Pediatrics Group Urges IUDs, Hormonal Implants for Teen Girls
But many doctors suggest the new guidelines overlook many consequences that could occur as a result.
PITTSBURGH — According to some medical authorities, parents struggling to help girls grow up sexually healthy and strong may now have a surprising person working against them: their child’s own pediatrician.
In an updated policy, the American Academy of Pediatrics (AAP) recommends long-acting contraception (such as intrauterine devices or contraceptive rods implanted into girls’ arms) as the “pillar” for reducing teen-pregnancy rates in the United States.
Promoters of birth control were enthusiastic about the new guidelines.
“I’m so happy about this,” said physician Ana Radovic, who runs a family-planning clinic for women and girls ages 12 to 21 in Pittsburgh. “This will give primary-care physicians and pediatricians the much needed information” that inserting an IUD “is a safe procedure, even for young girls who have never had intercourse,” Radovic told the Pittsburgh Post-Gazette.
But many doctors suggest the new guidelines are myopic and overlook many consequences that could occur as a result.
The new guidelines are “a really bad idea,” observed Dr. Donna Harrison, executive director of the American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG). “First, pediatricians are not trained in inserting IUDs. The uterus in a child is much smaller than the uterus in a grown woman. So you have a fairly significant risk of perforating that uterus. And who is going to take care of that perforation? It will be the ob-gyns.”
Further, Harrison added, “What about other, more significant complications, like infections or tubal-ovarian abscesses. Or what if the IUD string gets lost? How is the pediatrician going to remove that IUD? So you have the AAP encouraging pediatricians to do a procedure for which they’re untrained to handle the kinds of complications that can and occasionally do happen.”
Dr. Mary Davenport, past president of AAPLOG and herself an obstetrician/gynecologist, expressed concerns that premature sexual activity with the IUD as a girl’s only protection could affect her future fertility. She said, “If you get gonorrhea or chlamydia, it can turn a local infection in your cervix into an infection that permanently damages your fallopian tubes.”
The Dalkon Disaster
Davenport recalled the IUD disaster that occurred with the Dalkon Shield in the 1970s. “Many young women lost their fertility, some had to have hysterectomies, and a few died. It was an extremely serious thing that happened. But we have a short memory.”
The American Academy of Pediatrics says this new generation of devices are a far cry from the Dalkon Shield and that these long-acting, reversible contraceptives, referred to as LARCs, have become a standard in medical care.
“To be fair, most teens who use IUDs will not have a perforation, expel the IUD or become pregnant,” said Dr. Karen Poehailos, a family physician in Charlottesville, Va. “However, the [American] Academy [of Pediatrics] is advocating procedures with risks and not with parental consent. What happens to the girls who have a problem and are afraid to tell their parents who don’t know they have IUDs in?"
Harrison called the revised policy “irresponsible” in that “the AAP went out of its way to emphasize that pediatricians should isolate this girl, this child, from the input of her parents in these really important health decisions.” The policy is doubly worrisome, she said, because studies have shown parental input decreases premature sexual activity in teens.
“Given the life-altering consequences of early sexual activity, it is a travesty to ban a parent from such a discussion,” said Dr. Dem Trumbell, president of the American College of Pediatricians.
Risk Avoidance vs. Risk Reduction
Trumbell suggested the underlying scientific controversy in this debate is between risk avoidance, through abstinence before marriage, and risk reduction, by using condoms or IUDs to prevent pregnancies and hoping that nothing negative occurs as a consequence of sexual activity.
The American College of Pediatricians represents a group of dedicated, board-certified pediatricians who split off from the American Academy of Pediatrics in 2002, after the academy endorsed abortion and homosexual adoption of children.
Registered nurse Marie Hilliard, director of bioethics and public policy at the National Catholic Bioethics Center in Philadelphia, was “dismayed” by the revised policy “because the academy is basically offering young women two bad choices — either get pregnant or go on one of these long-term contraceptives.” Instead, she said, “the message to young women needs to be, ‘You can treasure your human sexuality. You don’t have to be sexually available to young men.'”
The academy puts “no burden on young men,” Hilliard observed, but “puts the responsibility of respecting a woman’s reproductive health solely on her.” It also sends young women the unspoken message that “you are incapable of respecting your own body and treasuring your human sexuality until you’re in a long-term committed relationship, which we call marriage.”
Pointing out that the statistics on the increase of sexually transmitted diseases are “very, very worrisome,” Hilliard added that the academy’s advocacy of IUDs increases a young woman’s susceptibility to sexually transmitted diseases.
Although condoms protect against STDS, the notion that a sexually active teenager fitted with an IUD would also be inclined to use a condom consistently was met with disbelief by doctors the Register talked to.
‘Shilling’ for the Contraceptive Industry?
Father Shenan Boquet, president of Human Life International, called the new policy “reckless.” He said it is “only about money — specifically, it is [about] a formerly reputable medical academy shilling for the profiteers of the contraceptive industry — for Planned Parenthood and for the pharmaceutical companies who profit when girls give themselves over for sex before they’re ready.”
Father Boquet said, “Parents must in the clearest terms demand that this propaganda not drive public policy at the local or national level, lest your girls be treated like animals who cannot be trusted to make good decisions about their sexuality and their health.”
Register correspondent Sue Ellen Browder writes from Ukiah, California.
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