Medical Issues in Contraception for Minors
Contraceptives should be prescribed only if medically indicated and desired by
the minor. Most physicians worry about
the risks of giving minors prescription contraceptives without parental
consent. Parental pressure to force contraceptives on an unwilling minor is a
more subtle problem. A minor who is forced to use contraceptives by a parent or
guardian cannot be said to have voluntarily assumed the risks. If this minor
were to suffer a stroke or other serious side effect, the physician could be
sued for failure of consent. The physician should talk to the minor alone and
attempt to determine if she truly wants the contraceptive. If the minor is
reluctant, the physician should refuse to prescribe a contraceptive for her.
Adolescents are at special risk for STDs:
- Adolescent contraceptive practices affect the risk of infections. Many
adolescents never use a method or rely solely on the oral contraceptive.
Whether or not oral contraceptives increase susceptibility to certain
infections, they clearly reduce the impetus to use a barrier method or to
involve males in prevention. Adolescents who decide or can be persuaded to use
barrier methods seldom use them consistently and often use them incorrectly.
IUD are rarely advised for adolescents and should never be considered for those
at high risk for infection or for poor compliance with close follow-up.
Physicians prescribing contraceptives should provide the minor with all
the information that is usually provided to adult patients. If the
contraceptives are prescribed without parental permission, then it is advised
that additional information be considered and recorded in the medical record:
- Inquiry should always be made as to the feasibility of parental
- A full case history, including preexisting sexual activity,
should be obtained and maintained, and it should demonstrate that the physician
has considered the "total situation" of the patient.
- A record should be kept of the "emergency" need and a judgment by
the physician that pregnancy would constitute a serious health hazard, one more
serious than the possible disadvantages of the prescription.
- The minor should be clearly aware of the problems presented and
the nature and consequences of the procedures suggested, including very
specific discussions of the side effects of contraceptive pills if those are to
be prescribed. She should be required to sign a consent form so stating.
- Where follow-up care is indicated, it should be insisted on.
To this list and the consent form should be added a discussion of the risks
of STD infection, with particular reference to HIV.
ACOG: Technical Bulletin 145, The
Adolescent Obstetric-Gyncologic Patient. (Sept 1990).
Brookman RR: Adolescent sexual
behavior. In Holmes KK et al.: Sexually Transmitted Diseases. 1990.
Holder AR: Legal Issues in
Pediatrics and Adolescent Medicine, 2d ed. 1985.