The Pill for your teen girl?

Most parents don't want to face the fact that their teen daughter might be sexually active. But the truth is that 29% of South African teens are, and the majority of them have had sex before the age of 15, according to a national survey by loveLife on South African youth.

You could do a lot to help ensure that your daughter protects herself against an unwanted pregnancy, or worse still, sexually transmitted infections (STIs), including HIV.

"We cannot pretend that kids are not having sex. We can't close our eyes. There are those who abstain, but not everyone does. Teenage pregnancy is on the increase – this tells us that teens are having unprotected sex," according to Esther Kaleji, projects manager of the Planned Parenthood Association of South Africa (PPASA).

According to Kaleji, most young people don't go to clinics because they are scared that their parents will find out. These teens are particularly vulnerable to pregnancy and STIs.

How should a teen protect herself?
"Sexually active girls should not only use condoms (male or female), but should also make use of another form of contraception," says a Cape Town gynaecologist. "Although condoms are useful in preventing STIs, they are not the most effective method to prevent pregnancy."

The following options of contraception are available:
*The Pill and hormonal injections. Both are available free of charge at clinics. The contraceptive pill is most often used and rarely carries health risks for teens. They are available as a combination of oestrogen and progestogen or as progestogen-only pills. The prescribing doctor would be able to determine what is best suited for your daughter.

If taken correctly, oral contraceptives are highly effective in preventing pregnancy. The combination pill has a Pearl Index of less than one, which means that there will be less than one pregnancy among 100 women who are using it correctly for one year. The progestogen-only pill has a slightly higher risk for pregnancy with a Pearl Index of two. Added advantages of oral contraceptives are that they can make periods more regular and relieve iron deficiency anaemia, premenstrual tension and period pains. The combination pill is also effective in treating acne.

The cons: The disadvantage is that they need to be taken regularly, preferably at the same time each day – it may therefore not be the ideal choice for an absent-minded, disorganised teen. Some medications, including antibiotics and epilepsy drugs, may cause the pill to become less effective in which case condoms have to be used until the next period. Some teens suffer side-effects such as skin pigmentation or nausea, in which case, a different pill may be prescribed.

Injectable contraceptives are 99% effective, as long as the injection is repeated at the correct intervals. This may be a better option for someone who is not disciplined enough to use oral contraceptives. Some teens prefer this method, because they want to hide the fact that they are sexually active from their parents.

*Intrauterine devices (IUDs) are highly effective (Pearl Index = 0.3 – 0.8). The advantage is that they provide immediate protection and are long-acting.

However, IUDs are usually not the preferred choice of contraceptive for teens. They are better suited for women older than 35 years and for those who have completed their families. An IUD should never be used by someone who has multiple sexual partners because they have a higher risk of STIs and therefore of developing pelvic inflammatory disease.

*Diaphragms, cervical caps, condoms and spermicides are all barrier methods. Diaphragms and cervical caps are not freely available in South Africa. They are also not as effective against pregnancy as the pill, injection or IUDs.

Condoms (male or female) are effective in preventing STIs, but should not be used as the primary method of contraception.

Spermicides are sperm-killing chemicals available as gel, foam, jelly, foaming tablets, vaginal suppositories or cream which are inserted into the vagina. They should be used with diaphragms, caps or condoms. If 100 women use the diaphragm or cap together with a spermicide, five to 20 users will become pregnant within one year.

On their own, they have a higher failure rate. Some spermicides require a waiting period before becoming active inside the vagina. Others must be inserted immediately before intercourse. Spermicides can be bought at most pharmacies.

*The rhythm method and withdrawal are both natural methods. Many teens fall pregnant because they mistakenly believe that withdrawal (coitus interruptus) or the rhythm method, protect against pregnancy. Withdrawal (removal of the penis immediately before ejaculation) is a very unreliable method (Pearl Index = 8-17) because some sperms can be deposited in the vagina before or during withdrawal. For the same reason, it does not protect against STIs.

The rhythm method, which involves a woman keeping a menstrual calendar to predict her most fertile period, requires accurate record-keeping and additional measurements of the basal temperature. This is definitely not a safe choice of contraception for teens, as they often don't have regular, well-established menstrual cycles.

What about the morning after pill?
Most teens don't plan their first sexual experience and are therefore not using contraceptives at the time. What do you do if your teen breaks the news that she has had unprotected sex the night before? Don't panic - if you act fast, you can prevent an unwanted pregnancy.

Emergency contraceptive pills (ECPs), also called the "morning-after-pill", are a safe and effective method of birth control to prevent pregnancy after unprotected sex. ECPs prevent pregnancy by stopping or delaying an egg from being released from the ovary, by preventing the sperm from getting to the egg, or by stopping a fertilised egg from attaching to the womb. ECPs are available from clinics, pharmacies and hospitals.

Although ECPs may be used up to 120 hours (five days) after unprotected sex, they are most effective if taken 24 hours after sex.

But doctors warn that ECPs should not be used as regular birth control. They are not as effective as other birth control methods and furthermore, frequent use of high doses of hormones is not recommended.

If all else fails
For those who do fall pregnant, safe, legal termination of pregnancy up to 12 weeks of pregnancy is available in most parts of South Africa.

Let's talk about it
Fortunately, sexuality is not such a taboo topic as it used to be. Nowadays most teens are exposed to sex education at schools and programmes such as loveLife have done much to bring sex into the open.

But the primary responsibility still lies with the parent. According to Kaleji, open communication between parents and their children is they key. Talking about sex does not encourage a child to have sex. The opposite is true: If done correctly, it could promote abstinence or at least, more responsible sexual behaviour.


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