President's Message, November 2023
Mary Ann Rigas, MD, FAAP
Hello my fellow PA AAP members!
I’ve known Nevaeh since she was born; she is the oldest of three sisters. She came with her sisters and mom for her 16-year well child visit, sports physical, and learner’s permit physical this past summer. During her private interview, Nevaeh shared with me that she had started dating a boy in her class and that they had had sex a few times. Her mom knew that they were dating but not that they were sexually active, and Nevaeh was quite sure that her mom would be furious with her if she found out. Nevaeh admitted that she didn’t want to become pregnant at that time, and we talked about the pros and cons of talking to her mom about contraception. I suggested that we could talk to her together, focusing on the benefits that hormonal contraception can provide to menstrual flow, cramps, and acne if Nevaeh didn’t feel comfortable talking about using it for contraception. We also discussed the option of starting contraception without discussing it with her mom. Ultimately, Nevaeh did not feel comfortable with either of these plans. I reinforced the importance of always using condoms and provided information about emergency contraception.
Last week, Nevaeh returned to the office with her mom. She had missed several days of school over the past few weeks due to nausea and vomiting upon awakening in the morning and needed a doctor’s excuse. Mom asked me outright, “Could she be pregnant?” Needless to say, Nevaeh’s pregnancy test was positive.
Where I practice in rural north central Pennsylvania, the teen birth rate from 2017-2021 was 30 births per 1000 females aged 15-19, compared to the state average of 15 per 1000. There is no way to walk to our Rural Health Clinic, and many patients live in the country or in another town as far as 40 miles away, so they need their parents to bring them into the office. Commercially insured patients do not have access to free and confidential reproductive and sexual health services, so if we perform a pregnancy or STI test, it will appear on the insurance statement that their parents receive. We have inquired about becoming an Adagio site, but the decision will be based on the number of patients expected to need their services, which is, by definition, low in a rural area. Of note, it is not only rural Pennsylvania teens who are at high risk for pregnancy. In 2018, non-Hispanic white teens in Pennsylvania had a birth rate of 9 births per 1000 females aged 15-19, compared to non-Hispanic Black teens who had a birth rate of 27 per 1000 and Hispanic teens who had the highest birth rate of 35 per 1000.
Last month, it was wonderful to see so many of you at the AAP National Conference and Exhibition in Washington, D.C. One of the presentations that excited me most was Dr. May Lau’s Update on Over-the-Counter Oral Contraceptives. In her captivating Plenary Talk, Dr. Lau told us about a 75 mcg norgestrel (progestin-only) oral contraceptive pill that was approved by the FDA for prescription use 50 years ago and has now been FDA-approved for OTC use. It will become available in stores and online in January 2024 with no restrictions or age limits. Dr. Lau listed three contraindications to the progestin-only pill--pregnancy, active breast cancer, and liver cancer or tumor—and noted that the latter two are uncommon in teens and the first can be diagnosed with an OTC pregnancy test. She also pointed out that the American College of Obstetrics and Gynecology states that no physical exam or test is required prior to starting any form of contraception, including the OTC progestin-only pill. Progestin-only pills have been sold OTC and used safely in many countries around the world; their side effects are similar to those with other forms of hormonal contraception, including headache, acne, nausea, stomachache, and menstrual flow changes such as heavy bleeding, breakthrough bleeding, and amenorrhea.
As pediatricians, we are a trusted source of information to the families in our practice. Soon we will have the unique opportunity to counsel our patients (and possibly their parents) about this exciting new pregnancy prevention tool. As Dr. Lau highlighted in her presentation, OTC progestin-only pills are safe, they can protect against pregnancy, and they are very likely to increase access to contraception IF they are affordable. Perhaps they will protect against some unwanted pregnancies in high-risk teens like Nevaeh.
In this season of Thanksgiving, I am thankful for this exciting new development and for all that you do to ensure the health and safety of Pennsylvania children. Have a wonderful holiday!
Sincerely,
Mary Ann Rigas, MD, FAAP
President 2022-2024
Reference for teen birth rate by county: Pennsylvania | County Health Rankings & Roadmaps
Reference for teen birth rate by race/ethnicity: National Vital Statistics Reports Volume 69, Number 6, July 10, 2020, State Teen Birth Rates by Race and Hispanic Origin: United States, 2017–2018 (cdc.gov)
Dr. Lau’s presentation: eventScribe Live (eventscribeapp.com)
Sincerely,
I’ve known Nevaeh since she was born; she is the oldest of three sisters. She came with her sisters and mom for her 16-year well child visit, sports physical, and learner’s permit physical this past summer. During her private interview, Nevaeh shared with me that she had started dating a boy in her class and that they had had sex a few times. Her mom knew that they were dating but not that they were sexually active, and Nevaeh was quite sure that her mom would be furious with her if she found out. Nevaeh admitted that she didn’t want to become pregnant at that time, and we talked about the pros and cons of talking to her mom about contraception. I suggested that we could talk to her together, focusing on the benefits that hormonal contraception can provide to menstrual flow, cramps, and acne if Nevaeh didn’t feel comfortable talking about using it for contraception. We also discussed the option of starting contraception without discussing it with her mom. Ultimately, Nevaeh did not feel comfortable with either of these plans. I reinforced the importance of always using condoms and provided information about emergency contraception.
Last week, Nevaeh returned to the office with her mom. She had missed several days of school over the past few weeks due to nausea and vomiting upon awakening in the morning and needed a doctor’s excuse. Mom asked me outright, “Could she be pregnant?” Needless to say, Nevaeh’s pregnancy test was positive.
Where I practice in rural north central Pennsylvania, the teen birth rate from 2017-2021 was 30 births per 1000 females aged 15-19, compared to the state average of 15 per 1000. There is no way to walk to our Rural Health Clinic, and many patients live in the country or in another town as far as 40 miles away, so they need their parents to bring them into the office. Commercially insured patients do not have access to free and confidential reproductive and sexual health services, so if we perform a pregnancy or STI test, it will appear on the insurance statement that their parents receive. We have inquired about becoming an Adagio site, but the decision will be based on the number of patients expected to need their services, which is, by definition, low in a rural area. Of note, it is not only rural Pennsylvania teens who are at high risk for pregnancy. In 2018, non-Hispanic white teens in Pennsylvania had a birth rate of 9 births per 1000 females aged 15-19, compared to non-Hispanic Black teens who had a birth rate of 27 per 1000 and Hispanic teens who had the highest birth rate of 35 per 1000.
Last month, it was wonderful to see so many of you at the AAP National Conference and Exhibition in Washington, D.C. One of the presentations that excited me most was Dr. May Lau’s Update on Over-the-Counter Oral Contraceptives. In her captivating Plenary Talk, Dr. Lau told us about a 75 mcg norgestrel (progestin-only) oral contraceptive pill that was approved by the FDA for prescription use 50 years ago and has now been FDA-approved for OTC use. It will become available in stores and online in January 2024 with no restrictions or age limits. Dr. Lau listed three contraindications to the progestin-only pill--pregnancy, active breast cancer, and liver cancer or tumor—and noted that the latter two are uncommon in teens and the first can be diagnosed with an OTC pregnancy test. She also pointed out that the American College of Obstetrics and Gynecology states that no physical exam or test is required prior to starting any form of contraception, including the OTC progestin-only pill. Progestin-only pills have been sold OTC and used safely in many countries around the world; their side effects are similar to those with other forms of hormonal contraception, including headache, acne, nausea, stomachache, and menstrual flow changes such as heavy bleeding, breakthrough bleeding, and amenorrhea.
As pediatricians, we are a trusted source of information to the families in our practice. Soon we will have the unique opportunity to counsel our patients (and possibly their parents) about this exciting new pregnancy prevention tool. As Dr. Lau highlighted in her presentation, OTC progestin-only pills are safe, they can protect against pregnancy, and they are very likely to increase access to contraception IF they are affordable. Perhaps they will protect against some unwanted pregnancies in high-risk teens like Nevaeh.
In this season of Thanksgiving, I am thankful for this exciting new development and for all that you do to ensure the health and safety of Pennsylvania children. Have a wonderful holiday!
Sincerely,
Mary Ann Rigas, MD, FAAP
President 2022-2024
Reference for teen birth rate by county: Pennsylvania | County Health Rankings & Roadmaps
Reference for teen birth rate by race/ethnicity: National Vital Statistics Reports Volume 69, Number 6, July 10, 2020, State Teen Birth Rates by Race and Hispanic Origin: United States, 2017–2018 (cdc.gov)
Dr. Lau’s presentation: eventScribe Live (eventscribeapp.com)
Sincerely,
Mary Ann Rigas, MD, FAAP
President 2022-2024
President 2022-2024