Adolescent contraception: addressing unplanned pregnancies and barriers to care

Despite a steady decline in adolescent pregnancies in Canada, most of these pregnancies remain unplanned, with many resulting in termination. In 2019, only 1.7% of live births were to mothers younger than 19, a significant decrease from previous decades. However, over 80% of adolescent pregnancies are still unintended. The Canadian Pediatric Society recommends quick-start methods of contraception and year-long prescriptions to help reduce unintended pregnancies and improve continuation rates of contraceptive use.

Adolescents face multiple barriers to accessing contraception, including financial concerns and difficulty obtaining confidential care. These barriers highlight the need for healthcare professionals to emphasize physician-patient confidentiality while addressing any legal obligations related to disclosing harmful behaviors. Long-acting reversible contraceptives (LARCs), such as intrauterine devices (IUDs) and implants, are recommended as first-line options due to their high efficacy and growing popularity, particularly when provided at no cost.

It is crucial to consider the impact of hormonal contraceptives on adolescent bone health, as bone mineralization during this period accounts for up to 40% of adult bone mass. Oral contraceptives with low estrogen doses may not support optimal bone density, while long-term use of certain injectables, like Depo-Provera, can decrease bone density, though this can be reversed upon discontinuation. Moreover, barrier contraceptives, such as condoms, should be encouraged alongside LARCs to prevent sexually transmitted infections, as adolescents using LARCs are less likely to use condoms than those on oral contraceptives.