Provision of Reproductive Health for Teens During a Pandemic

Created by Nichole Tyson, MD, Elise Berlan, MD, MPH, and Geri Hewitt, MD, in collaboration with NASPAG Advocacy Committee members: Rachel Casey, MD, Martin Fisher, MD, Shaketha Gray, MD, Megan Harrison, MD, Andrea Huneeus, MD, MPH, Susan Kaufman, DO, Kate McCracken, MD, Julie Strickland, MD, Nichole Tyson MD. Approved by the NASPAG Board of Directors.

NASPAG asserts reproductive health care is an essential component of health care and adolescents need access to reliable contraception during a pandemic. While shelter in place orders and social distancing public health mandates restrict freedom and access to friends and sexual partners for many teens, it also gives teens increased free time, less structure and for many, less adult supervision.

NASPAG recognizes telehealth is an effective modality to provide thorough contraceptive counseling and provision of contraception. All available methods of contraception can be discussed, including risks, benefits, alternatives and indications.¹ NASPAG supports initiating birth control pills, patches and vaginal rings during telehealth visits, providing a 12 -month prescription, and educating families about mail order or curb side pharmacy benefits. NASPAG also supports utilizing creative modalities to provide contraception including drive up Depo Provera injections and self-injected subcutaneous Depo Provera.² The American College of OB/GYN (ACOG) Covid-19 Practice Advisory states contraceptive services, including LARCs, should continue “where possible.”³ NASPAG endorses initiating LARC methods during the pandemic after counseling about all methods and shared medical decision weighing the risk of unintended pregnancy against the risk of potential exposure to coronavirus in the health care setting. In addition, NASPAG supports the use of immediate post-placental LARC placement for young mothers seeking LARC methods as an opportunity for LARC use without in person postpartum visits.^{4 , 5}

NASPAG encourages providers to strive for private, confidential care during the pandemic even when utilizing telehealth platforms. Suggestions include inquiring where the patient is and who is present, as well as asking if the provider and patient can speak freely. Depending on the circumstances, providers may need to restrict sensitive subjects and adhere to yes or no questions. Moreover, NASPAG supports ongoing utilization of adolescent telehealth visits long after the pandemic and further advancement of strategies to optimize contraceptive access for teens.

The North American Society for Pediatric and Adolescent Gynecology (NASPAG) Headquarters, 19 Mantua Road, Mt. Royal, NJ 08061.

E-mail address: hq@naspag.org