First it is very important to explain to young people that the discussion among them and the healthcare professional is confidential. Both boys and girls must understand that the recommended products are safe and efficient. If they like to discuss the method further with their parents this will also be taken into account, since the parents are not usually well informed which may be the starting point of an argument on the necessity of the use of the method or may need further explanation on the side effects of the proposed method (table 2).
The condom is recommended in all cases, especially if the young couples do not have a permanent relationship. For young girls who have frequent sexual intercourse, low-dose COCs should be recommended. It should be explained that there is only a limited number of side effects, especially if ultra low dose COCs are used. Perhaps they understand that the use of both methods at the same time is an excellent choice. They should also be discouraged to start smoking. The healthcare professionals at FPCs should be available at any time for further explanation through a hotline system and capable of providing emergency contraception at any time, if necessary (table 3).
Table 2. Approaching young people
- What’s the problem? Is there a solution?
- Are you ready to start a family?
- Consequences of premature sexual life
- Doctor, healthcare professional and family
- Let them talk – peer, media and school
- What does the doctor suggest? Is the method safe?
- The cost?
- ‘How often do I have to visit the center?’
Another topic for discussion is the increased discontinuation rate. Young women usually stop contraception without any significant reason. The compliance of all methods used during adolescence, with the exception of injectable contraception, is very low. Thus, young people should be advised to contact their physician or the nearest Health Care Center before they stop or change the method.
Table 3. Factors related to the preference and acceptability of a contraceptive method during adolescence
- Previous sexual behavior and sexual history (pregnancy, abortion or STD)
- Socioeconomic status
- Education level – information and consultation
- Access to safe sources – family planning centers and adolescent gynecology unit
- Peer, family, school and media
- Physician and the healthcare professionals
- Duration and kind of relationship
- Possible side effects of the method and reversibility
Revision date: June 14, 2011
Last revised: by Jorge P. Ribeiro, MD