The American Academy of Pediatrics (AAP) recommends IUDs as the first choice for teens

It took quite a bit of time to get around to it, but the American Academy of Pediatrics (AAP) has finally gotten around to making "the recommendation that the first-line contraceptive choice for adolescents who choose not to be abstinent is a Long Acting Reversible Contraceptive (LARC), which is an intrauterine device or a sub-dermal implant."

Here is some history, and today's new recommendation.

In 2011 The American College of Obstetricians and Gynecologists released the following statement:

IUDs Implants Are Most Effective Reversible Contraceptives Available 

June 20, 2011
Washington, DC -- Long-acting reversible contraceptive (LARC) methods—namely intrauterine devices (IUDs) and implants—are the most effective forms of reversible contraception available and are safe for use by almost all reproductive-age women, according to a Practice Bulletin released today by The American College of Obstetricians and Gynecologists (The College). The new recommendations offer guidance to ob-gyns in selecting appropriate candidates for LARCs and managing clinical issues that may arise with their use. 

"LARC methods are the best tool we have to fight against unintended pregnancies, which currently account for 49% of US pregnancies each year," said Eve Espey, MD, MPH, who helped develop the new Practice Bulletin. "The major advantage is that after insertion, LARCs work without having to do anything else. There's no maintenance required." 

More than half of women who have an unplanned pregnancy were using contraception. The majority of unintended pregnancies among contraceptive users occur because of inconsistent or incorrect contraceptive use. LARCs have the highest continuation rates of all reversible contraceptives, a key factor in contraceptive success. 

IUDs and contraceptive implants must be inserted in a doctor's office. Two types of IUDs—small, T-shaped devices that are inserted into the uterus—are available. The copper IUD, which effectively prevents pregnancy for 10 years, releases a small amount of copper into the uterus, preventing fertilization. In addition, copper interferes with the sperm's ability to move through the uterus and into the fallopian tubes. The device can also be used for emergency contraception when inserted within five days of unprotected sex. 

Women using the copper IUD will continue to ovulate, and menstrual bleeding and cramping may increase at first. Though data suggest that these symptoms lessen over time, heavy menstrual bleeding and pain during menstruation (dysmenorrhea) are main causes of discontinuation among long-term copper IUD users. Women considering IUDs should be informed of this adverse effect beforehand. 

The hormonal IUD releases progestin into the uterus that thickens cervical mucus and thins the uterine lining. It may also make the sperm less active, decreasing the ability of egg and sperm to remain viable in the fallopian tube. The hormonal IUD may make menstrual cycles lighter and is also FDA-approved for the treatment of heavy bleeding. The hormonal IUD prevents pregnancy for five years. 

The contraceptive implant is a matchstick-sized rod that is inserted under the skin of the upper arm and allows the controlled release of an ovulation-suppressing hormone for up to three years. It is the most effective method of reversible contraception available with a pregnancy rate of 0.05%. 

Despite the many benefits of LARC methods, the majority of women in the US who use birth control choose other methods. Fewer than 6% of women in the US used IUDs between 2006 and 2008. According to The College, lack of knowledge about LARCs and cost concerns may be to blame. "Women need to know that today's IUDs are much improved from earlier versions, and complications are extremely rare. IUDs are not abortifacients—they work before pregnancy is established—and are safe for the majority of women, including adolescents and women who have never had children. And while upfront costs may be higher, LARCs are much more cost-effective than other contraceptive methods in the long run," Dr. Espey said.

In 2012 the American Academy of Pediatrics issued this statement:

AAP Recommends Emergency Contraception Be Available to Teens 

11/26/2012 For Release:  November 26, 2012
Teen pregnancies have declined over the past few decades, but the United States continues to see substantially higher teen birth rates compared to other developed countries. A new policy statement by the American Academy of Pediatrics (AAP) discusses the use of emergency contraception and how it can reduce the risk of unintended pregnancy in adolescents. The statement, “Emergency Contraception,” will be published in the December 2012 Pediatrics and released online Nov. 26. According to the AAP, adolescents are more likely to use emergency contraception if it’s prescribed in advance.  

Many teens continue to engage in unprotected sexual intercourse, and as many as 10 percent are victims of sexual assault. Other indications for use include contraceptive failures (defective or slipped condoms, or missed or late doses of other contraceptives). When used within 120 hours after having unprotected or under-protected sex, selected regimens for emergency contraception, such as Plan B, Next Choice, etc., are the only contraceptive methods to prevent unwanted pregnancy.  

According to the AAP, pediatricians can play an important role in counseling patients and providing prescriptions for teens in need of emergency contraception for preventing pregnancy. Patients should also know that emergency contraception does not protect against sexually transmitted infections (STIs), and pediatricians should discuss the importance of STI testing, or treatment if needed. The AAP also encourages pediatricians to advocate for better insurance coverage and increased access to emergency contraception for teens, regardless of age.

And today tthe American Academy of Pediatrics issued this statement: 

AAP Updates Recommendations on Teen Pregnancy Prevention 

9/29/2014
Over the past 10 years, a number of new contraceptive methods have become available. The American Academy of Pediatrics (AAP) continues to review and update its recommendations on contraceptive methods to provide pediatricians with the information they need in order to counsel and prescribe contraception for adolescents. 

 In an updated policy statement and accompanying technical report in the October 2014 Pediatrics, “Contraception for Adolescents,” (published online Sept. 29), the AAP recognizes the pediatrician’s role as a trusted advisor and source of sexual health information, and supports adolescents and their families to discuss and ask questions about sensitive issues such as sexual health and relationships. 

According to AAP recommendations, pediatricians will conduct a developmentally-targeted sexual history, assess risk for sexually transmitted infections, and provide appropriate screening and/or education about safe and effective contraceptive methods. 

Regardless of which method of contraception is chosen, pediatricians should stress that all methods of hormonal birth control are safer than pregnancy, allow adolescents to consent to contraceptive care, and become familiar with state and federal laws regarding disclosure of confidential information in minors. 

New in this report is the recommendation that the first-line contraceptive choice for adolescents who choose not to be abstinent is a Long Acting Reversible Contraceptive (LARC), which is an intrauterine device or a subdermal implant.  

The past decade has demonstrated that LARCs, which provide 3 to 10 years of contraception, are safe for adolescents. Pediatricians should be familiar with counselling, insertion, and /or referral for LARCs. Additional updates to the policy statement focus on patients with special health care needs, including physical or developmental disabilities, medically complex illness, and obesity.  

It is important for pediatricians to regularly update patients’ sexual histories and allow sufficient time for follow up appointments when needed. Pediatricians are also encouraged to promote healthy sexual health decision-making, such as abstinence and proper condom use.  

Raise Your SAT Score NOW!

Milford-based
College Placement Firm Expands

Disclosure: The following is a Press Release from First College Placement,  the brainchild of the terrific James Maroney, who is our newest State Rep from Milford. Beyond that, they do wonderful work and increase teens SAT scores to get them into the best possible position for applying to College.
Get your kids enrolled right away!

First Choice College Placement is pleased to announce it will be opening new classroom facilities to serve students in Norwalk, Monroe, Wallingford and their respective surrounding communities. In Norwalk they will be located at 430 Main Avenue, in Monroe at 601 Main Street, and in Wallingford at 950 Yale Avenue. The new facilities are the result of a strategic partnership with All-Star Driver, Connecticut’s leader in driver’s education. 

First Choice College Placement has been providing SAT/ACT test preparation classes in Milford since 1999, and beginning in August, those same test preparation classes will be available at the three All-Star Driver classroom facilities - Norwalk, Monroe and Wallingford.

“Our two businesses serve the same groups of high school juniors and seniors, so it just made sense to utilize these state-of-the-art classrooms when they are available,” said James Maroney, Director of First Choice College Placement LLC. “We employ a variety of technologies to assist students in the classroom, such as white boards, iPads, and recording of each session for review at the student’s convenience. In addition, all classroom sessions are taught by our highly qualified tutors who are graduates of top universities.”

First Choice has worked with a number of recruited athletes to help them get the scores to qualify for Ivy League schools and other academic requirements, along with helping a wide variety of students, including high academic achievers, realize their college-related goals.

“First Choice gave my son direction on studying for the SAT’s, his essay and selecting the right school,” said Peter Graeb of Wallingford. “My son’s ultimate college choice could not have been better for him and the experience was so rewarding we used them again with my younger son, with the same great results.”

For more information, call (800) 575-0950 or email jmaroneyct@gmail.com.  www.firstchoicecollege.com/

 And, yes, James, I am impressed.

Mental Health - Informative OP ED

I am reprinting this in full because it is long and complex. It was sent to me by a friend who is active in Mental Health and Addiction Services work. Normally I try to give a link and only extract a paragraph or two, for copyright reasons and to redirect to the original source. In this case, Sue Me.

I actually got a cup of coffee and sat in quiet to read the whole piece, since it gives background and history that is helpful knowledge as we continue to discuss all solutions and variables to working forward. 

My take-away is the need or better services for children and youth. But then again, that is always my take-away. ...Or Leftovers, when it involves a good restaurant!

OP-ED from The Hartford Courant

Forced Mental Health Treatment Wrong

By JANET VAN TASSEL |  January 7, 2013
In the past month there have been numerous thoughtful recommendations for improving the state's mental health system, and Connecticut is, from a policy perspective, well-positioned to implement most of these proposals.

Since the Report of the Blue Ribbon Commission on Mental Health was issued in July 2000, the state has pursued evidence-based practices and become a national leader in promoting a community-based, family- and consumer-oriented system of care.

Unfortunately, many of these innovative measures have been funded through federal grants that are limited in scope and time, or hampered by state budget constraints that have prevented their full implementation. In addition, funding for private nonprofit agencies that provide many community supports and services has not kept pace with state-operated counterparts. In short, Connecticut has the programmatic building blocks to construct the comprehensive community-based system of care it promised when state hospitals were closed, but not the resources to support it.

For example, it is well-documented that supportive housing is a cost-effective way to provide a stable living arrangement for families and individuals with mental illness, which reduces hospital expenditures and promotes self-sufficiency. However, despite recent investments by the state, housing subsidies fall well below the demand, forcing vulnerable people into shelters, and leaving discharge-ready people in expensive state hospital beds. Similarly, a federally supported initiative to expedite Social Security disability applications for people with mental illness is understaffed, and people with mental illness are being released from the state Department of Correction facilities are homeless.

Funding to expand school-based clinics and programs for children an youth have been cut, as the number of homeless youth rises. And despite a mental health parity law, private insurers routinely deny claims for mental health treatment services, particularly for children.
Although Connecticut has been recognized as having one of the best mental health systems in the country, accessing services and supports is still a futile effort for many. In fact, persons with mental illness routinely seek legal services because their services have been denied, reduced or terminated by agencies with limited funds.

Given this context, it is troubling that legislative proposals to authorize involuntary outpatient treatment for persons with mental illness have again been raised. The appeal of such a measure, which on its face sounds eminently reasonable, is understandable. However, it is fraught with complexities, starting with the fact that determining whether a person who is not currently a danger to self or others or gravely disabled, but is "potentially dangerous" is not straightforward. There is no system for identifying persons who might be dangerous, and violent behavior is not linked to a psychiatric diagnosis.

Because a forced medication or treatment law would restrict the fundamental civil rights of people with mental illness, there are questions about whether it would violate Connecticut's constitutional protections for these individuals. Certainly, it would require an enforcement system and court proceedings comparable to those used in New York, which cost more than $32 million per year. Consequently, it would be very costly, and use money that would be better spent on community services.

A Task Force Report on Issues Related to Involuntary Outpatient Commitment and Alternatives, which was issued in January 1997, rejected outpatient commitment and recommended specific alternative measures which were subsequently pursued by the state. Last year, the Judiciary Committee had a full hearing on similar legislation, which was opposed by groups as diverse as state agencies, psychologists and police officers, and rejected by the committee. This is the time to invest the state's limited resources into constructing a comprehensive system of screening, services and housing supports for children, youth and adults with mental illness rather than pursue a course that would divert funds from the real problem. It is the wrong tool for Connecticut.

Janet Van Tassel, a lawyer, is executive director of the Connecticut Legal Rights Project and founder and co-chairwoman of the Keep the Promise Coalition.

Copyright  2013, The Hartford Courant

In conclusion: Thanks for reading this.