The American Academy of Pediatrics (AAP) issued updated guidelines recommending that pediatricians provide contraceptive counseling and services to adolescents, emphasizing access, confidentiality, and reproductive health equity.

The statement updates the 2014 policy and is designed for use alongside the accompanying clinical report, “Contraceptive Counseling and Methods for Adolescents.” The guidance addresses recent legal, social, and health system developments influencing adolescent reproductive care.

According to the AAP, pediatricians are well-positioned to provide contraceptive counseling because adolescents often view them as trusted sources of medically accurate sexual health information. “A developmentally appropriate approach informed by principles of shared decision-making and person-centered care enables adolescents to choose the best method for their goals, preferences, and needs,” the authors wrote.

According to 2021 Youth Risk Behavior Surveillance System data cited by the AAP, 16% of ninth-grade students and 48% of 12th-grade students have ever had sexual intercourse. Among sexually active high school students, 52% reported using a condom and 33% reported using any hormonal contraceptive method at last intercourse. Many adolescents remain at risk for unintended pregnancy and sexually transmitted infections.

The updated policy applies a reproductive health equity framework, acknowledging that structural inequities—such as racism, income disparities, provider bias, and restrictive legislation—can limit adolescents’ access to effective contraceptive care. The AAP noted that some youth report experiencing coercive counseling to use long-acting methods that do not reflect their preferences.

The policy reaffirmed the Academy’s position that supporting adolescent self-consent for contraception and maintaining confidentiality are critical to adolescent safety and well-being. “The American Academy of Pediatrics considers policies supporting adolescent self-consent for contraception and protecting adolescent confidentiality to be in the best interest of adolescent safety and well-being,” the authors wrote.

As of 2023, 27 states explicitly allowed minors to consent to contraceptive care, and 19 states allowed certain classes of minors to do so. Federal protections such as Title X and the Health Insurance Portability and Accountability Act (HIPAA) also provide some safeguards for confidentiality. Under HIPAA, providers may protect minor confidentiality when the minor can legally consent or when a parent or caregiver agrees to confidentiality. The AAP also emphasized that providers may use professional judgment to protect confidentiality even when no law applies, provided this reasoning is documented in the health record.

The policy addressed confidentiality risks posed by insurance billing statements, electronic health records, and patient portals. The AAP recommended that pediatric practices develop written confidentiality policies and regularly discuss them with both adolescents and caregivers.

The guidelines recommend that contraceptive counseling begin with the adolescent’s reproductive goals and preferences. A shared decision-making framework was emphasized over efficacy-based counseling alone. This adolescent-centered approach considers medical history, developmental stage, and social context.

According to CDC data cited in the policy, the following typical-use failure rates were reported per 100 users over 1 year:

• Contraceptive implant: 0.1%

• Hormonal intrauterine device (IUD): 0.1%–0.4%

• Copper IUD: 0.8%

• Progestin-only injection: 4%

• Pills, patches, rings: 7%

• External condoms: 13%

• Fertility awareness methods: up to 23%

The AAP supported expanding access through innovations such as telehealth (including low- and no-touch prescribing models), pharmacist prescribing, mobile health applications, and over-the-counter options. The policy cited research demonstrating that adolescents are capable of self-screening for contraindications and are interested in expanded-access options.

The guidelines included recommendations for transgender and gender-diverse adolescents, emphasizing the importance of inclusive language, gender-affirming care, and individualized contraceptive counseling. The AAP clarified that gender-affirming hormones such as testosterone do not prevent pregnancy and should not be relied upon as a contraceptive method.

To support pediatricians in delivering comprehensive, confidential care, the AAP recommended health system reforms such as adequate appointment time, supportive billing structures, and training for staff in confidentiality and reproductive health. The policy also highlighted the importance of coordination across systems, including pharmacies, schools, and digital platforms, to ensure equitable contraceptive access for all adolescents.

Source: Pediatrics