Why Aren’t Teens Using More Effective Birth Control?

By Kait Scalisi, MPH

Earlier this year, the CDC released a new report addressing the lack of long acting reversible contraceptives (LARCs) use by teens (15-19 years old). While teen birth rates are at a historic low, increased use of LARCs would reduce this number even more. Unfortunately, healthcare providers serving teens aren’t always prepared to offer this option.

The CDC brief uses data from the Title X Family Planning Annual Reports compiled between 2005-2013. It offers a lot of good news: Teens are waiting to have sex; they’re reporting more birth control use; and the rate of LARC use has increased 6% over the years studied. Even with this increase, LARC use among teens remains low (about 7% nationally) and there are nearly 300,000 children born to teens each year.

The benefits of using LARCs are plentiful—no remembering to take or change anything, a less than 1% chance of pregnancy, and coverage lasting three to ten years. Unfortunately, so are the barriers, especially for federally-funded clinics like those represented in this report. Three major barriers include:

high upfront costs for supplies.
providers’ lack of awareness about the safety and effectiveness of LARC for teens.
providers’ lack of training on insertion and removal.

These factors inform the recommendations provided in the report. Specifically, providers should:

recognize LARCs as safe and effective birth control choices for teens.
offer a variety of birth control options to teens, including LARCs.
create the infrastructure to support LARCs, such as seeking training on insertion and removal, having supplies available, and exploring funding options to cover cost.

Beyond these barriers, some of the variation in teen LARC use is geographic. Traditionally, “blue” states, such as those in the Northeast and on the West Coast, have above-average rates while “red” states hover at or below average. That being said, there were a few surprises including Iowa, Oklahoma, and Texas. This variation may have to do with the states’ sex education and birth control access policies. It would also be interesting to compare abortion laws and LARC use to see if there is a connection between the two. My hunch is that one exists.

A major limitation of this report is that it only covers teens getting healthcare at a Title X clinic. This means the data is not totally nationally representative; however, it does cover populations that typically have higher rates of unplanned pregnancy. While we need truly nationally representative data, it also is important to ensure there is information about the most at-risk populations. This enables public health policy, education, and communication campaigns to be better tailored and ultimately more effective.

LARCs alone cannot bring the teen pregnancy rate down to zero. For some teens, they won’t be a good fit, either due to the cost or personal preferences related to contraception (e.g., some people don’t like having something in them). Additionally, the larger societal factors which influence teen pregnancy cannot be solved simply through contraception. However, LARCs are an important part of the larger strategy. The recommendations in this report are the next best step towards making them more universal.