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To the Editor The contraception guidance and algorithm of Wilkinson et al1 are not consistent with the recommendations of the US Centers for Disease Control and Prevention,2 the US Department of Health and Human Services, and the American College of Pediatricians.3 All emphasize the primacy and importance of offering and exploring abstinence as a contraceptive option with young people and adolescents. Abstinence engages a range of behavior including delaying sexual debut and reducing the number of partners, among other behaviors. The option of abstinence is obstensibly missing from the authors’ model.
It has been universally recognized that measures implemented during pandemics, such as isolation, can increase the risk of exposure of young people to abusive, coercive, or otherwise harmful relationships.4,5 At this time, it is incumbent on all clinicians to exercise a heightened level of vigilance to ensure opportunities are not missed to identify and offer to support to those at risk. This is exceptionally important for those health care professionals practicing in disciplines where vulnerable young people are likely to present. The truncated contraceptive algorithm proffered, rather than giving clinicians a framework to sensitively explore this with young people seeking contraceptives, potentially perpetuates the culture of secrecy in which injurious relationships thrive. Exploring a young person’s view on abstinence is a sensitive and subtle means of making inquiry into the potential vulnerability of the individual involved. A young person expressly stating or intimating that abstinence is not an option that they are free to choose raises concerns regarding their autonomy, self-determination, and consent within relationships and in more transient encounters. This then acts a cue for the clinician to make further inquiry and offer support as needed. In its current form, it is suggested that the algorithm presented is neither entirely adequate nor appropriate to safely and inclusively counsel young people and adolescents at the time of global pandemic.
Corresponding Author: Chika Uzoigwe, MA, Harcourt Building, Harcourt Crecent, Sheffield, Yorkshire S10 1DG, United Kingdom (email@example.com).
Published Online: November 30, 2020. doi:10.1001/jamapediatrics.2020.5077
Conflict of Interest Disclosures: None reported.
Uzoigwe C, Ali O. Contraception for Adolescents During the Coronavirus Disease 2019 Pandemic. JAMA Pediatr. 2021;175(3):320–321. doi:10.1001/jamapediatrics.2020.5077
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