“It’s important to remember that what we find important in medicine is not necessarily what our patients find important,” Dr. Wilkinson said. Often, doctors focus only on the efficacy of a particular method, rather than how acceptable it is to a particular patient. When she talks to adolescents, “I ask them, does it matter to you to have your period every month,” she said, and “whether your partner can see the method or is aware that you’re on birth control.”
For some adolescents, it may be important that they can stop the method whenever they want. And the conversation has to include a discussion of what would happen if a method were not to be used, or were to fail, and about the importance of being able to discuss all these issues with your partner.
Pediatricians need to be comfortable having these conversations, Dr. Wilkinson said. “Data shows young people are transitioning into their sexual lives during the time we are taking care of them,” she said. The dialogue should include conversations about when they are ready for that transition, and how that reflects their personal values.
Even in medicine, some may have assumed that contraception would not be a priority during a pandemic, she said, but that is not necessarily true. And the topic is even more important this fall, with a whole cohort of young people either going back to universities under extraordinary conditions, or else not going back to their universities, where they might be accustomed to getting health care.
As some college students do go back to campus, Dr. Lindberg said, “colleges’ and universities’ response and guidance around safe behaviors around Covid ignored the fact that young people are sexual beings.”
“Instead, what we see are guidelines that say, no guests allowed in your room,” she said. “Kids are going to break that rule, and then we’re going to be mad at them.” Guidance should emphasize careful decision making, she said, both with respect to sex and with respect to Covid, and guidelines should be cast in terms of risk reduction and consent. “It can’t be all or nothing, because that model fails,” she said.
“The themes repeat themselves again and again,” Dr. Lindberg said. “You need to have empowered them and given them the skills — how they make decisions, how they choose their actions wisely.” She pointed to the New York Department of Health guidelines for sexual behavior, which start with the advice that you are your own safest sexual partner, but move beyond that to address the specific risks of different kinds of behavior.