Long-Acting Reversible Contraception for Adolescents: A Review of Practices to Support Better Communication, Counseling, and Adherence.

Long-acting reversible contraception (LARC) methods, including levonorgestrel and copper intrauterine devices (IUDs) and the subdermal contraceptive implant, are the most effective reversible forms of contraception and thus are an important aspect of adolescent pregnancy prevention. While LARC efficacy, safety, and appropriateness are supported by major medical organizations and usage rates are increasing, overall LARC uptake among United States (US) adolescents remains lower than uptake of short-acting contraceptive methods. A better understanding of the barriers affecting adolescent LARC uptake and reasons for discontinuation could help facilitate effective communication. For example, learning how to improve adolescent-centered communication, shared decision-making, and motivational counseling strategies may be the first step to improving utilization rates. This narrative review includes three sections. First, this review will describe the history, mechanisms of action, and epidemiology of adolescent LARC use in the US and globally. Next, this review will describe key factors influencing adolescent LARC uptake, reasons for discontinuation, and multilevel barriers specific to adolescent LARC use. Finally, this review will characterize communication techniques and LARC counseling strategies for adolescents in the context of a reproductive justice approach set in the health belief model framework. The distinction between moving away from a presumptive counseling approach towards an adolescent-centered, shared decision-making approach to encourage parent-adolescent sexual health communication to lay the foundation of empowering adolescent reproductive autonomy should be the underpinning of all effective reproductive communication strategies.

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© 2023 Durante et al.

Déclaration de conflit d'intérêts

This work was funded by the National Institutes of Health (K23 HD097291) and the UT FOCUS award from the American Heart Association, Doris Duke Charitable Foundation, and the Harry S. Moss Heart Trust. The content is solely the authors’ responsibility and does not necessarily represent the official views of the study sponsors. The sponsors did not have a role in the review design, analysis, interpretation of data, writing of the report, or decision to submit the article for publication. Dr Melanie A Gold reports grants from Merck/Organon, consulting fees from Bayer, outside the submitted work. Dr Jenny KR Francis reports grants from the National Institutes of Health (K23 HD097291), grants from the UT FOCUS award funded by the American Heart Association, the Doris Duke Charitable Foundation, and the Harry S. Moss Heart Trust, and grants from an Organon Investigator-Initiated Study during the conduct of the study. The authors have no other relevant conflicts of interest to disclose.