UNASSIGNED: Adolescent pregnancy, while recently in decline, remains a matter in need of addressing. Education and counselling are deemed crucial and this review aims at comparing published contraceptive guidelines, thus resolving any surrounding misconceptions.
UNASSIGNED: Recently published contraception guidelines regarding adolescent pregnancy were retrieved. In particular, guidelines and recommendations from ACOG, RCOG, SOCG, AAP, CPS, NICE, CDC, and WHO were compared and reviewed based on each guideline\'s method of reporting.
UNASSIGNED: Three categories of contraceptive methods are available for adolescents and recommendations on their initiation should be made based on their efficacy, according to all guidelines. Therefore, long acting reversible contraceptives (LARCs) should be highly recommended as the most effective method (typical use failure rate: 0.05%), followed by short-acting hormonal contraceptives (typical use failure rate: 3-9%). The third contraceptive option includes contraceptives used in the moment of intercourse and displays the lowest effectiveness (typical use failure rate: 12-25%), mostly due to its dependence on personal consistency, however offers protection against STI transmission.
UNASSIGNED: Adolescents should be encouraged to initiate contraception, with LARCs being the primary choice followed by short-acting hormonal contraception. However, regardless of the chosen effective contraceptive method, the use of condom is necessary for STI prevention.
Adolescent pregnancy, while recently in decline, remains a matter in need of addressing. The use of contraceptive methods such as LARCs and short-acting hormonal contraceptives should be encouraged and suggested based on effectiveness with the addition of condom for STI prevention.

BACKGROUND: Contraceptive decision aids may support adolescents and young adults (AYA) in choosing contraceptive methods that fit their unique reproductive health needs.
OBJECTIVE: To provide a systematic review of studies examining the effectiveness of contraceptive decision aids in AYA.
METHODS: A systematic search was conducted of studies published between January 1, 2011, and March 31, 2021 using PubMed, Cochrane, and ClinicalTrials.gov. Studies were included if a contraceptive decision aid (ie, paper handout, mobile application, website, or video) was evaluated in AYA populations (age ≤30 years) in the United States. The primary outcome was decision aid effectiveness (ie, change in contraceptive knowledge, interest in contraception, contraceptive use, unintended pregnancies, and satisfaction with the decision aid).
RESULTS: Seven randomized controlled trials and 3 pre-post studies, reporting on 3725 AYA (range, 11-30 years), met inclusion criteria. No studies were excluded due to risk of bias. The methodologies and results were heterogeneous, but most consistently demonstrated increased contraceptive knowledge.
CONCLUSIONS: Ten studies evaluated a range of contraceptive decision aid formats for AYA. Decision aids appear to be effective at increasing contraceptive knowledge temporarily, but their effect on other contraceptive outcomes is unclear. Future research should evaluate decision aids specifically in adolescents.

Adolescent pregnancy prevention programs in the US pertain to sex education about reproduction, condom availability in schools, and outreach. This review of state actions on reproductive health policy in 1995 shows that, of the more than 100 bills introduced in 41 states, 16 bills were enacted. Some states eliminated condom and sex education programs in schools. 64 bills related to sexuality education in 30 states. 75% of these bills aimed to eliminate or restrict the scope of comprehensive sexuality education. The five laws enacted were identified as receiving a comprehensive analysis in the \"State Reproductive Health Monitor,\" Vol.6, No.2, June 1995. The conservative states of North Carolina, Oklahoma, and Texas enacted new laws, which eliminated the teacher requirement for providing pregnancy prevention and disease education. These states retained education about sexually transmitted diseases and sexuality education. North Carolina and Texas granted parents the right to remove students from these classes, and schools must inform parents of their rights. Oklahoma required parental consent for attendance in these classes. Most proposed legislation about condom distribution in schools attempts to prohibit condom access. In 1995, there were 11 measures on prohibiting condom access proposed in 9 states, but none were enacted. Massachusetts is the only state where the State Board of Education policy recommends that schools consider condom availability as part of their HIV/AIDS prevention education efforts. This action was upheld in the Massachusetts Supreme Court. Four bills, out of 50 bills introduced in 1995, were enacted on unintended teenage pregnancy prevention issues. Opponents to sexuality education tend to promote abstinence-only education and an emphasis on the immorality and negative consequences of sexual intercourse. Opponents also tend to remove information from the curricula on pregnancy prevention and disease prevention on the grounds that it promotes sexual activity. School boards in Georgia must approve textbooks. About 22 states require some form of sexuality education. 40 states require education about sexually transmitted diseases and AIDS. There has been no new legal activity in the last three years among states to promote comprehensive education. Over 400 schools have condom availability programs. A more complete description of these programs is available from the \"State Reproductive Health Monitor,\" Vol.6, No.3, September 1995.

The once-a-month combined progestogen and estrogen injectables were developed to overcome menstrual irregularity, a major reason for discontinuation of progestogen-only contraceptives. About 2 million women have already used the combined once-a-month injectables, particularly in Latin America and China. The currently available once-a-month combined injectable contraceptives are Chinese Injectable No. 1 (17 alpha-hydroxyprogesterone caproate, estradiol valerate), another formulation marketed under various brand names in Latin America (dihydroxyprogesterone acetophenide, estradiol enanthate), Cyclofem (medroxyprogesterone acetate [MPA], estradiol cypionate), Mesigyna (norethisterone enanthate, estradiol valerate), and Mego-E (megestrol acetate, 17 beta-estradiol). Cyclofem and Mesigyna are very effective at preventing pregnancy (1-year rate, 99.8-99.6%). The rate for the dihydroxyprogesterone acetophenide/estradiol enanthate formulation is 100%, while that for Chinese Injectable No. 1 is 94%. Even though menstrual disturbances occur less often in once-a-month injectable users, they are the leading medical reason for discontinuation. At 1 year of use, about 70% of Cyclofem and Mesigyna users have regular bleeding patterns compared to 8% of Depo-Provera users. None of the Cyclofem and Mesigyna studies have found them to induce any adverse or clinically relevant metabolic changes. Once-a-month combined estrogen and progestogen injectables do not cause any significant delay in return to ovulation, but researchers should collect more data on conception rates for women who discontinue for planned pregnancy and those who discontinue for bleeding disorders and amenorrhea. Research into service delivery of these injectables is needed to assess managerial requirements or adaptations that would be required should there be more wide scale introduction of a contraceptive into both public and private sectors. Age, contraceptive history, learning about injectables and husbands\' attitude, and knowing another user\'s satisfaction with the service appear to be important determinants of acceptability of once-a-month injectables.

On April 27, the Fertility and Maternal Health Drugs Advisory Committee of the US Food and Drug Administration (FDA) unanimously recommended that Norplant, a long-acting contraceptive implant, be given final FDA approval for marketing in the US. This comes after almost 20 years of research conducted around the world. It was also announced that Wyeth-Ayerst would be manufacturing Norplant for distribution in the US as well as marketing it in countries overseas. FDA officials expect final approval of Norplant, along with its labeling, to be completed within the next several weeks. Norplant will be introduced to the US market, however, only after a full-scale training program has been instituted to ensure enough well-trained providers for both insertion and removal. Wyeth company representatives plan to immediately begin working with experts at the Population Council, and they expect Norplant to be ready for marketing within a year. The final cost of the new method remains in question and detailed post-marketing surveillance studies need to be ready for implementation.

The deadly consequences of HIV have focused new concern on condom reliability, i.e., whether condoms break when used. Historically, researchers have measured condom effectiveness by focusing on how consistently condoms are used, either for pregnancy prevention or for protection from such diseases as gonorrhea and syphilis. But research has now begun to examine more closely how well condoms actually work. Experts at the Materials Technology Division at Family Health International (FHI) have identified the major factors that affect condom reliability and are beginning to understand their relative importance. Three stages in the life of a condom affect whether it breaks when used: the manufacturing process, the duration and conditions of storage, and human use. Worldwide, an estimated 6 billion condoms are used each year. The US Agency for International Development (USAID), the largest donor of condoms to developing countries, delivered about 800 million condoms overseas in 1990. The UN Population Fund and the International Planned Parenthood Federation delivered the next largest totals, about 98 million and 18 million, respectively. Experts on condom issues welcome research that can enhance the understanding of what causes condoms to break, because the degree of condom reliability affects how likely couples are to use condoms. While this research continues, they emphasize the importance of using condoms now. A Program Analyst at USAID in charge of contraceptive commodity quality assurance, including condoms, stated that with proper attention to procurement specifications, manufacturing, storage, and use, condoms have been proven to be highly reliable for prevention of sexually transmitted diseases, including AIDS, and pregnancy.

The effects of progestogens on hemostatic function seems to be minimal, however, in this longterm surveillance study of the effects of Norplant among 100 healthy, nonsmoking, nonalcohol drinking, and nonlactating Singaporean women indicates the possibility of an increased predisposition of thrombosis. Clinical assessment and blood sampling were taken prior to insertion and at 6, 12, 24, 36, and 48 months. Laboratory tests included prothrombin time (PT), activated partial thromboplastic time (APTT), hematocrit and platelet count as hemostatic measures. Also measured were fibrinogen, coagulation factor II, a 1-stage assay for factors V and VII, factor VII, factor X, antithrombin III, plasminogen activator activity on the fibrin plate and FDP, platelet aggregation, factor VIIIR. 20 normal controls not on any medication were used and international standards were applied in most cases. The coefficients of variation of the various tests with reference control plasma or sera are summarized. The paired t test was used to assess statistical differences. Skewed results were analyzed with the Wilcoxon signed rank test. % changes between pre- and postinsertion levels were also utilized. The results were that the hemoglobin concentration increased from 12.1 gm/dl to 13.4 gm/dl in the 1st year, and then decreased to preinsertion levels within 3 years, and increased to 13.3 gm/dl in the 4th year. The 4th year also reflected no menstrual disorder. PT and APTT appeared significantly shortened in year 1. PT continued to shorten in 3 more years, while APTT increased to the preinsertion mean. Vitamin K dependent factors II and VII decreased significantly in year 1, while factors V and X increased significantly. Factor II increased minimally within 2 more years, but decreased again in year 4. Factor VII continued to decrease over the 4 years. The concentration of factors II and VII were significantly lower after 4 years. Factor V increased 14.4% in year 1, but decreased below preinsertion levels in the next 3 years, and then decreased to preinsertion levels in year 4. No significant changes in fibrinolytic activity occurred in 4 years. Major changes occurred in mean platelet count, which rose significantly in year 1 and increased concentration in year 4. In 4 years, platelet aggregation using ADP or equine collagen rose significantly. Serious thought must be given to the risk of thrombosis and potential for hypercoagulation.

Currently, more than 60 million women throughout the world use oral contraceptives (OCs). Therefore, it is particularly important to study the possible effects of OCs on the risk of getting cancer. In order to understand the divergent results presented in the literature relating to breast cancer, the authors reviewed the different types of studies carried out worldwide and considered the principal problems encountered in the organization and analysis of these studies. The authors then reviewed the results of the meta-analysis performed by Prentice and Thomas in 1987 and discussed articles published since that time. 1 of the essential conclusions of the studies by Prentice and Thomas was that cancer mortality, considering all sites, was similar in OC users and nonusers (relative risk=1.0; 95% confidence interval, 0.8-1.3). A decrease in the number of OC users would therefore not produce a decrease in worldwide cancer mortality. In spite of the large fluctuations in results from the various studies on breast cancer, the overall risk evaluated by Prentice and Thomas in 1987, based on 16 case- control studies and 4 cohort studies have demonstrated a positive and significant relationship between the pill and breast cancer, while other studies, also very recent, have not demonstrated such a relationship. If a new summary of the results were to be performed at the present time, it would have little chance of producing conclusions which would differ from those obtained previously. (author\'s modified)

The Sex Information and Education Council of the US (SIECUS), has initiated a program to review content, of education and AIDS education curricula. There are 23 states now requiring education and 33 requiring AIDS education. 33 states have recommended curricula for education and 42 have a curricula for AIDS education. The purpose of this review was to find out if the human sexuality information was thorough, accurate, and up to date and if it was presented in a positive or prohibitive and judgmental way. It was found that 30% of the states were using a curricula on sex education published before 1985 and 47% were using more recent curricula. Most of the sex education curricula did not focus specifically on human sexuality, and many were out of date on guidelines, especially those on AIDS. There was an about an equal ratio of adequate to inadequate curricula used for family planning; to be adequate, the curricula must describe each birth control method, its risks, effectiveness, and availability. More than 50% of the states are implementing AIDS curricula that are over 3 years old. Most of the programs emphasize abstention (85%) but only 9% teach safe sex. Although most states are mandating sex and AIDS education, they are not following up with a comprehensive curricula, and are avoiding sexual topics, possibly to avoid controversy. It appears there are many obstacles to overcome in developing comprehensive programs that will prepare students for healthy, sexual adult lives and protection from AIDS.

The 14 studies on IUDs undertaken in Uttar Pradesh between 1965 and 1980 are broadly similar although variations in reporting and analysis make exact comparisons difficult. Age of acceptors has declined from an average of 32.5 years before 1970 to 31 year in recent studies, with urban acceptors younger than rural, and copper-T acceptors younger than Lippers loop acceptors. Lippes loop acceptors in rural areas had 4.1 living children in the 1960s compared to 3.4 in 1979. 15% of acceptors had prior experience with another method of contraception in 1965, compared to 34% recently. 3 studies indicated that expulsion rates after 9 months for lippes loops have measured from 15 to 24% between 1967 and 1979, while another study of urban women found a 5% expulsion of copper Ts after 12 months compared to 19% for Lippes loops. Removal rates of 22.5% were found after 9 months in rural areas in studies done in the 1960s and recently, while the removal rate in urban areas was 30%. The copper T had a removal rate of 13% after 12 months compared to 37% for Lippes loops. The percentage of Lippes loop acceptors reporting no side effects declined from 68-73% before 1967 to 55-59% after 1967. Insertions done by paramedical personnel had fewer side effects and lower expulsion and removal rates than those done by physicians.