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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 are the
TOPP Program, contraceptive behaviors, and individual contraceptives. The first area of
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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
TOPP Program
TOPP is an 18-month program that supplied teens ages 19 years old and younger access
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.
Luca et al. states, “In the context of TOPP, 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
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
do we have to provide different methods of birth control to our teens, but we have to teach young
Access to and education on different birth control go hand and 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 also a decrease in repeat
pregnancy for those teens who have already been pregnant. “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 in order to slow down the rate of teen pregnancy in America.
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). This is
why it is so important for us to give our teens in America education and access to birth control.
Not only to stop unintended pregnancies, but to protect them from the emotional, physical, and
Contraceptive Behaviors
There have been many changes in behavior since the 1900s that have been attributed to
the decline in teen pregnancies. “Changes in contraceptive behavior have been attributed to
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sexuality and reproductive health information, and clinical recommendations from medical
groups that make hormonal contraception more accessible to teens.” (Green et al.,2017, p.679).
As reproductive health information has increased and the availability of different types of
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, this is a
multiyear program and when they 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.
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
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
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.
Some of the other aspects that influence contraceptive behavior are family structure,
employment, and education. All of these factors play a part in what method of contraceptive is
used and how frequently contraceptives are used. The study showed that teenagers coming from
an intact childhood family were more likely to use contraceptives than those coming from a
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single-family home, statistically, 6.4% from a single-family did not use any type of contraceptive
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.
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,
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
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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.”
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, social media use, (Kelčíková et al., 2020), and the early onset of
puberty. 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
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
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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
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
needs to be more affordable and accessible options for contraceptives through either school
Conclusion
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
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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
References
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Maness, Sarah B., et al. “Associations between Social Determinants of Health and Adolescent
Contraceptive Use.” Family & Community Health, vol. Publish Ahead of Print, no. 45, 4 Feb.
2022, 10.1097/fch.0000000000000316.
Green, Jennifer, et al. “Beyond the Effects of Comprehensive Sexuality Education: The
www.sciencedirect.com/science/article/pii/S1054139X17303221,
10.1016/j.jadohealth.2017.06.021.
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
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:
https://doi-org.eps.cc.ysu.edu/10.1186/s12905-020-0886-z
Kelčíková, S., Pydová, M., & Malinovská, N. (2020). Sexual Behavior of Adolescents with an
https://doi-org.eps.cc.ysu.edu/10.15452/CEJNM.2020.11.0002