Reproductive Health and Teenage Pregnancy: Tips for Providers

Curious about updates to standards around contraception, reproductive health and teenage pregnancy care, and safer sex for adolescents? Here are my livetweeted notes + some slides from a webinar overviewing key evidence-based practices which streamline reproductive health and teenage pregnancy services for adolescents. The webinar also gave data on what teens need and what kind of behaviors they’re engaging in. Though aimed at medical providers, I think the session produced nuggets of information for all kinds of folks!

The Time is Now:
Adolescent Friendly Reproductive Health Care Webinar

Speakers:

Erica Gibson, M.D., & Judy Lipshutz, MSW, RN, NYPATH
Heilbrunn Dept. of Population & Family Health, Columbia University

Topics that were covered include:

Quick Start Contraceptive Initiation
Emergency Contraception
Pregnancy Testing
Long-Acting Reversible Contraceptives (LARCS)
Expedited Partner Therapy (EPT)
STI Treatment

Did you know?

  • In 2013, the Youth Risk Behavior Survey said that over 60% of HS students reported using a condom at their last sexual encounter.
  • The average sexually active teen waits 14 months before seeking reproductive/sexual health services, and the catalyst is usually the desire for a pregnancy test.
  • The types of emergency contraception  in the U.S. include Levonorgestrel pills (e.g. Plan B), the copper IUD (e.g. ParaGard), & ulipristal acetate pills (e.g. ella).
  • In July 2014, the The European Medicines Association issued the following statement: “emergency contraceptives can continue to be used to prevent unintended pregnancy in women of any weight or body mass index (BMI). The available data are limited and not robust enough to support with certainty the conclusion of decreased contraceptive effect with increased body weight /BMI.”

 

Q&A: I Think I Might Be Pregnant…

I might be pregnant. I had unprotected sex with my boyfriend and I’m about 5 days late (I’m pretty regular). I have NO idea what to do about it. I consider myself Pro-Choice, but I’m also a believer that things happen for a reason? I’m very confused. While I believe it is every woman’s right to choose what she wants to do with her body, I feel that if I were to choose aborting this hypothetical child, it’d be selfish that another being got denied life because I was too careless to prevent it.

Post last updated on 7/8/15

Hi Anonymous! It’s normal to feel confused, especially around a situation like this. Because you’re already 5 days late, I’m assuming this sexual contact was more than 5 days ago and thus taking emergency contraception wouldn’t do much. So, my suggestion would be to first assess your risk (to see how likely it is that you are pregnant), and then take a pregnancy test ASAP to check it out. In my opinion, you don’t need to think further ahead until you have the results and facts more concretely; over-thinking the possibilities will probably just stress you out. First of all, though, remember that many things can throw off your cycle, including changes in diet, stress-levels, and exercise…it doesn’t have to be a pregnancy.

In terms of assessing risk, I’d ask you a few questions

  • Did he ejaculate inside of your vagina (or on your vulva)? If yes, there is a chance you could be pregnant.
  • Did he pre-cum inside of your vagina? If yes, there’s a possibility, but it’s fairly slim. Pre-cum doesn’t contain sperm unless there was a previous ejaculation and the guy didn’t pee between ejaculating and pre-cumming; then the sperm comes from semen still in the urethra.
  • Did you engage in any activity that could’ve led semen to enter your vaginal canal (e.g. anal sex with bf ejaculating when you were facedown and thus it could’ve dripped)? If so, there is a chance of pregnancy.

Like I said before, it’s perfectly normal to feel confused and even feel at odds with your political beliefs/thoughts. Remember, though: being pro-choice doesn’t mean automatically having to get an abortion; it means considering the options and having the freedom to pick the one that best suits you in a variety of ways. Keeping a child or putting it up for adoption doesn’t make you any less of a pro-choicer (or feminist, if you ID that way). There are support groups, message boards, counselors, and a variety of folks available to talk you through these thoughts and situations. See what resources you have at your disposal. Be wary of crisis pregnancy centers, though–many are anti-choice/pro-life and use scary rhetoric that doesn’t actually give you all the information you need to make an educated choice about what to do if you’re actually pregnant.

After assessing your risk, I’d suggest a pregnancy test ASAP. (The longer you wait, the narrower your options get for dealing with it.) They have them at drugstores and some HS/college health clinics, but access to them depends on your location. Some places even offer them for free! I could perhaps help point you in some direction if I knew your area? Feel free to private-message me or email me, if you want! If you can’t access them or don’t feel comfortable doing so, perhaps asking a friend would work? Some folks even ask strangers because there’s little investment in their opinion! While pregnancy tests are not infallible, they can at least give you a preliminary answer. I’m a fan of always taking two tests just in case (one a few days after the other). For more info on how to do them, how they work, and all that, click here.

You can choose to mention that you’re going to take a pregnancy test to your boyfriend, but you can also choose to do it without notifying him. Depending on how you feel about your relationship and how long you’ve been going out, you may feel a need to talk through this with him (before, during, and/or after), but it’s also perfectly fine for you to take care of yourself first. Bottom line, though: you don’t have to go through any of this alone, and you get to decide who you talk to–find someone who will be helpful, respectful, and supportive. If you’re in the US or Canada, you can call Planned Parenthood’s hotline (1.800.230.PLAN), the NAF hotline (1.800.772.9100), and/or Backline (1.888.493.0092).

If for some reason you feel you need another test or another opinion, you can try to visit a local Planned Parenthood or any sort of clinic with access to a physician, and OBGYN, and/or some sort of professional that can either perform a fluid (urine/blood) test or do an ultrasound.

So, post-test, if you AREN’T pregnant, this is a good opportunity to think through what you would’ve done if you had been. It can be something to bring up with your boyfriend, and something to keep in mind next time you are thinking of how to protect yourself against pregnancy. Maybe using another birth control method could be useful? Maybe making up some rules regarding contraception and when you can have sex? Who knows. If you ARE pregnant, you should learn about your options so you can make the best decision for you. The short-list would be: put it up for adoption, keep it, or abort it. You don’t have to make the decision immediately, but definitely be aware of your time-frame!

(Now, this is my VERY PERSONAL VIEW on others bringing life into this world and by no means do I wish to impose it on you; I wish to merely share it in an attempt to provide perspective.) I’m someone who considers overpopulation and the fact that we have so many kids in the foster system already when thinking of bringing new life into the world. For someone who currently does not want a child and/or feels unprepared to (and/or cannot) care for one, I feel it’s best to put it up for adoption or to abort it. Due to the aforementioned issues, I believe that if a fetus is going to grow into a baby, then it should be born into a space that can nurture it, and it’s often more sensical to pursue abortion rather than adoption when such a space can’t be provided/secured.

It’s not an issue of being selfish or not, especially now; this fetus is something that can grow only if you help it grow, and you have the choice to make that happen or not, and to decide what will come of that. Since you feel everything happens for a reason, consider the fact that if you get pregnant, the implication doesn’t HAVE to be that you should keep it. Perhaps this happened so you would change your birth control, have a conversation with your partner, or any number of other reasons. Personally, I don’t think it makes you selfish to not keep it, but in the end, the opinion that truly matters is your own. At the end of the day, you should make the choice that, given everything, is best for you and you can safely make.

For more information, feel free to contact me again + please check out the amazing Scarleteen resources on this topic.