To my colleagues of the American Academy of Pediatrics,
I am writing on behalf of all children and parents in our country in response to your recent policy statement “Contraception for Adolescents.” I am speaking both as a pediatrician and a mother of three children when I say that I simply cannot take your advice on this matter. The children and families of our country deserve more from the American Academy of Pediatrics (AAP). I realize that you are simply trying to respond to families who are trying to get along in a society filled with widespread confusion on matters of sexuality. You are right to attempt to reduce teen pregnancy rates as this is not good for teens or for our society as a whole. For this reason, I applaud your efforts. However, by recommending this approach to reducing teen pregnancy rates, you are neglecting our primary goal of healthcare providers of being “dedicated to the health of all children.”
When I was training as a resident physician in Internal Medicine and Pediatrics, I was not taught that oral contraceptives were classified as Class 1 carcinogens by the World Health Organization in 2005. I learned only three years ago that oral contraceptives can increase the risk of breast, cervical and liver cancers. I then learned that there is a very high correlation between the use of contraception and the rates of abortion in our country. I then learned that the rates of depression in teenagers who are sexually active are approximately three times higher than in teens who abstain from sex. As physicians, we were taught that the intention of our medical care is to improve the health of our patients. So why do we recommend medical treatment that has the opposite effect? I have never considered giving a patient a medication to cause another system in the body to no longer function properly, so why would I prescribe a medication that causes the female reproductive system to cease to function properly?
When the AAP recommends such widespread use of contraception, the academy is sending a message to parents and children that implies that they believe that teenagers are similar to animals in that they have no control over their urges and impulses, so we need to protect them from the consequences of their actions. Every child is a unique and unrepeatable human person with an enormous capacity for learning and growth if given the proper environment in which to thrive. Just as I will ensure that my children have been properly trained to drive a vehicle before they are free to drive on the highway, so will I ensure that they have the proper understanding of the beauty and purpose of human sexuality before they are faced with the decision of whether to engage in sexual activity. All children are equipped with hearts made to love and be loved and with minds created to know truth.
What is the best approach to take in order to lower the pregnancy rate in adolescents? The most important factor guiding a teen’s decision to engage in sexual activity is the quality of the relationship between the parent and the child. This has been proven in studies and I have seen this in my own practice. When mom and/or dad spend time educating the child about the gift and purpose of their sexuality, teens are much less likely to engage in sexual activity before they are emotionally and physically able to deal with the consequences of their behavior. The deepest desire of the human heart is to love and to be loved. Perhaps if teens found authentic love in the family, they would not settle for a counterfeit version of love found in sexual promiscuity. So if we really are “dedicated to the health of all children,” we pediatricians should first educate ourselves and then have honest conversations with parents so that they are empowered to protect their precious children from the harms of early sexual encounters and from our medical interventions that may harm their normally functioning reproductive systems. This is no small or easy task, but it is one that is worth pursuing. May we all work together to heal our culture, one family at a time.
Dr. Susan Caldwell practices Internal Medicine and Pediatrics near New Orleans, LA. She has also studied at The Pope Paul VI Institute where she learned the practice of Naprotechnology that seeks to restore the reproductive health of women in a way that respects the gift of fertility and upholds the dignity of all human life.