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January 2018

Long-Acting Reversible Contraceptives for Adolescents: More Complex Than “First-Line”

Author Affiliations
  • 1Department of Pediatrics, University of California San Diego, San Diego, California
  • 2Rady Children’s Hospital, San Diego, California
JAMA Pediatr. 2018;172(1):6-7. doi:10.1001/jamapediatrics.2017.3520

Rates of adolescent pregnancy in the United States are the highest in the developed world,1 and most pregnancies in adolescence are unplanned.2 Long-acting reversible contraceptives (LARCs), including subdermal implants and intrauterine systems, are recommended as first-line contraceptives for adolescents by the American Academy of Pediatrics, as they have the highest continuation rates (78%-84% after 1 year of use) and lowest failure rates (<1% per year with typical use) of all contraceptive methods.3 Health care professionals are encouraged to mention LARCs first and strongly recommend them when reviewing contraceptive options with adolescents. The goal of this well-intentioned recommendation was to reduce reluctance among health care professionals to offer LARCs to adolescents, thus improving young women’s access to and uptake of highly effective and convenient contraceptive options. However, health care professionals should remember that LARCs may not be the best choice for every adolescent girl.

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