What are the recommended interventions for managing teenage pregnancy?

Managing Teenage Pregnancy in Bulacan, Philippines

Long-acting reversible contraception (LARC) methods—specifically progestin implants and IUDs—should be offered as first-line contraceptive options to all adolescents, whether preventing first pregnancy or repeat pregnancy, due to their superior safety, effectiveness, and ease of use. 1, 2

Primary Prevention: Contraceptive Access and Education

First-Line Contraceptive Recommendations

• Prioritize LARC methods (implants and IUDs) as first-line options when counseling adolescents about contraception, as these have failure rates of only 0.1-0.8% compared to 4-13% for other methods 1, 2
• Educate adolescents about all contraceptive methods, but present the most effective methods first during counseling 1, 2
• Explicitly explain that LARC methods are safe and effective for adolescents who have never been pregnant, as this misconception remains a barrier to use 1

Removing Barriers to Contraceptive Access

• Never require a pelvic examination before prescribing contraceptives or placing an IUD, as this creates an unnecessary barrier that delays contraceptive initiation 1, 2
• Provide confidential family planning services to adolescents while observing legal reporting obligations for abuse, as confidentiality is critical—many adolescents will not access services if confidentiality cannot be assured 1
• Establish "youth-friendly" services that prioritize accessibility, confidentiality, and quality provider interactions, as these factors significantly influence adolescent utilization 1
• Consider expanded access options including telehealth, pharmacist prescribing, and over-the-counter access to address transportation and privacy barriers 1

Adolescent-Centered Counseling Approach

• Use shared decision-making that centers the adolescent's priorities, goals, and life circumstances rather than focusing solely on contraceptive efficacy 1
• Recognize that a less-effective method used consistently may provide better pregnancy protection than a more effective method that is discontinued 1
• Allow adolescents the choice to involve parents or trusted adults, but offer contraception as a confidential service when legally permitted 1

Comprehensive Sex Education

• Implement comprehensive sexual health education that includes information about both abstinence and contraception, as this approach has demonstrated substantial impact on reducing adolescent risk behavior 1, 2
• Avoid abstinence-only education, as evidence for its effectiveness is insufficient while comprehensive approaches show clear benefits 1, 2
• Emphasize consistent and correct condom use with every sexual act to prevent both pregnancy and sexually transmitted infections 1, 2

Management of Pregnant Adolescents

Initial Assessment and Counseling

• Screen all pubertal girls for pregnancy immediately upon presentation to allow early consideration of all options 2
• Provide nonjudgmental counseling regarding all pregnancy options (continuing pregnancy, adoption, abortion) with appropriate referrals 2
• Ensure pregnant adolescents receive the same comprehensive prenatal and perinatal care as adult women 2

Preventing Repeat Pregnancy

• Provide postpartum contraception immediately, with LARC methods as first-line options, as 20% of adolescent births are repeat pregnancies 2
• Refer pregnant and parenting adolescents to home visiting and comprehensive support programs that have demonstrated effectiveness in reducing repeat teen pregnancy through clinical, school, case management, and community components 1, 2

Mental Health and Trauma-Informed Care

Screening and Assessment

• Screen all adolescents with sexual assault history for suicidal ideation, self-harm behaviors, and homicidal ideation, as sexual assault survivors have significantly elevated rates of depression and suicide attempts 1, 3, 2
• Refer urgently to an experienced mental health professional if you are not comfortable performing psychiatric assessment, or if any suicidal/homicidal ideation is present—this requires immediate intervention 1, 3

Psychological Interventions

• Initiate cognitive-behavioral therapy (CBT) immediately for trauma survivors, as CBT-based interventions delivered within days to weeks demonstrate efficacy in reducing PTSD symptoms, depression, and anxiety 3
• Address trauma-specific reactions including violated trust, self-blame, and anxiety through ongoing counseling 3
• Monitor for risky behaviors associated with sexual assault history, including poor contraception use and self-harm 1, 3

Family and Community Engagement

• Encourage and promote family-child communication about sexual and reproductive health, as increased parent-child communication leads to safer sexual behavior among teens 1
• Refer families to community-based programs that strengthen parents' ability to have these conversations, as numerous programs have demonstrated effectiveness 1
• Stock and offer a broad range of FDA-approved contraceptive methods on-site, with strong referral systems for methods not available 1

Context-Specific Considerations for the Philippines

Given the Philippine context where adolescent pregnancy rates increased from 8% (2003) to 10% (2008), and where more than 35% of pregnant women under 20 are nutritionally at-risk 4:

• Develop adolescent-friendly health centers with information and education materials specifically designed for Filipino youth 4
• Address nutritional deficiencies (particularly iodine deficiency and anemia) in pregnant adolescents through targeted supplementation 4
• Improve the content and key messages of family planning information disseminated through internet and print media, as current messages show limited effectiveness 5
• Increase reach of family planning messages through social media and online platforms commonly used by Filipino youth 5

Critical Pitfalls to Avoid

• Never delay contraceptive provision while waiting for a pelvic examination—this creates an unnecessary barrier to care 1, 2
• Never delay psychiatric assessment if concerning symptoms are present, as suicidal or homicidal ideation requires immediate intervention 1, 3
• Avoid abstinence-only education approaches, as they have been proven ineffective 1, 2
• Never provide pregnancy care without simultaneously addressing repeat pregnancy prevention 2
• Do not assume LARC methods are inappropriate for nulliparous adolescents—this is a harmful misconception 1