Case Study #5: Contraception for Adolescents
The United States has the highest teen pregnancy rate among developed countries. In recent years, however, the teen pregnancy rate has been dropping, which is attributed largely to improved contraceptive use. Counseling is particularly important in adolescent girls to ensure they understand their contraceptive options and use contraception consistently. One-third of teenagers have not received education in their schools about contraception. Counseling should provide an opportunity for adolescents to explore the emotional, physical, and financial consequences of sexual activity with a knowledgeable, nonjudgmental adult. In the United States, adolescent girls have their first sexual experience at 17 years of age on average, and 7 of 10 have intercourse by the time they are 19 years of age, but most do not marry until their mid-20s. Therefore, they may be at increased risk of unintended pregnancy and STDs for several years. From 2005 through 2008, 84% of sexually active teenaged girls used contraceptives during their first sexual encounter. A sexually active teen who does not use contraception has a 90% chance of becoming pregnant within a year.
More than half of sexually active adolescent girls who use contraception take an oral formulation. Oral contraceptives are a safe choice for them, even those who smoke. The absolute risk of thrombosis with use of combined oral contraceptives in a healthy adolescent is 0.05% per year. However, teens are more than twice as likely to become pregnant while using the pill for contraception compared with women aged ≥30 years, largely due to inconsistent use. Most adolescents have difficulty using any contraceptive method consistently, including the pill. Remembering to take a dose often is difficult during weekends away, family vacations, trips to visit relatives, or visits to noncustodial parents. Given a choice, most adolescent girls choose a long-acting contraceptive option.
Jocelyn is a 15-year-old adolescent girl who asks her primary care clinician for a refill of her prescription for combined oral contraceptives. She began taking the pill 1 year ago to help control her acne. Since then, she has become sexually active. She denies experiencing breast tenderness, headaches, or breakthrough bleeding. However, Jocelyn says that because of her busy schedule in school and in a women’s soccer program, she does not always remember to take the pill on time. She is planning on going to college and has no interest in starting a family for several years. Jocelyn does not smoke and has no chronic medical illness. No positive findings for disease were found during the physical assessment and Body mass index (BMI): 23 kg/m2
1. What is the APN’s obligation to the patient?
2. Is the APN required to inform Jocelyn’s parents about her sexual activity?
3. Can Jocelyn give her informed consent?
4. What type of contraceptive is the best choice for Jocelyn?
