Medical Issues in Contraception for Minors
Contraceptives should be prescribed only if medically indicated and desired by the minor. [ACOG Technical Bulletin 145. The Adolescent Obstetric- Gyncologic Patient. September 1990.] Most medical care practitioners 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 medical care practitioner could be sued for failure of consent. The medical care practitioner should talk to the minor alone and attempt to determine if she truly wants the contraceptive. If the minor is reluctant, the medical care practitioner 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. [Berman SM, Hein K. Adolescents and STDs. In Holmes, KK, et al, eds. Sexually Transmitted Diseases. 3rd ed. New York: McGraw- Hill Professional Publishing; 1998:117–128. ]
Medical care practitioners 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:
1. Inquiry should always be made as to the feasibility of parental consent.
2. A full case history, including preexisting sexual activity, should be obtained and maintained, and it should demonstrate that the medical care practitioner has considered the “total situation” of the patient.
3. A record should be kept of the “emergency” need and a judgment by the medical care practitioner that pregnancy would constitute a serious health hazard, one more serious than the possible disadvantages of the prescription.
4. 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.
5. Where follow-up care is indicated, it should be insisted on. [Holder AR. Legal Issues in Pediatrics and Adolescent Medicine. 2nd ed. New Haven, CT: Yale University Press; 1985.]
To this list and the consent form should be added a discussion of the risks of STD infection, with particular reference to HIV.