Marriage Matters

What is better for My Daughter: Natural Cycling or Contraception?

Most parents seem interested in providing the best of everything for their children. From education to recreation, environment to medical care, moms and dads across the U.S. go to extreme lengths to provide for their offspring. They investigate school systems before enrolling their children. They hover over their kids at sporting events to make sure they are safe and treated fairly. They offer their kids vitamins and bottled water to ward off illnesses and contaminants. Clearly, parents try to do what is best. Unfortunately, identifying what is truly “the best” is not as easy as it seems. 

Late in 2014, the prestigious American Academy of Pediatrics (AAP) published a Policy Statement and a Technical Bulletin on “Contraception for Adolescents”. At first blush, the proposals appear to offer parents “the best” in adolescent healthcare. But, upon further scrutiny, most of the recommendations call this organization’s trustworthiness regarding the health and physical well-being of youth – especially female youth – into question. Let’s first look at some factual information about healthy female development and secondly at what the AAP recommends.

Somewhere between the ages of 10 and 15, most girls begin cycling. At this time, two hormones – estrogen and progesterone – will trigger the female body to develop its sexual and reproductive abilities. The visible changes (increase in height, breast growth, hip spread, etc.) and the presence of a menstrual cycle that allows her to be fertile are only part of the development caused by these hormones. They also affect the urinary tract, the heart and blood vessels, bones, breasts, skin, hair, mucous membranes, pelvic muscles, and the brain. Clearly, reproductive hormones impact the complete physical development of the young woman.

When a girl becomes a woman, she benefits from the naturally occurring pattern of hormonal fluctuations.  The consistent ebbs and tides of estrogen and progesterone positively impact learning, memory, and mood. They also enhance full brain development and hinder brain deterioration. And, they protect against osteoporosis and the formation of blood clots that can cause a stroke or vascular issues. 

In short, natural menstrual cycling is necessary for complete and healthy growth and development. Allowing a girl to cycle normally is “the best” for her. Any interruption or suppression of the natural menstrual cycle by contraceptives has the potential to negatively impact a lot more than just her fertility. Contraception risks delaying or even preventing complete physical, emotional and intellectual maturation. In addition, it increases the risk of developing breast cancer, liver cancer, and cardiovascular diseases.

Keeping these basic facts in mind, let’s review some of the recommendations from the AAP report. These proposals are based upon the assumption that adolescent or unmarried women are probably going to be sexually active but will not want to get pregnant. Therefore the AAP is trying to convince everyone that “the best” medical care is to recommend an implant long-acting-reversible-contraceptives in any fertile female so that she can engage in sexual activity without the possibility of pregnancy. It is their opinion that preventing pregnancy is more important than allowing healthy and complete physical development in young women. Here are the first four proposals.

  1. Pediatricians should counsel about and ensure access to a broad range of contraceptive services for their adolescent patients. This includes educating patients about all contraceptive methods that are safe and appropriate for them and describing the most effective methods first.

  2. Pediatricians should be able to educate adolescent patients about LARC (long-acting reversible contraceptive) methods, including the progestin implant and IUDs. Given the efficacy, safety, and ease of use, LARC methods should be considered first-line contraceptive choices for adolescents. Some pediatricians may choose to acquire the skills to provide these methods to adolescents. Those who do not should identify health care providers in their communities to whom patients can be referred.

  3. Despite increased attention to adverse effects, DMPA and the contraceptive patch are highly effective methods of contraception that are much safer than pregnancy. Pediatricians should continue to make them available to their patients.

  4. Pediatricians should allow the adolescent to consent to contraceptive care and to control the disclosure of this information within the limits of state and federal laws. There are a number of supports for protecting minor consent and confidentiality, including state law, federal statutes, and federal case law. Pediatricians will need to be familiar with national best practice recommendations for confidential care and with the relevant minor consent laws in their states.

Clearly, there is dissidence between the critical need for young women to naturally cycle and the recommendations from the AAP. The question that needs to be considered is “which is better; allowing a girl to develop naturally or give her long acting reproductive contraceptives so that she doesn’t become pregnant?” 

The research shows that natural cycling is healthiest and best. Normal cycling allows for maximum physical, emotional and intellectual maturity. That being said, natural cycling does come with the responsibility to honor and respect the gift of fertility that is present. If parents want their daughter to natural cycling, then they must also teach her how to maintain chastity through abstinence. They must intentionally communicate to their daughter that sexual activity is a right and good of marriage rather than some casual activity. And, they will need to accompany their daughter to all of her medical appointments so that she is not counseled on or provided access to long-acting reversible contraception. 
 

Providing the best is not easy to do. But, it is what we are called to as parents. 

By Alice Heinzen

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