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International Perspectives: IUDs and Adolescents

      Abstract

      Unplanned or unwanted pregnancy among adolescents is a worldwide public health issue. In many countries unmarried young women are denied contraceptive services. Long-acting reversible contraceptive methods such as the intrauterine devices (IUDs) have been shown to be more effective than short-acting such as the pill, and safe also for adolescents. The popularity has varied a lot with time and between populations. Health care providers, health system, and user factors all influence IUD use. A good sexuality education through school provides a foundation, and health care providers give specific individual counseling. International and country-specific guidelines have been published during the past decade indicating the advantage of IUDs. New smaller size devices make placement easier for nulliparous adolescents. Still the uptake has remained rather low in most regions, cost being one barrier. Several municipalities have started to provide long-acting reversible contraceptive methods for adolescents free of charge, and this has led to a significant increase in IUD use, accompanied by a reduction in abortion rates. Adolescent-friendly services should offer low-cost or free contraception, including male and female condoms, emergency contraception, and a full range of modern methods, including long-acting reversible methods, according to adolescents’ preferences and needs.

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      References

        • Hindin M.J.
        • Kalamar A.M.
        Country-specific data on the contraceptive needs of adolescents.
        (Available:)
        • FP
        Global consensus statement for expanding contraceptive choice for adolescents and youth to include long-acting reversible contraception.
        (Available:)
        http://www.familyplanning2020.org/youth-larc-statement
        Date: 2020
        Date accessed: February 6, 2019
        • Smith S.
        The use of intrauterine devices (IUDs) in adolescents and nulliparous women: a systematic review.
        J Womens Health Care. 2015; 4: 277
        • Chandra-Mouli V.
        • Lane C.
        • Wong S.
        What does not work in adolescent sexual and reproductive health: a review of evidence on interventions commonly accepted as best practices.
        Glob Health Sci Pract. 2015; 3: 333
        • WHO Collaborating Centre for Sexual and Reproductive Health
        Standards in sexuality education.
        (Available:)
        • Apter D.
        Recent development and consequences of sexuality education in Finland.
        BZgA Forum. 2011; 2: 3
        • Bitzer J.
        • Abalos V.
        • Apter D.
        • et al.
        Targeting factors for change: contraceptive counselling and care of female adolescents.
        Eur J Contracept Reprod Health Care. 2016; 21: 417
        • Apter D.
        Contraception options: aspects unique to adolescent and young adult.
        Best Pract Res Clin Obstet Gynaecol. 2018; 48: 115
        • ACOG committee opinion no
        735: adolescents and long-acting reversible contraception: implants and intrauterine devices.
        Obstet Gynecol. 2018; 131: e130
      1. Committee on Adolescence: Contraception for adolescents.
        Pediatrics. 2014; 134: e1244
        • World Health Organization
        Medical Eligibility Criteria for Contraceptive Use.
        5th ed. WHO, 2015
      2. Faculty of Sexual and Reproductive Healthcare: UKMEC.
        (Available:)
        • Faculty of Sexual and Reproductive Healthcare
        FSRH clinical guidance: intrauterine contraception - 2015.
        (Available:)
        • Whiteman M.K.
        • Tyler C.P.
        • Folger S.G.
        • et al.
        When can a woman have an intrauterine device inserted? A systematic review.
        Contraception. 2013; 87: 666
        • Hognert H.
        • Skjeldestad F.E.
        • Gemzell-Danielsson K.
        • et al.
        Ecological study on the use of hormonal contraception, abortions and births among teenagers in the Nordic countries.
        BMJ Open. 2018; 8: e022473
        • Bratlie M.
        • Aarvold T.
        • Skårn E.S.
        • et al.
        Long-acting reversible contraception for adolescents and young adults – a cross-sectional study of women and general practitioners in Oslo, Norway.
        Eur J Contracept Reprod Health Care. 2014; 19: 194
        • United Nations, Department of Economic and Social Affairs, Population Division
        World contraceptive use 2018.
        (Available:)
        • Hubacher D.
        • Kavanaugh M.
        Historical record-setting trends in IUD use in the United States.
        Contraception. 2018; 98: 467
        • McCurdy R.J.
        • Jiang X.
        • Schnatz P.F.
        Long-acting reversible contraception in adolescents in sub-Saharan Africa: evidence from demographic and health surveys.
        Eur J Contracept Reprod Health Care. 2018; 23: 357
        • Decat P.
        • De Meyer S.
        • Jaruseviciene L.
        • et al.
        Sexual onset and contraceptive use among adolescents from poor neighbourhoods in Managua, Nicaragua.
        Eur J Contracept Reprod Health Care. 2015; 20: 88
        • Ponce de Leon R.G.
        • Ewerling F.
        • Serruya S.J.
        • et al.
        Contraceptive use in Latin America and the Caribbean with a focus on long-acting reversible contraceptives: prevalence and inequalities in 23 countries.
        Lancet Glob Health. 2019; 7: e227
        • Health Communication Capacity Collaboration
        Barriers to LARC uptake among youth.
        (Available:)
        • Nalwadda G.
        • Mirembe F.
        • Tumwesigye N.M.
        • et al.
        Constraints and prospects for contraceptive service provision to young people in Uganda: providers’ perspectives.
        BMC Health Serv Res. 2011; 11: 220
        • Agha S.
        • Fareed A.
        • Keating J.
        Clinical training alone is not sufficient for reducing barriers to iudprovision among private providers in Pakistan.
        Reprod Health. 2011; 8: 1
        • Eke A.C.
        • Alabi-Isama L.
        Long-acting reversible contraception (LARC) use among adolescent females in secondary institutions in Nnewi, Nigeria.
        J Obstet Gynaecol. 2011; 31: 164
        • Foran T.
        • Butcher B.E.
        • Kovacs G.
        • et al.
        Safety of insertion of the copper IUD and LNG-IUS in nulliparous women: a systematic review.
        Eur J Contracept Reprod Health Care. 2018; 23: 379
        • Silva-Filho A.L.
        • Lira J.
        • Rocha A.L.
        • et al.
        Non-hormonal and hormonal intrauterine contraception: survey of patients’ perceptions in four Latin American countries.
        Eur J Contracept Reprod Health Care. 2016; 21: 213
        • Suhonen S.
        • Haukkamaa M.
        • Jakobsson T.
        • et al.
        Clinical performance of a levonorgestrel-releasing intrauterine system and oral contraceptives in young nulliparous women: a comparative study.
        Contraception. 2004; 69: 407
        • Gemzell-Danielsson K.
        • Buhling K.J.
        • Dermout S.M.
        • et al.
        A phase III, single-arm study of LNG-IUS 8, a low-dose levonorgestrel intrauterine contraceptive system (total content 13.5 mg) in postmenarcheal adolescents.
        Contraception. 2016; 93: 507
        • Rasheed S.M.
        • Abdelmonem A.M.
        Complications among adolescents using copper intrauterine contraceptive devices.
        Int J Gynecol Obstet. 2011; 115: 269
        • Alton T.M.
        • Brock G.N.
        • Yang D.
        • et al.
        Retrospective review of intrauterine device in adolescent and young women.
        J Pediatr Adolesc Gynecol. 2012; 25: 195
        • Aoun J.
        • Dines V.A.
        • Stovall D.W.
        • et al.
        Effects of age, parity, and device type on complications and discontinuation of intrauterine devices.
        Obstet Gynecol. 2014; 123: 585
        • Madden T.
        • McNicholas C.
        • Zhao Q.
        • et al.
        Association of age and parity with intrauterine device expulsion.
        Obstet Gynecol. 2014; 124: 718
        • Gemzell-Danielsson K.
        • Apter D.
        • Hauck B.
        • et al.
        The effect of age, parity and body mass index on the efficacy, safety, placement and user satisfaction associated with two low-dose levonorgestrel intrauterine contraceptive systems: subgroup analyses of data from a phase III trial.
        PLoS One. 2015; 10: e0135309
        • Diedrich J.T.
        • Klein D.A.
        • Peipert J.F.
        Long-acting reversible contraception in adolescents: a systematic review and meta-analysis.
        Am J Obstet Gynecol. 2017; 216: 364
        • Kaislasuo J.
        • Heikinheimo O.
        • Lähteenmäki P.
        • et al.
        Predicting painful or difficult intrauterine device insertion in nulligravid women.
        Obstet Gynecol. 2014; 124: 345
        • Kaislasuo J.
        • Heikinheimo O.
        • Lahteenmaki P.
        • et al.
        Menstrual characteristics and ultrasonographic uterine cavity measurements predict bleeding and pain in nulligravid women using intrauterine contraception.
        Hum Reprod. 2015; 30: 1580
        • Bachofner M.
        • Blickenstorfer K.
        • Hutmacher J.
        • et al.
        Intrauterine device continuation rates and reasons for discontinuation in a Central European clinic with a high standard of care and ultrasound follow-up: a retrospective cohort study.
        Eur J Contracept Reprod Health Care. 2018; 23: 407
        • Black K.
        • Lotke P.
        • Buhling K.J.
        • et al.
        A review of barriers and myths preventing the more widespread use of intrauterine contraception in nulliparous women.
        Eur J Contracept Reprod Health Care. 2012; 17: 340
        • Merki-Feld G.S.
        • Caetano C.
        • Porz T.C.
        • et al.
        Are there unmet needs in contraceptive counselling and choice? Findings of the European TANCO study.
        Eur J Contracept Reprod Health Care. 2018; 23: 183
        • Apter D.
        • Briggs P.
        • Tuppurainen M.
        • et al.
        A 12-month multicenter, randomized study comparing the levonorgestrel intrauterine system with the etonogestrel subdermal implant.
        Fertil Steril. 2016; 106: 151
        • Peipert J.F.
        • Madden T.
        • Allsworth J.E.
        • et al.
        Preventing unintended pregnancies by providing no-cost contraception.
        Obstet Gynecol. 2012; 120: 1291
        • McNicholas C.
        • Madden T.
        • Secura G.
        • et al.
        The contraceptive CHOICE project round up: what we did and what we learned.
        Clin Obstet Gynecol. 2014; 57: 635
        • Gyllenberg F.
        • Juselius M.
        • Gissler M.
        • et al.
        Long-acting reversible contraception free of charge, method initiation, and abortion rates in Finland.
        Am J Public Health. 2018; 108: 538
        • Gyllenberg F.K.
        • Saloranta T.H.
        • But A.
        • et al.
        Induced abortion in a population entitled to free-of-charge long-acting reversible contraception.
        Obstet Gynecol. 2018; 132: 1453