Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, December 6, 1994 TAG: 9412060049
SECTION: EXTRA PAGE: 1 EDITION: METRO
SOURCE: BETH MACY STAFF WRITER
DATELINE: LENGTH: Medium
And the last time Dr. Robert London lectured a group of doctors on the topic of contraceptives, "They could hardly get a condom wrapper open, let alone explain to their patients how to use it.
"We're talking about a group of middle-aged physicians who haven't used condoms since the 1960s," London said.
An OB/GYN professor at Johns Hopkins University School of Medicine, London addressed a group of Roanoke health-care professionals last week at Community Hospital. He focused both on the latest available methods of contraception and the need for doctors to broach the subject with teen-agers and their parents.
With increasing teen-pregnancy and sexually transmitted disease rates, "Now's the time for physicians to be talking about reproductive needs," said Harriette Mullins, director of the Regional Perinatal Coordinating Council, which co-sponsored the seminar, along with Planned Parenthood of the Blue Ridge and the Roanoke Adolescent Health Partnership.
"We do it with safety issues when kids are 2, we do it with fire safety when they're 5. Sexuality is a developmental part of growing up as a teen in America, and we need to talk about it before they become pregnant."
Birth-control usage is declining, London said, especially among teens. Among 15- to 19-year olds - for which Roanoke had the highest teen-pregnancy rate in 1991 - one in five use no contraception at all, not even occasionally.
Many teens wrongly believe that Norplant causes hair loss, he added, and that birth-control pills cause acne and significant weight gain.
Doctors prescribing birth control should also consider the compliance factor when working with teens: The easier a method is to use, the more effective it will be.
"We're not going a good job giving teens pills," London said. "The data says they typically stop taking them after six to nine months. And one-third are pregnant within 12 to 18 months."
He praised Norplant, which is surgically implanted in the arm, for its low removal rate of 4 percent, although most women do typically experience prolonged bleeding the first six months. Depo Provera, an injection that must be given every three months, also has a high success rate, London said, although it has minor side effects, too, including menstrual abnormalities.
Counseling is the key to getting teens to use birth-control, he said. If doctors don't have the time to do it, then trained counselors should be on hand.
Or better yet, peers. "Word-of-mouth carries a lot more weight with teen-agers than the New England Journal" of Medicine, said Planned Parenthood educator Janet McDowell. She cited the peer counseling program run by the Roanoke Adolescent Health Partnership, in which student leaders are trained to talk to teens about sex, abstinence and birth control.
Dr. Art Slaughter, who treats patients at RAHP's teen health center, explained the teen-health questionnaire he gives to athletes who come to the center for physicals. Especially useful for reaching males, the questionnaire includes: "Are you able to comfortably discuss sexual matters with your parents?" "Do you know how to prevent infection by the AIDS virus?" "Do you ever ride with a driver who has been drinking alcohol?"
"It's a good tool because it gets them talking," Slaughter said. "We do encourage abstinence, but abstinence is like condoms: You have to use it every single time."
"Everyone's so enamored with the abstinence message, but in a year your patient might not be abstinent," added Planned Parenthood director Kathryn Haynie. "Meanwhile, you've missed the opportunity to educate her. If you miss that, you may be helping to promote an unintended pregnancy."
Pediatrician and family-practitioner offices are logical places for teens to get information on changing bodies, abstinence and contraceptives, Mullins added.
"We should be asking the parent of the 12-year-old, 'Have you talked to her about her changing body?' 'Are you participating in family-life education with your kid?'
"That way you make it a community responsibility, which is how it should be - all of us talking together."
by CNB