Transcript for CDC press briefing: Few Teens Use the Most Effective Types of Birth Control

OPERATOR: I would like to remind all parties that the call is now being recorded. If you have any objections, please disconnect at this time. I would like to turn the call over to Kathy Harben. Thank you, you may begin.

KATHY HARBEN: Thank you, and thank you all for joining us today for the release of another CDC vital signs. This one on the use of long acting reversible contraception, also called LARC, among teens ages 15-19. You will first hear remarks from Dr. Ileana Arias, Principal Deputy Director for the Centers for Disease Control and Prevention. She is joined by Dr. Lee Warner, Associate Director for Science with CDC's Division of Reproductive Health and Dr. Lisa Romero, also a co-author of the article. I would like to turn the call over to Dr. Arias.

ILEANA ARIAS: Thank you, and thank you for joining us today. CDC works 24/7 to save lives and protect people. As a part of our effort on the first Tuesday of each month, we release a vital signs report highlighting critical public health issues about what faces the country and importantly what can be done about it. Those of you who cover CDC regularly know that we do have vital signs to shed light on economic, health and societal cost of teen pregnancy to the teen mother and her child. We have worked hard on this issue, and we are glad to say that we have seen declines in birth to teens. It's clear that the declines are victories that help individuals, families and communities as well. Yet, we cannot be complacent when we hear about this news. We still need to help teens delay having sex or make informed choices about birth control if they are sexually active. Nationally we know from earlier work done by CDC and others, that nearly 90 percent of teens used birth control the last time they had sex. However, most teens use condoms and birth control pills which are not always used consistently or correctly. Less than 5 percent of teens used one of the two most effective and reversible types of birth control.  Intrauterine devices or IUDs, and implants, which are also known as long lasting, reversible contraception or LARC. With the use of LARC, less than 1 percent of users would be pregnant. Because of their effectiveness and their anticipated impact on teen pregnancy, we examined patterns of LARC use on female teens ages 15-19 who were seeking contraceptive services at federally funded family planning centers from 2005, to 2013. We focus on federally funded planning, family -- sorry, we focus on federally funded planning centers because they have long been leaders in providing family planning and other preventive services particularly for teens and low income individuals. In fact, the centers see about 1 million teens per year, accounting for almost 10 percent of all teen girls in the United States. What we found in our analysis is that LARC use among teens, seeking birth control services at these centers increased from 2005 to 2013, going from less than 1 percent to 7 percent. The use of implants rather than IUD's accounted for most of the increase in LARC use for both younger teens that is both ages 15-17, and older teens, those 18-19. We also found that LARC use in 2013 was highest in Colorado, about 26 percent, but ranged widely from less than 1 percent to 20 percent in the remaining states. This vital signs report is a great reminder of the important role that health professionals have in preventing teen pregnancy. While the rate of birth per 1,000 teens ages 15-19 has gone down 57 percent in the past two decades, from almost 62 per 1,000 teens in 1991, to 27 per 1,000 teens in 2013, there were still more 273,000 birth to teens this age.  Improved contraceptive views contributed to this decline. More needs to be done to increase awareness, access and availability of the most effective contraceptive method if we are to drive down teen pregnancy rates further. LARC, and for IUD's and implants once inserted do not require effort to use and depending on the type of method can prevent pregnancy for 3 to 10 years. IUD's and implants have failure rates of less than 1 percent. That is less than 1 pregnancy per 100 women during the first year of typical use. In comparison, oral contraceptives have a 9 percent failure rate and condoms have an 18 percent failure rate. LARC is safe and appropriate for teens and has been recommended as a first line contraceptive choice for them by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists.  Health professionals can encourage teens to not have sex, recognize LARC as a safe and effective choice of birth control for teens, offer a broad range of birth control options for teens, including LARC and discuss the advantages and disadvantages of each one, seek training in LARC insertion and removal, have supplies of LARC available and explore the funding issues that exist to cover costs, and finally reminding teens that LARC by itself does not protect against sexually transmitted diseases, including HIV, and that condoms should also be used every time they have sex. Before I ask Dr.Warner to discuss the data and explain things in more detail, I want to bring to your attention two aspects of this vital signs that are important to us. First, we have the opportunity to provide our teens with complete and accurate health information in a respectful and culturally-appropriate way so that they can make healthy and good decisions about preventing pregnancy. This includes providing teens seeking contraceptive services with a client-centered approach to contraceptive counseling. With this approach, a client's reproductive life plan, social needs, and contraceptive preferences are discussed along with medical information to identify the best birth control methods for her. Second, we can begin to address the barriers that can prevent teens from accessing LARC and health providers from offering LARC. This includes offering and discussing the advantages and disadvantages of a broad range of birth control options for teens, including LARC, and educating teens that LARC is a safe and effective choice of birth control. This also includes more providers being training and educated on LARC insertion and removal, and providing contraception at no- or reduced-cost. At CDC, we're working to see these data move quickly from science into practice. I'd like to turn it over to Dr. Warner to go through the important data in today's Vital Signs report.

DR. WARNER: Thank you, Dr. Arias. I'm delighted to have the opportunity to talk with all of you about this Vital Signs report. We are encouraged by the media's response about our Vital Signs series on preventing Teen Pregnancy with a focus on increasing access to LARC, as LARC represents the most effective type of birth control for teens. It is nice when we can bring you positive news about teens taking responsibility for their reproductive health needs and the important role of health care providers in preventing teen pregnancy. It is also good to know you remain interested in the dynamics that affect teens in our nation. The good news Dr. Arias shared with you before about increases in LARC use comes from analyses conducted using data from the Title X National Family Planning Program. This federally funded grant program supports confidential family planning and related preventive services, giving priority to teens as well as low-income and uninsured clients. The Title X program has taken a number of steps to increase awareness and availability of LARC for teens. These steps include educating providers that LARC is medically safe for teens, training providers on LARC insertion and use of a counseling  approach where the most effective contraceptive methods are discussed first, and providing contraception at no-or reduced-cost to the client. Nearly 8 million teens ages 15 to 19 sought contraceptive services during 2005–2013 from service sites that are part of the Title X National Family Planning Program. The number of teens who adopted or continued use of LARC at their last visit increased from about 4,000 in 2005 to nearly 45,000 in 2013. In addition, the percentage of teens using LARC increased from less than one-half of a percent in 2005 to more than seven percent in 2013, as Dr. Arias has noted. During this time, we've also seen a shift from the use of moderately effective contraceptive methods (such as birth control pills) and least effective methods (such as condoms) to the most effective methods (IUDs and implants). Specifically, use of moderately effective methods – such as birth control pills – went down from about 77 to about 73 percent and use of least effective methods – such as condoms - decreased from about 23 to about 20 percent. We also found that increases were greater for implants than IUDs. Use of IUDs grew from less than one-half of a percent to almost three percent. Use of implants grew from almost zero percent to more than four percent. While use of IUDs was more common from 2005 to 2011, use of implants became more common starting in 2012 and continuing in-2013. Finally, use of LARC varied widely by state. In 2013, the highest rate of use of LARC among teens was in Colorado (26 percent), but use ranged widely from less than 1 percent to 20 percent in the remaining states. This Vital Signs report suggests that health clinics that provide quality contraceptive services, including LARC, can take specific steps to increase awareness of and access to LARC among teens. The data from this Vital Signs can help identify areas where there are barriers to providing teens LARC and can guide interventions to increase access to and awareness of LARC among sexually active teens. Finally, I would like to remind you that May is Teen Pregnancy Prevention Month. This is a time when many community and national groups organize special activities and programs. Please consider the Vital Signs information when you consider your editorial content for next month. We know you have the ability to turn data into thoughtful narratives and dialogues on the conditions facing a young woman or a young man in your community. Thank you.

KATHY HARBEN: Thank you, Dr. Arias and thank you Dr. Warner. We are now ready for questions, please.

OPERATOR: Thank you, about this time, if you would like to ask a question, please press star 1 on your touch tone phone. You will be prompted to record your name and do so clearly when prompted. Our first question today is from Robert Lowes from Medscape Medical News.

ROBERT LOWES: Yes, thank you for taking my call. I have a question about one of the obstacles or barriers that was reported in the study that high cost. It's one thing for clinicians to become better educated about, you know, the safety and effectiveness of LARC and to learn how to insert and remove the devices. But what can the average doctor do in terms of dealing with the higher costs of IUD's and implants?

ILEANA ARIAS: That's an excellent question, there is a difference in the start-up cost and over time, the relative cost of IUD's versus other forms of contraception like the more popular forms like the pill, in addition to that, there are subsidies that allow to reduce the cost of methods and I will let Dr. Warner and Romero give you more specific information about the costs.

DR. WARNER: Again, thank you for the question. I agree with you, it's one of the biggest barriers that are experienced typically with teens and LARC with the higher cost. If you look at as an investment over time, it is more cost effective and I think one thing that Title X National Family Planning Program does is make the methods available to teens to consider among all the contraceptive options. You have anything to add, Dr.  Romero?

LISA ROMERO: The only thing I would add is that the title ten program is not large enough to cover all the costs of contraceptive and other family planning services and it really relies on leveraging resources from other programs such as Medicaid and we know that states that have Medicaid family planning expansions have, which are able to cover family planning services are more likely to provide LARC on site, report fewer cost related difficulties at paying LARC, have extended weekend and evening hours and have a higher percentage of clients paying for services with Medicaid as they assist clients with Medicaid enrollment. Although the cost is high, we are working with our Title Ten service sites and others to address the cost barrier.

ROBERT LOWES: What about private insurers? Are they covering the cost of IUD's and implants for teens on a parents plan?

DR. WARNER: Just one minute, please. Yeah. Well, two things, one, it's focused on the national title ten family planning program, so, we really didn't deal as much with the private insurers, but under the affordable care act plans are required to cover FDA approved methods of contraception without cost sharing and LARC, IUD's and implants are approved methods. So at least for women, and this includes teens, these should be covered without cost sharing, but of course there's exceptions with this.

ROBERT LOWES: Okay. Thank you.

OPERATOR: Thank you, once again to ask a question, press star 1 and our next question is from Tom Corwin from the Augusta Chronicle.

TOM CORWIN: Hi, thanks for taking my question. The vast disparity between the states is really striking, is there any further detail you could provide on why you know, for instance, Colorado is so good and Mississippi is not so good or the south in particular?

DR. WARNER: I think that is a fantastic question, actually, we were wondering the same thing. And I think we have a couple of general thoughts on this. One is that Colorado is a state, it's been known for working on addressing some of these barriers, at least in the Title Ten Programs by educating the providers that LARC is safe for teens, and going back to the previous caller, working on training the providers on insertion and having supplies on site and making sure clinician present the methods to teens that are sexually active or are contemplating the sexual activity, using the approach for LARC as a first option. I think for any further detail on this, I would recommend you contact the office of population affairs who has been working closely with their state programs to understand better some of these disparities and we can put you in touch with them.

TOM CORWIN: Okay, great, thank you.

DR. WARNER: Thank you.

KATHY HARBEN: Next question, please.

OPERATOR: Thank you, our next question is from Anne Glausser from WCPN.

ANNE GLAUSSER: I was wondering what you make of the rise of implants versus IUD's. What might be behind that?

DR. WARNER: Thank you for that question as well. I think one thing, especially for younger teens, and you will see this in the vital signs report, implants are generally more acceptable than IUD's, where IUD's are higher in 18 and 19-year-olds. One reason, I think is that younger teens might find the IUD to be a little more invasive. And also, they don't like the idea of a painful insertion of the IUD and the last piece is that the implants are relatively new.  For the IUD's, I know some of the older ones are off the market. But for the newer redesigned IUD's and implants those have become available in the last ten years so you expect the trajectory and updates to be higher in implants than IUD's.

ANNE GLAUSSER: Okay, thanks.

KATHY HARBEN: Next question, please.

OPERATOR: And as a reminder if you would like to ask a question, please press star 1. One moment please for the next question. And our next question is from Maggie Fox from NBC News.

MAGGIE FOX: Thanks, I'm sorry, can you just repeat what you said, and I believe it was Dr. Warner about kids being scared of search and removal of an IUD. Did I understand that correctly?

DR. WARNER: No, what I was saying is that some teens may not be comfortable with having a foreign object as an IUD that is invasive placed in their body. They might instead prefer the implant in the arm.

MAGGIE FOX: Okay. And so what was the word about what did you say about removal, you said something about it.

ILEANA ARIAS: Teens interestingly and when you think of it makes sense, may be more squeamish of the insertion or removal since it's a reversible form of contraception of an IUD versus an implant. There's anecdotal suggestion that teens may have attitudes toward the two methods and may be more squeamish about an IUD than an insertion.

DR. WARNER: And I think to underscore that point, that's why we want to make sure that we make IUDs and LARCS an option for teens, among the array of options that are available.

MAGGIE FOX: Can you talk about, I know in some schools teens have joked that you can see an implant in the girl's arm and it's like a slut/shaming type of thing that goes on.

DR. WARNER: And I think that is one of the disadvantages with the implant is that for some teens, there's a -- felt that the implant can be seen or felt.  I think that is, again, in most cases you can't see it, but it is possible. So, again for those teen they may prefer other methods.

MAGGIE FOX: Thank you.

KATHY HARBEN: Questions, please?

OPERATOR: Once again, if you would like to ask a question, please press star 1.  One moment please for the next question. I am showing no further questions at this time.

ILEANA ARIAS: Okay, thank you. This is Dr. Arias, the bottom line for us is that we encourage teens who are not sexually active to continue to wait, but those that are having sex, we want them to make an informed choice and we want them to think of the most effective types of birth control and ask their doctor or family planning councilor about LARC and other family options. As we mentioned earlier in 2013, nearly 90 percent of teens used birth control the last time they had sex, and fewer 5 percent used LARC. We need health care professionals to help us remove the barriers and increase the access, and availability of LARC. We need to keep encouraging teens to not have sex and also LARC is an option for those that choose to be sexually active. It is safe for teens, it is easy to use and very effective and depending on the method, we know it works for ten to ten years without any action on the part of the teen. So thank you very much for joining us, and if there are any other questions that you may have, please feel free to follow-up with us off line.

KATHY HARBEN: this concludes today's media briefing tell conference, if you have other questions, please contact the media relations office at CDC at 404-639-3286.  Thank you.

OPERATOR: thank you and this does conclude today's conference, you may disconnect at this time. 

**This transcript is not edited and may contain errors**

###
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES