The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
Division of General Pediatrics and Adolescent Medicine, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
Perspect Sex Reprod Health. 2024 Jun;56(2):85-89. doi: 10.1111/psrh.12270. Epub 2024 Jun 4.
In the United States (U.S.), adolescents and young adults are increasingly using contraception, including long-acting reversible contraception (LARC) [e.g., subdermal implants (e.g., Nexplanon®) and intrauterine devices (IUDs)]; however, access to LARC device removal may be difficult for adolescents and young adults. Reproductive justice is the right to bodily autonomy, have children, not have children, and safely parent the children we have.
In this commentary, we discuss that while the specialties of family medicine and obstetrics and gynecology have incorporated the principles of reproductive justice into their contraceptive care, further work is needed to ingrain this philosophy into pediatrics training. Since LARC devices are historically only removable by health care providers, pediatricians may act as gatekeepers to removing LARC, obstructing the reproductive justice of adolescents and young adults.
We describe that adolescents and young adults in the U.S. face unique barriers to LARC removal including limited access to the health care system, potential breaches in confidentiality, and provider bias. These barriers may lead adolescents and young adults to remove their own LARC device when experiencing unwanted side effects or desiring pregnancy. While IUD self-removal is a safe and accessible option, safety and efficacy data on subdermal implant self-removal is currently limited.
In order to promote reproductive justice in adolescents and young adults, we recommend that (1) pediatricians should address potential barriers to LARC removal prior to insertion, (2) pediatricians must offer unbiased LARC removal, (3) pediatricians who place LARC must be knowledgeable about complicated LARC removal, and (4) pediatricians should discuss LARC self-removal options with adolescents and young adults.
在美国，青少年和年轻人越来越多地使用避孕措施，包括长效可逆避孕（LARC）[例如，皮下埋植（例如 Nexplanon®）和宫内节育器（IUD）]；然而，青少年和年轻人获得 LARC 装置取出服务可能存在困难。生殖正义是指拥有身体自主权、生育子女、不生育子女以及安全养育我们所拥有的子女的权利。
在这篇评论中，我们讨论了虽然家庭医学和妇产科专业已经将生殖正义原则纳入其避孕护理中，但仍需要进一步努力将这种理念融入儿科培训中。由于 LARC 装置历史上只能由医疗保健提供者取出，因此儿科医生可能会充当取出 LARC 的把关人，从而阻碍青少年和年轻人的生殖正义。
我们描述了美国的青少年和年轻人在取出 LARC 方面面临独特的障碍，包括获得医疗保健系统的机会有限、可能违反保密规定以及提供者的偏见。这些障碍可能导致青少年和年轻人在出现不良反应或希望怀孕时自行取出 LARC 装置。虽然 IUD 自行取出是一种安全且可及的选择，但目前关于皮下埋植自行取出的安全性和有效性数据有限。
为了促进青少年和年轻人的生殖正义，我们建议（1）儿科医生应在插入 LARC 之前解决取出 LARC 的潜在障碍，（2）儿科医生必须提供无偏见的 LARC 取出服务，（3）放置 LARC 的儿科医生必须了解复杂的 LARC 取出方法，以及（4）儿科医生应与青少年和年轻人讨论 LARC 自行取出的选择。
