WHO Discussion Papers on Adolescence - Contraception

Adolescent fertility regulation and pregnancy prevention is one of the most important health-care issues of the twenty-first century. More than 15 million girls between the ages of 15 and 19 give birth every year worldwide, and an additional 5 million have abortions. In Central America, 18% of all births are to women in their teens and in Africa this figure is 23%. Even supposedly “developed” countries are not insulated from these trends. In the United States, there are nearly 1 million adolescent pregnancies each year, with over 450 000 ending in abortion (Alan Guttmacher Institute, 1998; International Planned Parenthood Federation, 1994). Although the full extent of the unmet need for contraception is hard to gauge there is clearly a great need for increased adolescent reproductive and sexual health education. The purpose of this document is to focus upon factors that influence health-care provider and adolescent client interactions. Once within a clinical setting, the qualities of those interactions further determine whether the provider will help or hinder an adolescent’s progress towards responsible reproductive and sexual health behaviours.  This paper’s principal aim is to consider the special requirements of adolescents for fertility regulation and pregnancy prevention and to make recommendations on how providers should tailor clinical management practices to meet these special needs. Recommendations made within this document are intended for policy-making and guideline-producing agencies to frame important considerations that should inform development of clinical guidelines for health-care providers. The underlying goal of this document is to define and distinguish between medical care approaches to providing reproductive and sexual health care to adolescents rather than adults.