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Adolescent and Young Adult Health
May 2016

Long-Acting Reversible Contraception and Condom Use: We Need a Better Message

Author Affiliations
  • 1Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
  • 2Department of Pediatrics, Columbia University Medical Center, New York, New York
JAMA Pediatr. 2016;170(5):417-418. doi:10.1001/jamapediatrics.2016.0141

The age-old argument has reared its head again—does giving adolescents access to effective birth control motivate them to engage in more or riskier sex? This time the question pertains to adolescents who are choosing long-acting reversible contraception (LARC), specifically intrauterine devices and implants; are these adolescents less likely to use condoms than users of other contraceptive methods?

Many health care professionals who care for adolescents believe that LARC methods are ideally suited to adolescents, given their high efficacy and ease of use. There is good reason to think that more effective contraception will help reduce unintended pregnancy. Almost half of unintended pregnancies occur in the context of contraceptive misuse, rather than nonuse, making the less user-dependent LARC methods appealing.1 However, as more adolescents elect to use LARC and national organizations like the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists support LARC as first-line contraception for adolescents,2,3 a theoretical concern has arisen: once adolescents have intrauterine devices or contraceptive implants, will they stop using condoms? This question is the focus of the investigation by Steiner et al4 in this issue of JAMA Pediatrics. Using the well-known Youth Risk Behavior Survey data set, the authors explore the question of whether LARC users differ in their use of condoms compared with users of other contraceptive methods, namely combined hormonal methods (the birth control pill, the transdermal patch, and the intravaginal ring) and the depot medroxyprogesterone acetate injection, or “the shot.”