The Canadian Paediatric Society is endorsing intrauterine devices as the first-line birth control option for teenage girls, saying it’s the most reliable form of contraception.
In a new position statement issued Thursday, the CPS says doctors should be recommending IUDs first in order to avoid the "personal, health care and social costs" of unintended youth pregnancies.
An IUD is a small, usually T-shaped device placed inside the uterus by a health care provider to prevent pregnancy. Left in place, IUDs are effective for years, but they can be removed at any time.
The IUDs prevent pregnancy by thickening the cervical mucus and blocking sperm from reaching the egg. Depending on the type of device used, the sperm deterrent is either copper or a synthetic hormone.
The Canadian Paediatric Society says that IUDs are more than 99 per cent effective in preventing pregnancy. By comparison, the effectiveness of the combined oral contraceptive pill is 91 per cent, while condoms are 82 per cent effective with proper use.
The American College of Obstetricians and Gynecologists endorsed IUDs as first-line birth control recommendations for youth in 2012.
"We’d like to see more ease with recommending the use of IUDs," said Dr. Giuseppina Di Meglio, one of the authors of the CPS position statement and an adolescent medicine specialist at The Montreal Children's Hospital.
She said the benefits of IUDs need to be stated clearly because there was a belief at one point that intrauterine devices could increase the risk of infertility, but that was based on flawed data.
“The evidence is pretty clear that IUDs…are the most effective birth control that’s available in Canada,” she told CTV News Channel on Thursday.
Dr. Di Meglio said the CPS would like doctors to recommend birth control methods in order of effectiveness, but she stressed the importance of working together with youth to choose a contraceptive that’s best or most practical for each individual.
She acknowledged that not all youth are comfortable with IUDs, and some teens may encounter financial barriers.
A copper IUD, for example, can cost up to $100, and hormonal IUDs are even more expensive.
For a teenager who doesn’t have insurance coverage, or is unwilling to approach her parents about getting an IUD, "that’s a lot of money," Dr. Di Meglio told CTVNews.ca.
While certain types of IUDs can be accessed for free (The OHIP+ program in Ontario, for example, covers the cost of the IUD Mirena for youth aged 24 or younger), access and availability are inconsistent across the country. And Dr. Di Meglio said that needs to change.
"As a society we need to be thinking about covering contraceptives for teens," she said
A 2008 survey found that more than half of Canadian youth are sexually active by age 17. The CPS says discussions with doctors about sexual health and contraception should start early, preferably before any sexual activity begins, and continue throughout adolescence.
Dr. Di Meglio said it’s also important for health care providers to discuss contraceptives and sexual health with boys and young men, so that the responsibility of birth control doesn’t fall solely on girls.
The CPS also says that youth should be counselled to use condoms each time they have sex in order to prevent the spread of STIs, regardless of whether they’re using other forms of birth control.
For girls who choose a non-IUD birth control method, such as an oral contraceptive, doctors should provide a prescription without a pelvic exam, the CPS says. While screening for sexually transmitted infections should be offered to all sexually active youth, it "should not be a prerequisite" for obtaining birth control, except in cases where an IUD is being inserted, the position paper says.
