intervention work? Girls in the intervention group were nearly 50% more likely to use condoms and 60% more likely to use birth control other than condoms.
In an accompanying commentary (10.1542/peds.2020-029801), Dr. Lauren Chernick notes that recruiting teens on social media (where teens spend a LOT of time) may be a great way to reach hard-to-reach youth. The authors were successful at recruiting a diverse group; 15% were from rural areas (a group that is often underrepresented in these types of studies), and 29% were from low-income families.
If you too were surprised by the answer to my informal survey question, you will likely be surprised at some of the information and lessons that you will get out of reading this paper. I will also look forward to future articles about this study. I wonder if it was just information-giving that was effective, or if the intervention changed attitudes or perceived norms (and if so, which part of the intervention was most effective). I also wonder if the changes are long-lasting.
In the meantime, remember to ask and counsel all of your teen female patients, regardless of their sexual orientation, about birth control. And don't assume that they can't get pregnant.
