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Access to Different Birth Control Reduces Teen Pregnancies

Abigail R. Langmeyer, Maci Musolino, Zeina Abdul-Aal

Centofanti School of Nursing, Youngstown State University

NURS 3749: Nursing Research

Dr. Randi Heasley

June 19, 2022

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Access to Different Birth Control Reduces Teen Pregnancies

PICOT

The purpose of this literature review was to see if there was a correlation between teen

pregnancy and the availability and access to different birth control. The following PICOT

question was put forth: “Does access to different birth control options reduce teen pregnancy?”.

Search Strategy

Using EBSCOhost through the Maag Library a search was started using the following

terms “teen pregnancy”, “birth control”, and “the United States”. The databases that were used

are Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Google

Scholar. The search was limited to the following criteria; peer-reviewed, written in English, and

written between the years 2017-2022. With that initial search, 672 articles were found. After

reviewing the criteria that were relevant to the question asked, the search was refined with the

following terms “pregnancy prevention”, “effective contraceptive”, and “teenagers”; this brought

the search down to 109 articles. With the refinement of the search parameters, the titles and

purpose of the articles were reviewed, and six articles were used in this research.

Literature Review

The purpose of this research paper is to answer the question that if teenagers have access

to different contraceptive options, will there be a decline in teenage pregnancy? The research

was obtained from six different sources and there were three different themes identified that

showed how access to birth control can reduce teen pregnancy. The themes that were identified
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are the TOPP Program, contraceptive behaviors, and individual contraceptives. The first area of

discussion for this paper will consist of information and results from an 18-month Teen Options

Program to Prevent Pregnancy (TOPP). The second theme in this paper is how contraceptive

behaviors have changed over the years and how these different behaviors have impacted teen

birth rates. The third theme is the comparison of different contraceptives accessible to teenagers

along with the statistical evidence and the research that supports the most favorable

contraceptive use for teenagers.

TOPP Program

TOPP is an 18-month program that supplied teens ages 19 years old and younger access

to a combination of personal contraceptive counseling and access to contraceptive services. The

first part of the program provided contraceptive counseling for the individuals. Education is the

very first step to helping adolescents understand birth control and the positive effects it has.

In the context of TOPP Luca et al. states, nurse educators used motivational interviewing

to gather information about participants’ past experiences with and beliefs about

contraception and pregnancy, provide individualized education about birth spacing and

contraceptive methods based on participants’ preferences and interests, and help guide

participants toward birth control methods of their choice, and support participants in

adhering to a birth control plan. (Luca et al.,2021)

There were nurses in this study educating the participants about their use of them, the side

effects, etc., as there will be in any teen getting birth control. This study gives a fair

representation of the participants in the trial vs. teens in real life getting birth control. Not only
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do we have to provide different methods of birth control to our teens, but we have to teach

teenagers the importance of using these different types of contraceptives.

Access to and education on different birth control go hand in hand with reducing teen

pregnancy. With that being said, each individual in the experiment group was provided direct

access to different methods of birth control. Each participant had a birth control method

individualized to them. By the end of the 18-month program, the experts conducting this

experiment found a significant decrease in teen pregnancy and a decrease in subsequent

pregnancies in those teens who have already had a pregnancy. “We found that TOPP led to

substantial increases in LARC use and subsequently large reductions in repeat pregnancy. At the

end of the 18-month intervention, 41.1 percent of treatment group participants reported using a

LARC method in the past 3 months, relative to 25.7 percent of women in the control group”.

(Luca et al.,2021) This program proves the fact that teens need education and direct access to

birth control.

If every young girl had these services, the percentage of teen pregnancies would go

down. Not only will the percentage of teen pregnancies go down, but so will the depression rate,

the poverty rate, and so many more negative aspects that affect teens when they are faced with an

unintended pregnancy. “Research shows rapid repeat pregnancies among adolescents lead to

enduring emotional, psychological, and educational challenges”. (AHC MEDIA, 2021). That’s

why the goal is to educate and provide access to all teenagers including those who have already

experienced a pregnancy, this will not only help prevent unintended pregnancies, but will also

protect teens from the emotional, physical, and financial burdens that may come with having a

child or multiple children.

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Contraceptive Behaviors

There have been many changes in behavior since the 1900s that have attributed to the

decline in teen pregnancies. According to Green et al., the recent changes in contraceptive

behavior are due to the fluctuations in the national economy, the way that childbearing norms

have changed, the availability of reproductive health information that is available online, and the

clinical recommendations from medical groups that have made birth control more accessible to

teenagers. As reproductive health information has increased and the availability of different

types of contraceptives, teen pregnancy rates are on a decline.

Sex education programs have been attributed to a positive change in teen pregnancy rates.

These programs are comprehensive and detail how dual methods of contraceptives have been

linked to effectively decreasing teen pregnancy. There has been a push over the last few decades

to increase developmental programs that teach teenagers how to increase their abilities to make

smarter choices. One such example is a program called Raising Healthy Children which is a

multiyear program. When the researchers followed up with the participants at age 21 the

following statistics were seen “African-American participants in the study (n = 349, 51% male,

mean age = 10.8 years at baseline, 47% African-American) reported more frequent condom use

than their single non–African-American peers in the comparison group.” (Green et al.,2017,

p.679) These programs have been designed to educate the youth about their sexual health and the

programs are usually designed to encompass all the areas of sexual health. The one issue that is

present is the decline of these programs in conservative communities and poorer communities.

With the lack of education about safe sexual conduct, a link is being shown between those of

lower social class and teens that are lacking this education with an increased amount of teenage

pregnancy.
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With more available birth control on the market, one of the most effective deterrents to

pregnancy in recent years is the intrauterine device (IUD), this prevention is just now being

promoted to teenagers as an effective form of birth control and will help to lower teenage

pregnancy rates even more.

Forms of highly effective pregnancy prevention contraceptives, including the IUD and

implant, have only recently been promoted for adolescents. Adolescents are the lowest

age group for IUD and implant use, which may be attributed to limited provider

recommendations for LARC use in adolescents and the requirement of a doctor's visit to

receive a LARC method. We also found associations between effectiveness level of

methods to prevent pregnancy and social determinants of health including language

spoken in the home and health insurance coverage. (Maness et al., 2022, p.98)

The use of contraceptives goes up when a teenager knows what is available but there is

still a lack of knowledge when it comes to all the different types of contraceptives that are

available “this study also found that comprehensive sexuality education was not associated with

the use of more effective types of contraceptives including hormonal methods or consistent

contraceptive use. This suggests a need for comprehensive sexuality education programs…”

(Green et al.,2017, p.683) This shows that there is still a need for more comprehensive teaching

to be done to ensure that the youth of America know what is available to help prevent

pregnancy.

Another thing that is shown to affect contraceptive behaviors is insurance coverage and

ease of access. Different birth controls are covered under certain insurance coverages and not all

of them are easily available. This makes it difficult for some teenagers to get access to things

such as an IUD or the Depo shot which are more reliable than other forms of contraceptives.
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Some of the other aspects that influence contraceptive behavior are family structure,

employment, and education. All these factors play a part in what method of contraceptive is

used and how frequently contraceptives are used. The study from Maness et al. showed that

teenagers coming from an intact childhood family were more likely to use contraceptives than

those coming from a single-family home, statistically, 6.4% from a single-family did not use any

type of contraceptive compared to 2.1% from an intact family home.

Individual Contraceptives

Many young women have different reasons for choosing their type of contraceptive to

protect them from unwanted pregnancies during sexual intercourse. In the United States, the

country with the highest teen birth rate, it is vital for sexually active teenagers to choose an

effective contraceptive method for unprotected sex. Shelly Kaller, the author of the research

article “Exploring young women’s reasons for adopting intrauterine or oral emergency

contraception in the United States,” depicts the comparison of choosing the IUD or ECP method

as a contraceptive method.

Overall, Kaller’s qualitative study interviewed 17 young-serving clinical patients that

were offered the IUD or ECPs as emergency contraceptive methods. As a result, 10 participants

left with the ECPs, and seven chose the IUD as their EC option. The ECPs outweighed the IUDs

because the patients had easy accessibility and were more familiar with this traditional

contraceptive.

First, Kaller describes the advantages and disadvantages of using the emergency

contraceptive pill (ECP). One of the most important advantages of using the ECP is the fact that

it can be purchased over the counter in local drug stores without a prescriber’s prescription. Also,
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another advantage of utilizing the ECP is the simplicity of a one-time single tablet that is taken

orally by mouth after unprotected sex. For many young teens, ECP is a discrete method of

contraceptive use that can be kept private from people such as parents and guardians. The review

of one young woman in the study explained, “‘It just makes me feel a lot better knowing that I

decreased the chances of being pregnant, so it just makes me happy.’” (as cited in Kaller et al,

2020. p.4) On the other hand, some disadvantages of the ECP include the constant use “was

‘irresponsible’, may not always be effective, and could cause negative effects on the body.”

(Kaller et al., 2020, p.4)

Secondly, the study details another form of contraceptive method known as an

intrauterine device (IUD). A positive attribute of utilizing the IUD is that it is considered to be

accepted as emergency contraception (EC) but is proven to be more effective than oral EC pills

(ECPs). In addition, the IUD provides ongoing contraception for up to 12 years. (Kaller et al,

2020) On the negative side, the IUD is prescription only and requires a physician's insertion at a

primary care facility. Due to this reason, the cost of an IUD is more expensive than the ECP

method.

Today, the changing of the times has heightened the age of sexual activity of teenagers.

This young population needs to understand the consequences of unprotected sexual intercourse

and the lack of contraceptive usage. Kelčíková argues the amount of teen sexual activity has

increased due to the internet and social media use and the early onset of puberty. (Kelčíková et

al., 2020, p.2) Nevertheless, the changing of the times is predisposing this young population to

many risks. According to the Kelčíková 2020, early teenage sexual behavior results in a greater

incidence of sexually transmitted infections (STIs) and unwanted pregnancies in adolescents.

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Which is why it is important that teens have access to different methods to help deter from early

sexual behavior.

Kelčíková, the author of one of the research articles, explored the different contraceptive

method preferences of 381 adolescents with a total of 95% responses. The contraceptives studied

include barrier, hormonal, chemical, and natural birth control methods. As a result of the study,

the outcomes that displayed the most popular use of contraceptive preference in teenagers were

the use of the barrier contraceptive such as the condom at 72%, the hormonal method at 12%,

and the withdrawal method at 11%. In addition, the participants considered hormonal methods

50%, IUD 21%, and condoms 21% to be the most effective contraceptive methods. Otherwise,

the least effective methods were the withdrawal method 53%, and the natural birth control

method 34%. After analyzing these results from the research study, these participants showed

personal preferences and were well informed of the negative methods.

Recommendations for Practice

The recommendation for practice is to continue to add educational resources to every

school curriculum that will encompass all sexual health needs. Another recommendation is to

limit the restrictions on what birth controls are available due to a person's age and to give equal

access to birth control options no matter what insurance the person currently has. The programs

that teenagers can access without parents or guardians being in the know will allow those

teenagers that are unwilling to talk with the adults in their life safe access to birth control

methods that might prevent teenage pregnancy. As for the cost of birth control and insurance

coverage, this is a problem that is beyond access to healthcare and goes into the insurance part of

healthcare that is ever-changing and not regulated as well as it should be, for the time being there
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needs to be more affordable and accessible options for contraceptives through either school

clinics or community programs.

Conclusion

In conclusion, there is a definite correlation between access to different contraceptive

methods and a decrease in teenage pregnancy. The more resources available to teenagers, the

more likely they will utilize them correctly. There was also a direct correlation between the

sexual education programs that are put in place and an increase in the number of teenagers using

what they learn to engage in safe sexual acts that reduce the risk of unwanted pregnancies and

STIs. After analyzing all the results that were compiled it can be said that the more knowledge

that is available to teenagers of all socioeconomic backgrounds statistically the downward trend

of teenage pregnancy will continue to be seen.

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References

Maness, S. B., Thompson, E. L., & Lu, Y. (2022). Associations Between Social Determinants of

Health and Adolescent Contraceptive Use: An Analysis from the National Survey of

Family Growth. Family & community health, 45(2), 91–102.

https://doi.org/10.1097/FCH.0000000000000316

Green, Jennifer, et al. “Beyond the Effects of Comprehensive Sexuality Education: The

Significant Prospective Effects of Youth Assets on Contraceptive Behaviors.” Journal of

Adolescent Health, vol. 61, no. 6, Dec. 2017, pp. 678–684,

https://www.sciencedirect.com/science/article/pii/S1054139X17303221101016/j.jadoheal

th.217.06.021.

Luca, D. L., Stevens, J., Rotz, D., Goesling, B., & Lutz, R. (2021). Evaluating teen options for

preventing pregnancy: Impacts and mechanisms. Journal of Health Economics, 77,

N.PAG. https://doi-org.eps.cc.ysu.edu/10.1016/j.jhealeco.2021.102459

Positive contraceptive outcomes seen in teen pregnancy prevention program. (2021).

Contraceptive Technology Update, 42(6) Retrieved from

https://www.proquest.com/trade-journals/positive-contraceptive-outcomes-seen

teen/docview/2536499810/se-2?accountid=29141

Kaller, S., Mays, A., Freedman, L., Harper, C. C., & Biggs, M. A. (2020). Exploring young

women’s reasons for adopting intrauterine or oral emergency contraception in the United

States: a qualitative study. BMC Women’s Health, 20(1), 1–9.

https://doi-org.eps.cc.ysu.edu/10.1186/s12905-020-0886-z
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Kelčíková, S., Pydová, M., & Malinovská, N. (2020). Sexual Behavior of Adolescents with an

Emphasis on Use of Contraceptives / Risk of Sexually Transmitted Infections. Central

European Journal of Nursing & Midwifery, 11(1), 2–8. https://doi

org.eps.cc.ysu.edu/10.15452/CEJNM.2020.11.000