CDC finds change in teen birth control use

More embrace implant option

The hormonal implant, a long-acting reversible contraceptive, is an increasingly popular choice among teenagers, according to data published last week from the Centers for Disease Control and Prevention. Just over 13 percent of sexually active teenage girls used the implant between 2015 and 2019, compared with 0.6 percent between 2006 and 2010. This represents the biggest jump in usage compared to all other contraceptive methods.

The uptick “probably contributed to a decline in teen pregnancies and births that we’ve seen,” said Joyce Abma, a social scientist with the National Center for Health Statistics and coauthor of the latest CDC report. The report notes that both teenage pregnancies and births have reached “historic lows.”

The implant, called Nexplanon, is a tiny rod that sits under the skin in the upper arm and releases progestin, a synthetic hormone that mimics progesterone, into the bloodstream. This is designed to suppress ovulation, though it might not always do so for everyone. The progestin also thickens the mucus of the cervix in order to prevent sperm from reaching an egg, if ovulation does occur. The implant is considered over 99 percent effective at preventing pregnancies.

The needle used to insert the implant is “a little bit bigger than a typical needle used to draw blood,” said Dr. Anne-Marie Amies Oelschlager, chair of the American College of Obstetricians and Gynecologists clinical consensus committee for gynecology, which develops clinical guidance. “You tent the skin so that you don’t go deep into the muscle or blood vessels or nerves, and then you basically put the needle in, remove the needle, and the implant stays in place.” Doctors will provide a local anesthetic at the spot where the needle is inserted.

The findings of the CDC’s report echo those of a 2011 study, called the CHOICE project, in which younger teenagers, ages 14 to 17, were found to be more likely to choose an implant than an intrauterine device, or IUD — another long-acting reversible contraceptive. Older teenagers, ages 18 to 20, preferred the latter.

A big draw of the implant is that getting it is far less painful than an IUD, and “no pelvic exam is required,” said Dr. Paula M. Castano, an associate professor of obstetrics and gynecology at Columbia University. It is also easier to train more health care providers to place an implant than an IUD, she added. “That may help expand availability to other clinicians that teenagers may interact with”; a pediatrician or a nurse practitioner can insert the implant, she said, whereas an IUD “requires someone who is much more familiar with pelvic anatomy.”

Another benefit is that the implant is what is known as a “forgettable method,” Dr. Amies Oelschlager said; once it is inserted, it can last for three years and requires no other action. Other contraceptive methods, like the pill, patch, or vaginal ring, require upkeep. The pill, for example, needs to be taken every day at the same time, and “adolescents have a lower rate of perfect use compared to older people,” she said. Many also “don’t have money; they don’t have transportation to get to the pharmacy; they don’t have the ability to make doctor’s appointments and get to doctor’s appointments for refills.” Studies have found that adolescents who use either an implant or an IUD are more likely to continue to use it and be satisfied with it, compared to those who use other methods, like condoms, the pill, or withdrawal.

The implant, however, may not address heavy, painful periods, Castano said, which is a common complaint among adolescents.