A smoked pork sandwich sat competing for space among volunteer sign-up sheets and polling station assignments while Megan Capeheart-Rubenstein sat negotiating her time between finally feeding herself and delegating orders to a group of reproductive rights activists.
Capeheart-Rubenstein, 35, a transplant from Las Vegas to Memphis, lives intentionally child-free with her husband. This would not be the case had Capeheart-Rubenstein not faced her teenaged years and an unwanted pregnancy with the help and resources of family that supported her choice to have an abortion at 16.
“Although I was raised in a strict Mormon environment — from an abstinence-only religious background — my mom was really always a feminist and realist, and she said to me, ‘If you ever need birth-control pills, just tell me. At 13, I went to her and said I needed birth control. She said ‘okay,’ and got me on the pill,” said Capeheart-Rubenstein.
At the time of Capeheart-Rubenstein’s pregnancy, long-acting reversible contraceptives, or LARCs, were nowhere to be found.
“If they existed, no one ever told me about them. Norplant, IUDs — no one even told me about that stuff until college,” said Capeheart-Rubenstein.
Capeheart-Rubenstein believes that a LARC would have been, “absolutely a better choice for me as teenager,” citing her personal example of not adhering to the strict daily-regimen of the pill.
LARCs — primarily intrauterine devices and birth control implants — have been in development in some form or another since the 1920s. Today, LARCs are a rapidly rising trend in birth control options, increasing from 2.4 percent of all women in the U.S. in 2002 to 8.5 percent of all U.S. women in 2008, according to a study by the American Congress of Obstetrics and Gynecologists.
Amid the long-standing ethical battlefields over women’s reproductive issues and cost-prohibitive hurdles, some health-care practitioners are hesitant to prescribe LARCs to sexually active teens for entirely different reasons.
“I get really nervous about putting an intrauterine device in a teen who hasn’t been pregnant yet. They are very uncomfortable, and can be slightly traumatizing (upon insertion),” said Jenn Sobrowski, a Memphis-area family planning practitioner.
According to Sobrowski, LARCs are still new to the realm of preventing unwanted teen pregnancy — their official recommendation by the American Academy of Pediatrics was issued just recently. Previously, LARCs were not recommended for women who had not yet had children or women who engaged in high-risk sexual behaviors and stood a greater statistical chance of contracting a sexually transmitted disease. For her own part, Sobrowski acknowledges the cons of prescribing LARCs to sexually active teens.
“Most of the teens I see are not having sex with one person, they have multiple partners. This puts them at a higher risk for disease,” Sobrowski said, referring to a LARC’s inability to prevent STD’s.
While Sobrowski’s stance on LARCs for teens is ambiguous, at least one Memphis-area OBGYN finds LARCs considerably problematic.
“If your only purpose in life is to prevent pregnancy — as if pregnancy is the only thing worth preventing that’s bad in a sexually active teenager — then long-term birth control makes sense, said Dr. Michael Podraza, an OBGYN with St. Francis Women’s Health and Fertility.
“My own personal viewpoints on contraceptives in general is negative,” said Podraza. “I don’t prescribe them in my practice because I don’t think that they are good for you — especially the hormonal things that they do. Young women are particularly sensitive to these hormonal changes.”
Podraza also noted that the hormonal changes caused by LARCs, in particular the altering of the vaginal pH balance, can leave a young woman more susceptible to inflammation and STDs.
Rather than prescribe LARCs or other contraceptive measures, Podraza recommends natural family planning — a method rooted in the traditional teachings of the Roman Catholic Church that encourages a woman to only have intercourse during the least fertile days of her menstrual cycle. Podraza said that the use of contraceptives — particularly in younger women — poses not only fertility-related health risks, but an overall false perception of lowered chances of pregnancy.
“What ends up happening is that they arrange their lives in such a way, and they think they won’t get pregnant, but then these contraceptives fail. If the failure rate of a contraceptive is 5 percent if used perfectly, then you give them to teenagers — who never use them perfectly — and the failure rate goes up to 20.”
The increased failure resulting from the misuse of contraceptives is exactly why Capeheart-Rubenstein believes LARCs are a more viable option to prevent unwanted pregnancy.
“Of course kids aren’t adult enough to handle the responsibility of an every-day pill. Of course at 13 I wasn’t able to responsibly handle that,” said Capeheart-Rubenstein. “You know what? Kids are going to have sex. That’s just it. So, whatever we can do to prevent them from making life changing mistakes is really the best thing.”
While the relationship between reduced pregnancies — and consequently reduced abortion rates — and the use of LARCs in sexually active teens is one that has decades of observation ahead. One study from the University of Washington St. Louis shows a strong interest among teens willing to try LARCs.
Out of the 1,404 teens in the study, more than 72 percent choose a LARC method. The teen pregnancy rate for study participants was 34 per 1,000 teens compared to the national average of 158.5 per 1000 teens. The abortion rate for study participants dropped to 9.7 per 1000 teens compared to the national average of 41.5 per 1,000 teens.
However, the vast majority of teens that Sobrowski sees are not open to the idea of implanted birth control that requires a procedure, even a minimally invasive one.
“With each patient, we have to discuss every single method and let them make their own choices based on their own lifestyle and what they would be comfortable with. I rarely, rarely have a sexually active teen inquire about LARCs, and out of my six months with this particular job, I’ve not yet put a LARC in a teen,” Sobrowski said.
There is a direct contrast between the results of the WUSTL study and the day-to-day practice of Sobrowski’s job. However, a key factor in the WUSTL study was the ability to provide an LARC at no cost to the participant. In the published report, WUSTL researchers assert that the cost of a LARC implant is a prominent deciding factor in whether or not a teen chooses one as her contraceptive method.
Kelsey Clark is a sexually active 16-year-old who regularly researches birth control options that are potentially available to her. Clark currently uses condoms, as they are affordable and accessible to her. The cost of a LARC in the main obstacle that has prevented Clark from having one implanted by her OBGYN.
“At the moment, condoms are just the easiest solution. I have had conversations with my mom, and she’s told me I could ask for birth control if I need it, but I haven’t asked,” said Clark, noting that the cost of a LARC causes her some hesitation in asking for financial assistance from her mother.
“For me it’s really about the cost of an implant — it’s my main restriction,” said Clark.
