Adolescent Health, Medicine and Therapeutics (May 2023)
Long-Acting Reversible Contraception for Adolescents: A Review of Practices to Support Better Communication, Counseling, and Adherence
Abstract
Julia C Durante,1,2 Jessica Sims,1,2 Jason Jarin,2,3 Melanie A Gold,4 Sarah E Messiah,5– 7 Jenny KR Francis1,2,8 1Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA; 2Children’s Health System of Texas, Dallas, TX, USA; 3Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA; 4Department of Pediatrics and Department of Population & Family Health, Columbia University Irving Medical Center, New York, NY, USA; 5University of Texas Health Science Center at Houston, School of Public Health, Dallas Campus, Dallas, TX, USA; 6Center for Pediatric and Population Health, UTHealth School of Public Health, Dallas, TX, USA; 7Department of Pediatrics, McGovern Medical School, Houston, TX, USA; 8Peter O’Donnell School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USACorrespondence: Jenny KR Francis, Department of Adolescent & Young Adult Medicine, University of Texas Southwestern/Children’s Health, 2350 N Stemmons Fwy, Ste F5200, Dallas, TX, 75207, USA, Tel +1 214-456-6790, Fax +1 214-456-2230, Email [email protected]: Long-acting reversible contraception (LARC) methods, including levonorgestrel and copper intrauterine devices (IUDs) and the subdermal contraceptive implant, are the most effective reversible forms of contraception and thus are an important aspect of adolescent pregnancy prevention. While LARC efficacy, safety, and appropriateness are supported by major medical organizations and usage rates are increasing, overall LARC uptake among United States (US) adolescents remains lower than uptake of short-acting contraceptive methods. A better understanding of the barriers affecting adolescent LARC uptake and reasons for discontinuation could help facilitate effective communication. For example, learning how to improve adolescent-centered communication, shared decision-making, and motivational counseling strategies may be the first step to improving utilization rates. This narrative review includes three sections. First, this review will describe the history, mechanisms of action, and epidemiology of adolescent LARC use in the US and globally. Next, this review will describe key factors influencing adolescent LARC uptake, reasons for discontinuation, and multilevel barriers specific to adolescent LARC use. Finally, this review will characterize communication techniques and LARC counseling strategies for adolescents in the context of a reproductive justice approach set in the health belief model framework. The distinction between moving away from a presumptive counseling approach towards an adolescent-centered, shared decision-making approach to encourage parent-adolescent sexual health communication to lay the foundation of empowering adolescent reproductive autonomy should be the underpinning of all effective reproductive communication strategies.Keywords: long-acting reversible contraception, LARC, Contraception, adolescent, pregnancy prevention, birth control, communication, contraception counseling
