Good News: Teens Are Using IUDs. Bad News: They're Not Using Condoms
For the first time in a long time, the exceedingly high rate of unintended pregnancy in the United States has finally started to drop. That's in part because so many women are getting intrauterine devices, which have a less than 1% failure rate. Pretty simple.
However, lowering the rate of unintended pregnancy is having an unintended consequence: Teens could be at a greater risk of giving each other the clap.
According to a study published this week in the journal JAMA Pediatrics, increased use of IUDs and other long-acting reversible contraceptives, or LARCS, could be linked to reduced condom use among young people, which is likely the result of a little confusion about why using condoms is a good idea: They don't just help prevent pregnancy, but sexually transmitted infections too.
Yet researchers found that teens who used LARCs were significantly less likely — 60% less likely! — to have a partner wrap it up when they had sex compared to peers who used other, less reliable forms of birth control, like the pill. That trend could be bad, bad news for STI rates.
The study: Researchers polled 2,300 sexually active high school-age girls about the primary method of contraception they used during their most recent sexual encounter, including everything from LARCs to withdrawal to condoms, the pill, the patch, the ring or Depo-Provera shot.
Nearly 30% used LARCs or some other "highly or moderately effective" method like oral contraception, which was the most commonly used form of hormonal birth control among those who used one regularly. While nearly a quarter of the girls said they relied on the pill, just under 2% used LARCs and nearly 6% used Depo-Provera, the patch or the ring. (Although LARC use is on the rise among teens, implants and IUDs still aren't always accessible.)
The questionnaire separately asked the teens whether they used a condom the last time they had intercourse. Generally speaking, for participants who used LARCs, the answer to the second question was "no." According to the study, condom use was highest (over 37%) among participants who also used oral contraceptives, a substantially higher rate than those who used other forms of birth control.
Of the young women who used LARCs, a mere 16.4% reported using condoms as well, which is particularly troubling given they were also twice as likely as oral contraceptive users to have had two or more sexual partners in the past three months. Having multiple partners increases the risk of contracting STIs, especially when condoms aren't being used. Unfortunately, the researchers noted, STIs don't seem to be teens' primary concern.
Pregnancy isn't the only risk of sexual activity: The findings indicate many teens view condoms as a secondary birth control method, and not necessarily a crucial means of preventing anything but unintended pregnancy (like, say, STIs).
According to the study, trends in condom use could have a lot to do with young people's perceptions of how effective different methods of contraception are: While teens who use the pill could easily miss a dose and see a need for a backup method, "adolescents using highly effective, user-independent LARC methods ... may be less likely to use condoms because they do not perceive a need for additional protection against pregnancy."
Sure, LARCs might be good at preventing pregnancy, but they aren't any help avoiding chlamydia (or gonorrhea or syphilis) — something which young people, in particular, could seriously stand to think about.
Last year, the Centers for Disease Control and Prevention found people between the ages of 15 and 24 accounted for the highest rates of chlamydia and gonorrhea in 2014. In fact, young people are believed to represent half of the estimated 20 million STIs diagnosed in the United States each year. While they might be increasingly educated about — and reliant on — dependable methods of preventing pregnancy, teens and young adults are, clearly, distressingly under-informed about how to protect themselves against other sexual health issues.
That makes sense given the dearth of comprehensive sex education in the United States, which has already resulted in teens learning virtually nothing about condoms or safe sex — not to mention how to have healthy relationships. In a country where educators are punished for teaching students about condoms, unfortunately, it's not really surprising teens don't realize that condom use is important.
Maybe, then, it's time to teach them.