Teens on a LARC

Teens on a LARC October 2, 2014

OK, I’ll bite:  I wrote about the drive to get teenage girls onto LARCs – long-acting, reversible contraception – in the context of the Colorado Family Planning Initiative, in which those methods, and only those methods, were provided to women free of charge at Title X family-planning clinics.  Now it’s appeared two more times:  an Atlantic article, “IUDs and Implants Are the New Pill; Long-term devices are now the first-line recommendation for women of all ages,” and an Amanda Marcotte piece, “Parents, Get Your Teenage Daughters the IUD.”

In both cases, the articles’ titles pretty much say it all.  According to The Atlantic,

According to an important new study that will appear in tomorrow’s New England Journal of Medicine, more than 16 times more teenage women would choose these options over birth-control pills if given proper information and affordable access to all forms of medical contraception. 

What’s changed?  Again, per The Atlantic,

One long-standing reservation about IUDs in young women was a high risk of expulsion from the uterus, which was evident in the CHOICE project; but the IUDs were falling out at lower rates than people who opted to take the pill were forgetting to take it.

In the bigger picture, from what I read in writing my post this past summer, what we’re seeing are multiple elements coming together:

  • There are studies demonstrating that the feared side-effects for teen girls from implants and IUDs aren’t as bad as feared.
  • The desire to bring down teen pregnancies “by any means necessary” has meant that potential greater side-effects or long-term harm for teens are deemed an acceptable consequence, and in any case, better than the otherwise-unavoidable alternative of teen pregnancy.
  • The move to make all contraception free of charge to the end user has produced a new mindset in which cost is not an issue for policy planners.
  • And there’s a new willingness on the part of these same social planners to openly say, “there’s nothing wrong with teen sex.” 
Let me unpack this last one a bit more.  
The liberal social planners telling us we needed to beef up contraceptive use among teens had always taken the approach of “teens can’t control themselves.”  Never mind that they expect zero-tolerance on such things as teen smoking or teen drunk-driving, sex is such an irresistible urge that everyone truly is doing it, except maybe the losers who couldn’t get a sexual partner.  And I was mulling this over this morning, in the context of “drunken sexual assault” and contemplating the mixed message that “teens can’t help it” and, at the same time, “teens sure as heck better get affirmative consent for every base they round” — until I concluded that there is no mixed message at all, just a bit of Orwellianness.  
The  bottom line is that promoters of LARCs haven’t deemed implants and IUDs as the contraception method of choice for teenagers because they “can’t help” having sex, but because they fundamentally aren’t really that troubled by teen sex.  
Here it is in The Atlantic, again:

Like any public-health solution, the primary challenge is culture. No less than the bastion of sexual liberation the U.S. Department of Health and Human Services recommends that countries with the most sex-positive sexual instruction have the best outcomes in preventing unintentional teenage pregnancy, and that the public-health issue is best addressed with “societal acceptance of adolescent sexual relationships.”

 In their view, there’s no particular reason to discourage teens from having sex, so the question of reducing teen pregnancy is simply a pragmatic one of moving teens from less effective to more effective forms of contraception.  It’s no different than saying, “teens will drive, so let’s make cars safer.”

Oh, and I suspect that there’s a further bit of social planning, and perhaps a recognition that poor teen girls don’t really mind getting pregnant all that much.  Many of the suggestions around LARCs sure seem like it’s not entirely voluntary, and there’s a significant potential for minimizing the side effects and placing pressure on girls to get implanted/IUDed, even if not outright compulsion — perhaps in part with the thought that a teen girl who wants to get pregnant will in any event go with the program rather than openly admitting the fact.

And here’s something ironic:  when the issue of the cost of contraception was in the news, the Party Line was that women had the potential to react poorly to the hormonal formulations of generic pills, so they needed access, at no out-of-pocket cost, to any number of brand-name formulations.  But, when it comes to IUDs and implants, and teenagers, the issue of side effects is pretty much disregarded.

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