RHO: Reproductive Health Outlook

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Table 3. Contraception for Adolescents

Male condoms

- Male condoms are a clear first choice for sexually active adolescents who are not in a monogamous relationship.
- Condoms help protect against STIs in addition to pregnancy.

Abstinence

- Should be discussed as an option, both for those who have not yet initiated sexual activity and for those who have.

Female barrier methods

- Female barrier methods, including female condoms and diaphragms, can be appropriate choices for some adolescents.
- Female condoms help protect against STIs in addition to� pregnancy.
- Barrier methods that cover the cervix (such as condoms and the diaphragm) may offer protection against STIs such as gonorrhea and chlamydia.
- Consistent and correct use can present problems for adolescents, however. Barrier methods require planning and negotiating with a partner about use. Partner acceptance may be difficult for some young women to achieve.

Spermicides

- Spermicides are somewhat protective against STIs; clinical studies show significant protection against gonorrhea and chlamydia for women who use nonoxynol-9 products.
- Whether spermicides used alone offer significant protection against transmission of HIV is not known. Abstinence or use of a male latex condom or female condom along with spermicide is the safest choice.

Emergency contraceptive pills (ECPs)

- ECPs do not protect against STIs, but are an important method to have available for adolescents, as they can be taken within 72 hours of unprotected intercourse (WHO/Emergency Contraception, 1998).
- Adolescents are especially unlikely to plan ahead for sex, and may have difficulty using condoms or other methods (Brooks, 1999).

Oral contraceptives

- Oral contraceptives do not protect against STIs, but are a popular choice among adolescent girls in many regions.
- Correct and consistent use can be difficult for some girls, however, especially when they experience common hormonal side effects.

Injectables and implants

- Injectables and implants do not protect against STIs but have some advantages for young women including convenience (as compared to daily pill regimens) and confidentiality.
- Young women should be counseled about potential side effects such as menstrual disturbances and weight gain.
- For clients under age 16, there are theoretical concerns about effects of progestin-only contraceptives on bone development, although WHO considers these generally acceptable to use (PATH/Outlook 1995; PATH/Outlook 1996; WHO, 1996).
- Adolescents who choose hormonal contraceptives should be advised to use a condom in addition to their primary method to protect against STIs (Blumenthal, 1995).

Withdrawal

- Traditional methods such as withdrawal do not protect against STIs, but should not be ignored as a contraceptive choice for adolescents.
- Withdrawal may be the only method available in some circumstances, and both male and female adolescents should understand how it works.

Natural family planning

- Natural family planning can be an effective method of birth control for women who have a regular menstrual cycle and a partner willing to abstain from vaginal intercourse during pre-ovulatory and fertile days.

Intrauterine devices (IUDs) and sterilization

- IUDs and voluntary surgical sterilization (either male sterilization or female sterilization) generally are not appropriate choices for adolescents.

For more information about contraceptives, see RHO's Contraceptive Methods section.

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