Safe Sex: Accessing Contraceptives as an Adolescent in the U.S.
By Emma Straus MPH candidate
An individual with the ability to get pregnant will spend three-quarters of their reproductive life trying to avoid pregnancy (7). For many people in the U.S., this time frame begins at puberty, which is on average around age 12 or 13 (4), and long before they turn 18 years of age. Minors will have sex no matter what their parents or guardians say or do, and hopefully they will know to use — and will be able to access — contraceptives. Because minors engage in sexual activity, Maryland law currently permits minors to receive confidential reproductive health care services without consent from their parents or guardians.
However, certain policymakers wanted to pass legislation during the 2020 Maryland General Assembly that would create a barrier for minors to access contraceptive services. As a Master of Public Health student at Johns Hopkins Bloomberg School of Public Health concentrating in Women’s and Reproductive Health, I have spent a significant amount of time in the last year learning about the positive impact of accessible contraceptives, especially LARCs (long acting reversible contraception), on unplanned pregnancies, as well as adolescent sexual behaviors. A bill such as HB0053, which would have required parental or guardian consent for minors to access LARCs, will not prevent minors from having sex. Policymakers like to think such legislation would make minors ask their parents about contraceptive use or maybe even make minors wait to engage in sexual activity. Instead, HB0053 would have pushed minors to engage in sexual activity without protection against unwanted pregnancy, even in cases when the minor would have liked to obtain contraceptives (5). In addition, this barrier could foster distrust between minors and providers, which can result in worse reproductive health outcomes for minors who might become nervous to seek the care they need.
Here’s the thing: minors will keep having sex. I can’t think a barrier will stop that.
Unplanned pregnancy is a significant public health issue in the United States, with 45% of pregnancies in the United States in 2011 reported as unintended (7). It is estimated that rates of unintended pregnancy are highest in those ages 15–19 when accounting for sexual activity (3). Of the 750,000 teen pregnancies each year in the U.S., 82% of adolescents ages 15–19 report that the pregnancy was unplanned (1). While these numbers are staggering, they are a significant improvement from 30 years ago, much of which is attributed to increased contraceptive access. To continue to improve this trend, public health professionals are turning toward promoting teen uptake of LARCs, including the options such as the implant and intrauterine devices (IUDs) (1).
Both implants and IUDs are not only extremely safe, but also very effective and economical (2). These types of contraceptive devices have become increasingly popular in the last few decades as a result of changing social norms and success with these methods. LARCs are especially effective because they relieve the individual from any daily burden, which is a common challenge when using other methods of contraception such as the oral hormonal pill, and they are effective for 3–10 years depending on the type of device. While the pill and condoms are effective and readily accessible, they are prone to user error and low adherence rates, especially among teens, both of which can prevented by the use of LARCs (1). When it comes to safety, both IUDs and implants have extremely strong safety profiles; there are minor side effects such as headaches or nausea, but more extreme outcomes are exceptionally rare (2).
Every individual should be able to make decisions about their reproductive health. While parents and guardians play an important role in healthcare for many minors, not all minors have family members that they would feel comfortable or safe talking to about their sexual activity. It might be a challenge for some adolescents to tell their parents that they are sexually active or that they want to be; or, some young people might know that their parents are against birth control, but recognize that effective contraception is essential to avoid unwanted pregnancy. Other adolescents might be scared of the repercussions they could face if they ask their parents for contraceptives, be it emotional, mental, or physical abuse or distress; perhaps they are even in a living or social situation in which they are trying to protect themselves from unwanted sexual harassment or abuse. Regardless of the reason, respecting the needs and privacy of minors is crucial to creating a safe space for them to receive the health care that they need.
Minors will be sexually active regardless if they have access to contraceptives, and regardless if their parents or guardians are aware. The focus, therefore, should be on ensuring that young people can engage in safe sexual activity. It is socially and economically beneficial for minors to have access to contraceptive services, rather than have to access abortion care or carry an unwanted pregnancy to term.
In order to do this, minors should continue to be able to seek confidential reproductive health care services without obtaining permission from their parents or guardians. Concerned parents should engage in honest and nonjudgmental conversations with their children about sex and sexual health, which will be more effective than pushing teens away from receiving the care they need.
No states have policies requiring parental consent for minors to receive LARCs; let’s not make Maryland the first (6).
1. Boonstra, Heather D. “Leveling the Playing Field: The Promise of Long-Acting Reversible Contraceptives for Adolescents.” Guttmacher Institute, December 6, 2016. https://www.guttmacher.org/gpr/2013/12/leveling-playing-field-promise-long-acting-reversible-contraceptives-adolescents.
2. “Current Research and Policy on Long-Acting Reversible Contraception (LARC): Key Points for Policymakers.” Jacobs Institute of Women’s Health, August 10, 2016. https://publichealth.gwu.edu/sites/default/files/downloads/projects/JIWH/LARC_Key_Points.pdf
3. Finer, Lawrence B. “Unintended Pregnancy Among U.S. Adolescents: Accounting for Sexual Activity.” Journal of Adolescent Health 47, no. 3 (April 9, 2010): 312–14. https://doi.org/10.1016/j.jadohealth.2010.02.002.
4. Hernandez, Dominic. “The Decreasing Age of Puberty.” Vital Record. Texas A&M University Health Sciences Center, February 7, 2019. https://vitalrecord.tamhsc.edu/decreasing-age-puberty/.
5. Jones, Rachel K., and Heather D. Boonstra. “Confidential Reproductive Health Services for Minors: The Potential Impact of Mandated Parental Involvement for Contraception.” Guttmacher Institute, March 9, 2018. https://www.guttmacher.org/journals/psrh/2004/confidential-reproductive-health-services-minors-potential-impact-mandated.
6. Strasser, Julia, Liz Borkowski, Megan Couillard, Amy Allina, and Susan Wood. “Long-Acting Reversible Contraception: Overview of Research & Policy in the United States,” n.d.
7. “Unintended Pregnancy in the United States.” Guttmacher Institute, January 9, 2019. https://www.guttmacher.org/fact-sheet/unintended-pregnancy-united-states.