The underrated benefits of oral contraception: consequences of pregnancy and induced abortion in teenagers

Abstract

If complications occur within a pregnancy planned and brought to term, they often can be dealt with and accepted. They are even more traumatic when they occur in an unwanted pregnancy that could have been prevented through contraception. Teenagers, because of their physical and psychological immaturity and also because of their social environment, seem to suffer with undue frequency from the complications of induced abortion. Its result, for the teenager, is a handicapped future in comparison to other women. Hence, access to contraception is important for all women, and especially for teenagers, in order to avoid such prejudicial situations. It is important, then, to prescribe oral contraception for its efficacy and its short- and long-term innocuousness. Because of her immaturity, the pregnant teenager is at risk: of spontaneous abortion, pre-eclampsia, anemia, hemorrhage, and prematurity. She is also at risk because of the social difficulties she will be facing. This is particularly true in families from developing countries. From birth, the child is also at risk: of low birth weight for the term, mortality in the first year of life, and all risks linked to abandonment, or education by a third party. In a proportion of 13 to 30% in western countries and in a proportion of 3% in East Asia or in Northwest Africa (Maghreb), induced abortions are a reflection of the following: early sexual activity without contraception even if fertility is still low in very young teenagers, absence of social protection or social independence, refusal of forced marriage, and presence or absence of liberal legislation.(ABSTRACT TRUNCATED AT 250 WORDS)

PIP: Adolescent pregnancy rates are higher among US teenagers than among Swedish teenagers, even though there is a higher proportion of teenage virgins in the US. A leading reason for this discrepancy is that contraceptive use among sexually active US teenagers, especially those who have recently become sexually active, is quite low. Even teenagers using contraceptives experience unwanted pregnancy due to incorrect or inconsistent use of a method, especially barrier methods. Thus, access to abortion services and postcoital contraception are needed. The reasons teenagers often delay abortion are denial of pregnancy, irregular menses and inexperience about signs of pregnancy, fear of telling parents, and not knowing where to seek help. In most countries, adolescents comprise a considerable percentage of abortion patients. They are also at high risk of suffering some abortion complications, one reason being they tend to undergo abortion at later gestational ages than older women. For example, 2nd trimester abortions pose a risk 3-10 times greater than 1st trimester abortions. Teenagers under 17 years old and undergoing suction curettage are at greater risk of cervical injury than older women. On the other hand, teenagers do not face higher risk of other abortion complications than do older women. Adolescents undergoing abortions in developing countries face greater risk of complications, especially mortality, due to certain cultural or sanitary conditions. An unwanted pregnancy places teenagers at considerable risk, e.g., delivering a low birth weight child at high risk of mortality. These findings indicate the need for sexually active teenagers to have accurate information on reproduction and contraception and access to family planning services at an early age. Oral contraceptives (OCs) are the most effective contraceptive for adolescents and provide other benefits as well. Physicians need to promote OC use and communicate OCs' noncontraceptive benefits to teenagers because they often are unable to perceive them. Physicians also need to stress that OCs do not protect against sexually transmitted diseases and AIDS.