Can I Require My Teen to Be on Birth Control?

The Ask Lisa Podcast does not constitute medical advice and is not a substitute for professional mental health advice, diagnosis or treatment. If you have concerns about your child’s well-being, consult a physician or mental health professional.

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Dr. Lisa Damour:
If we can treat sexual development as part of healthy development, talk with our teenagers of all genders about the four steps, what you want, what your partner wants, what you both want, how you keep everyone safe, make it clear that no one should be getting that intimate until they can do those four steps. Talking with our kids about the real ramifications of a misstep here. That’s what we know keeps kids safer.

Reena Ninan:
Episode 160, Can I Require my Teen to be on Birth Control?
I’m a little bit nervous about this week’s episode.

Dr. Lisa Damour:
Yeah. How come?

Reena Ninan:
I think it’s sort of the way I was growing. You don’t talk about sex in an Indian household. Nobody. You’re just magically children appear when you’re married.

Dr. Lisa Damour:
Okay.

Reena Ninan:
That is sort of the, so I guess it makes me, why do we feel so uncomfortable? And you talk about European countries, how this is not such a big deal. Why are we so scared in some families to talk about sex?

Dr. Lisa Damour:
It really is a taboo topic in a lot of families, and that’s too bad. And I’ll tell you why it’s too bad because we end up lumping sex together with risk factors. And certainly it can be risky, but we also know from the research that if it can actually be lumped under natural and healthy development and physical romance being part of that, you get better outcomes. Kids take better care of themselves. They’re less likely to have outcomes they don’t want.

Reena Ninan:
Better outcomes. Well, I can’t wait to get to all this. I want to read you the letter we got that made us pay attention for this episode.
Hello, Dr. Lisa. I’m a huge fan of your books and podcasts. I’m hoping you can help me with my daughter. I have a 15-year-old who’s been in a relationship with her boyfriend for almost a year now. I’ve talked to her about sex and the importance of being safe. She says she hasn’t had sex yet and I believe her, but I’d be naive to think she’s isn’t considering it. I want to put her on birth control, but every time I bring up the subject, she shuts me down and refuses to even consider it as an option. She says she doesn’t want to take another medication. She’s already on meds for her, ADHD. I’ve reached out to her counselor and doctor to talk to her about sex and protecting herself. But those conversations are kept between her and them. My question is, what more can I do? Can I put her on birth control even though she doesn’t want to be on it? Do I just trust? She’ll use protection. We all know that. Sometimes you can get swept up in the moment or condoms don’t always work. Please, any advice would be helpful. Thank you.
Oh my my, so is she on the right track here? What do you think?

Dr. Lisa Damour:
I think she’s on the right track. I think just again, what a balanced and thoughtful letter in terms of just like she’s like, this is the deal. And I am naive to think, I would be naive to think that we shouldn’t be having this conversation. And yet she’s hit a wall with this kid and has right to be concerned. I think everything in this letter stands out. Makes sense to me.

Reena Ninan:
Am I wrong to feel like in my generation, the generation Xers, we were having sex, people were having sex in high school much sooner than they are today. What does the data tell us? You are not wrong.

Dr. Lisa Damour:
We are raising the most chased generation. We have ever studied also for us as adults to come to this to be like, how do we think about this? Part of what we should know is kids are having much less sex in general, and the drop-offs are pretty incredible. So if we look back to 1991, 67% of kids that had sex before high school was over, those numbers started to slide. The most recent really reliable numbers, bring it to 48%. So from 67% to 48% by the end of high school, and it’s lower at all the younger ages too. Wow. That is a huge drop, Lisa. It’s a huge drop. It is a huge drop in. How many kids are having intercourse.

Reena Ninan:
Can you attribute that to, do we know why?

Dr. Lisa Damour:
So we have ideas. One is we just supervise kids a lot more than we used to. We’re with our kids a lot more when we look back at the safety data from the seventies, and I grew up in the seventies and eighties. I mean, we didn’t really watch kids all that carefully. And so there’s more supervision. We’ve done more education in some areas around sex. I will tell you probably Reena, that the most agreed upon or kind of powerful explanation is kids are less bored. And there is something to be said about the connection between boredom and intercourse. And it’s so funny because I was thinking about, I have been obsessed with, I don’t know if you’ve listened to it, Dolly Parton’s new album Rockstar.

Reena Ninan:
Okay. She is a rockstar.

Dr. Lisa Damour:
She is a rockstar.
Okay. So this has been on my mind because I’ve been obsessed with this album and she does a cover of Night Moves, Bob Seeger’s old song, which came out in the mid seventies. She does a cover with Chris Stapleton that I’ve been listening to on repeat. So I’m listening to and listening to and listening to it. Okay. The song Reena is entirely about teenagers running around having no strings attached sex, everywhere they can. I mean in the woods, in the car. I mean it’s sort of a celebration of this. And one of the lines is “we were young and restless and bored.”

Reena Ninan:
Oh wow. That says everything, doesn’t it?

Dr. Lisa Damour:
They had time on their hands. And then I was thinking about, do you remember the movie Juno?

Reena Ninan:
Yeah, of course.

Dr. Lisa Damour:
Okay, so there’s this great line. So Juno is a kid who gets pregnant at 16 and her dad’s beating himself up about it, and the mom played by Alison Jannie says to the dad, “Kids get bored and they have intercourse.” And I was like, I think that’s really true. And so probably the number one explanation for why kids are having less sex is that they’re spending more time on their phones. They’re less bored and they can interact with one another without being in the same space. And if you can interact and then of course kids also do sexting and stuff like that, you’re not having intercourse.

Reena Ninan:
Interesting. It’s fascinating. I wonder social media and the correlation between kids not being bored because the algorithms repeating them other things.

Dr. Lisa Damour:
And having less sex. I think that’s generally agreed upon explanation for why kids are having less sex.

Reena Ninan:
How does it break down ethnically? Do you know?

Dr. Lisa Damour:
Actually I do. And here’s what we see. There’s tremendous convergence among black, Latinx, Hispanic, and white teenagers are all having sex at the same rates. They’re indistinguishable. Asian kids have less sex than

Reena Ninan:
Less than , really?

Dr. Lisa Damour:
By a significant margin. When we look at the data, Asian kids are having much less sex than the kids in those other three categories.

Reena Ninan:
So they’ve all dropped is what you’re saying? All the categories?

Dr. Lisa Damour:
And they’ve all dropped. They have and they’ve all dropped. So Asian kids used to be having more sex. They’re having less sex, but relative to white, black and Latinx kids, they have less sex.

Reena Ninan:
What about condom use? Do we know our uh oh?

Dr. Lisa Damour:
Okay, this is interesting.

Reena Ninan:
That’s not good.

Dr. Lisa Damour:
No, this is where we get the general view is we prefer for kids to have less sex. I mean there’s generally we see that as a good sign. We see it as because there’s also unintended consequences. There’s the later in development, the better. We often say.

Reena Ninan:
Yeah, and let’s be real at 33. I could barely handle one kid. I could not imagine at 13 or 16.

Dr. Lisa Damour:
Exactly. Right? I mean just like there’s so much here.
Unfortunately condom use has dropped off.

Reena Ninan:
Really? Why is that?

Dr. Lisa Damour:
Yeah. Again, we don’t know, but here’s our best guess. The long-term birth control we think may be a factor that one of the things that has emerged is these under the skin implants that girls can get that deliver a steady stream of birth control. There’s a lot to be said for this. They don’t have to remember to take a pill. It’s all there. But there seems to be some coincidence with the emergence of these long-term forms of birth control and a drop off in condom use, which as a teenager you could see it. It stands to reason. You’re like, you got that base covered. Of course, as people who care for teenagers we’re like, you know what? Belt and suspenders, if you’re going to be having sex, you want to have both some form of birth control on board and use a condom both for backup and also of course to prevent the transmission of sexually transmitted infections.

Reena Ninan:
Okay. Another conversation. Note to self that is important to have. Okay.

Dr. Lisa Damour:
And if you say belt and suspenders, you can take down the overall awkwardness of the conversation with your kid about why they need to be using both. And again, we just put a giant big fat asterisk if they’re having heterosexual sex. Right.

Reena Ninan:
That’s a great point.

Dr. Lisa Damour:
So obviously some sort of barrier can be very important for same-sex sex because there’s still the possibility of transmitting an STI, but the pregnancy question goes away.

Reena Ninan:
STI?

Dr. Lisa Damour:
Sexually transmitted infection.

Reena Ninan:
So it’s this new word for STD is this?

Dr. Lisa Damour:
It’s the term that we’re using these days.

Reena Ninan:
And why the switch from STD to ST?

Dr. Lisa Damour:
Actually, Reena, I dunno. We’ll find a physician and ask, but I think infection seems to probably be more accurate description of what we’re trying to prevent.

Reena Ninan:
Got it. I want to get back to this letter, Lisa. And so this parent is saying that the child is 15. What’s your sense, I remember we had an episode where you were saying how try to keep your kids away from social media until 15 if it’s at all possible. And now I’m seeing this letter of the sex and hearing you say sex is on the decline. And so I’m so confused now. What do you make of that?

Dr. Lisa Damour:
I know. Okay. So yeah, I will stand by at 14 or 15 for social media at the earliest, if you can hold off at all. Okay, so 15 for sex. I will tell you statistically that’s kind of young. When we look at the numbers in terms of age and kids having sex, only about 22% of 15 year olds are having sex. So it puts this kid in the minority if she becomes sexually active. Here’s my view on it. The way I’ve always thought about readiness for sex, it’s a very hard conversation to have, but it’s a conversation we need to be able to have what constitutes readiness for sex. So when I talk with young people about it, I’ll say, look, here are the things that need to be happening for sex to make any sense at all. Number one, you should have a clear sense of what you yourself want to have happen. So there should be some awareness and some desire that is known. Number two, you should know what your partner wants. You should be able to have enough of an intimacy conversation to figure out what they’re interested in. Number three, you should come to agreement about what you both want. And I always say, this is where we talk about consent. I don’t love the word consent. It’s too low a bar. It should be like, yes, we both want this. And then number four, you should be managing the risks that come with sex.
And here if we talk about intercourse per se, so perhaps an unwanted pregnancy in a heterosexual context, the transmission of an STI, you should be able to manage those really effectively and well. Those four things in my book should be happening before anybody is having sex of any kind. And I’ll say, Reena, if you’re 40 and you can’t do that, you probably shouldn’t be having sex.

Reena Ninan:
Great point.

Dr. Lisa Damour:
What we know is the younger people are, of course, the less likelihood there is that they’re managing all four of those things. Well, what they want, what their partner wants, coming to agreement about what’s wanted, and then managing those risks well. So is 15 too young for sex? I’m not going to say absolutely not, but I would really want to see that that 15-year-old is bringing a level of maturity that allows for all of these things to be managed well before I would feel even the least comfortable with it.

Reena Ninan:
And often we don’t get a say in that level of maturity in that moment, unfortunately.

Dr. Lisa Damour:
Nope. Nope.

Reena Ninan:
Lisa, what do you make of that fact that this daughter just doesn’t want to be on birth control? She’s already on ADHD medication at this point. What else can the parents say?

Dr. Lisa Damour:
Well, it’s sort of an interesting dynamic. I try to picture this conversation of this parent saying to the kid, listen, let’s be realistic. You’ve been in this romance for a while. Let’s get you on birth control just in case. I can totally see the kid, first of all being like, oh my God, the last person I want to have a conversation about this with is my parent. How fast can I shut it down? The kid’s just trying to shut it down. The parent being right immaterial here. The kid doesn’t want to have the conversation. And of course this is a problem because the parent is realistic.
Now the parent’s already done something very wise, which is reach out to the counselor and reach out to the doctor. I mean, this kid has tremendous support, which is fantastic, to say, I am anxious about this and I trust that these clinicians are picking up the slack on that. But the parent says, they’ve got no information about this.

Reena Ninan:
So Lisa having reached out to the doctor and the counselor, what more could they extract? Could they get, where do they take it from here then if they’ve done that step?

Dr. Lisa Damour:
And it’s tricky because the counselor and doctor aren’t sharing information. And as a clinician, I have a lot of respect for that, that we really put a very tight bound of confidentiality around clinical conversations.

Reena Ninan:
Even under 18?

Dr. Lisa Damour:
Even under 18 though, that is penetrable in various ways. To use a weird word.

Reena Ninan:
I was just going to say, on theme.

Dr. Lisa Damour:
Interesting word choice.
But the general rule that we operate with is it’s got to be life or death or very, very dangerous. And this is part of why not everybody wants to care for teenagers, is that we do as clinicians, find ourselves in these kind of gray areas where we’re like, man, I know this kid’s having sex. And as a clinician it makes me anxious, but it’s not over the line of what I told this kid. I would keep private. So it’s a tough situation. Now here’s an opening though that the parent could consider, which is to say to the teenager, listen, I totally a hundred percent get it, that you do not want to have this conversation with me. Will you give me a release to talk with your clinicians about what they are talking about with you on this one subject?
So you can actually do a very limited opening in terms of what the clinician is allowed to disclose. And so you could work with the clinician and the kid to be like, let’s come up with a little document that says on the topic of birth control and sexual activity, I give my parent permission to talk or I give my clinician permission to talk to my parent. The kid may be like, yes, I am having all the conversations with them. I do not want to have them with you, but yes, I will give you permission to talk with them about this limited area. And then the clinician could hop on the phone and be like, we’re on it. She’s got it covered. And give tons of information, but be a sort of a go-between between the parent and the kid.
That’s a possibility. May not work, but it’s an option.

Reena Ninan:
One parent recently told me they couldn’t get their kids to brush their teeth. So they showed them these almost phony videos of teeth bugs of what really happens when, yeah, it’s kind of gross. So what’s the equivalent of teeth bugs for things that go wrong with sex? You talk about this in Untangled, right? About media and how it’s helped.

Dr. Lisa Damour:
Okay, so this is another option, which is again, back to this letter, the parent is so right in the heat of the moment, bad choices get made. So another way for adults to go at this question about unwanted pregnancies is to say to young people to start the conversation away from the topic of pregnancy to say, okay, what do you thinking you want for yourself by senior year of high school, where do you see yourself? What do you see yourself doing? What do you see yourself doing after high school? So a positive forward looking, let’s just talk about your plans for yourself. Then. And hopefully this will not feel like a full sneak attack to the kid. You have to do this carefully. Then you could say, how would a baby fit into that? How would having a baby change that for you? And if you do it gently and maybe give them some warning, it’s actually a very good way to have that conversation. Because what you’re doing is you’re trying to help them think through how a fleeting misjudgment could have massive ramifications for what the kid wants for themselves. And I think that that’s the key thing. Okay, so Reena in Untangled, you may remember this, my favorite, one of my favorite pieces of research that I got into and unpacked in Untangled. Do you remember that old TV show? 16 and Pregnant?

Reena Ninan:
Wasn’t this on MTV?

Dr. Lisa Damour:
It was on MTV.

Reena Ninan:
Yeah, of course.

Dr. Lisa Damour:
And it was a documentary show that followed 16 year olds who’d had babies.

Reena Ninan:
Yes.

Dr. Lisa Damour:
Okay, so first of all, you will hear from some quarters don’t show teenagers, pregnant teenagers, they’re just going to have more sex. Okay, so here’s what happened, and this is where I love my nerds and I love my research. So 16 and Pregnant comes out, and then in a sort of wave of time after that, not too far after that, the pregnancy rate for teenagers falls off a cliff Reena drops precipitously. And there were not more abortions. It was that they just were having fewer and fewer pregnancies in teenagers. And these researchers were like, what’s the deal? What could account for this? And somebody was like, do you think it’s, they’re all watching 16 and Pregnant? Right? Okay, so that was the question. So then, and I love their methodologies. So what they did is they started looking at Google searches that happened, timed to when the show had run and when the show ran, there would be this huge spike in Google searches of how do I find contraception?

Reena Ninan:
No way. And they can really make that correlation between

Dr. Lisa Damour:
They could map them together. Yes, they could map them together. And then they were also looking at Twitter activity and kids were saying stuff mapped to the time when kids were searching for this information and the time when the show come out, things like they’d make jokes like, oh my God, I’ve seen better decisions on 16 and Pregnant. I mean, kids were talking about watching these ramifications play out.
And they even were able, this is how they were, just the way in which we really try to make sure that we seeing what we think we’re seeing. They could even tell that where the show had greater audience, there were fewer pregnancies. They could make those correlations between how much people were watching it and how many fewer unwanted pregnancies were happening. So now nobody watches 16 and Pregnant anymore.

Reena Ninan:
Well, we might be, what age do I start showing this to my children, Lisa?

Dr. Lisa Damour:
Well, we’re like, I was actually even thinking, I haven’t watched it for a while. The parents should watch, go watch Juno, right? I mean,

Reena Ninan:
That’s a great one actually. You’re right.

Dr. Lisa Damour:
That’s 16 and Pregnant in a movie form.

Reena Ninan:
You’re totally right.

Dr. Lisa Damour:
But kids are rational. They don’t want their lives derailed. And I think if we raise these questions about unwanted pregnancy, not from the standpoint of you’re going to be a naughty person having unprotected sex, but from the standpoint of you want all these things for yourself, I want all of these things for you. Having a baby’s going to actually derail that. And then of course what we’re not talking about here is the possibility of abortion. And that for many families, that does not feel like an option, whatever the laws are. And then of course the landscape on that in our country has changed. And so the way to think about this I think is prevention. We don’t want kids in a position where they even have to make a decision like that.

Reena Ninan:
Prevention. Prevention and education is what I hear you saying to me today. Talking about this early on and having them see, I mean, 16 and Pregnant. Wow. I mean, just now that I think about it, there was no 16 and Pregnant when I was in high school. And so you don’t know what happens next. You don’t see that what happens next?

Dr. Lisa Damour:
You don’t. And one of the other debates that kind of hovers around what we’re talking about is teaching kids about sex or certainly about contraception. And there’s been a lot of controversy about that, and there’s been a lot of misinformation that there is a worry that if you talk with kids about contraception, they’re going to go have more sex. We know that’s not true. We know that they don’t have more sex, but we know that when they do have sex, they’re more likely to keep themselves and their partners safe. If we, I’m thinking about your early squeamishness as we got into this episode. If we can treat sexual development as part of healthy development, talk with our teenagers of all genders about the four steps, what you want, what your partner wants, what you both want, how you keep everyone safe, make it clear that no one should be getting that intimate until they can do those four steps. Talking with our kids about the real ramifications of a misstep here. That’s what we know keeps kids safer.

Reena Ninan:
And you’ve just showed us today the data, the science, and what’s behind it and how conversations really make a difference.

Dr. Lisa Damour:
They do make a difference. And I think the hard part, and this is so this just comes blaring across in the letter, is that the kids, the parent may be like, alright, I am here for that conversation. I can do it. And the kid is like, oh my gosh, I will do anything to make this conversation stop. So I think that we also have to be thoughtful about it and find openings that are not unbearable. Maybe give kids fair warning. Parents can say, you know what? I was listening to an episode of the Ask Lisa podcast and they were talking about sex and contraception. And actually the way I would have parents say it is, I need two minutes and I promise I won’t go past two minutes. I’ve sometimes done that.

Reena Ninan:
So they know it’s time limited. It’s going to be short and quick, but slightly painful.

Dr. Lisa Damour:
Slightly painful. But you can actually say to them, set a timer. Let me see if I can get it done in a minute. And you don’t even have to look at me.

Reena Ninan:
It’s good.

Dr. Lisa Damour:
That’s a perfectly acceptable way to do this. I think if the parent or caregiver holds the standard that the kid’s going to be like, I’m so glad you brought this up. Right. It’s not going to go well.

Reena Ninan:
I want to go back to this letter before we wrap up, but are there any other options on how to approach this with this Mom just really wants to get her on birth control and then have her when she gets to that moment, be ready and prepared.

Dr. Lisa Damour:
I think there’s one more. Alright, so we’re thinking, and I like this, we’ve hit a roadblock and then we’re finding these other alternate routes. So one alternate route is like, well, can I at least talk to your clinicians? Another alternate route is, come watch Juno with me and let’s think about what you want for yourself.
Another alternate route and a 15-year-old for the most part should be able to do this, is to do what I would call, pull the lens way back and say to the kid, okay, help me. I’m not dumb. I’m aware you may well have sex. I’m not here to judge that. I want nothing for you, but safety and all the options in front of you. But when you and I try to have a conversation about it, it goes nowhere. Is there something I could be doing differently or instead that would let us have the conversation that I think we need to have to keep you safe and make sure that all the choices remain available to you indefinitely. So involve that kid in trying to solve the problem of the fact that they can’t seem to have the conversation.

Reena Ninan:
So instead of shouting down from the mountaintop, which would be my approach, involve them so they feel like you’re an ally and not trying to lecture them because you know what the consequences are that they might not fully be aware of at this point.

Dr. Lisa Damour:
That would be my advice and the better route. I think that that’s got a much better chance of succeeding. But interestingly, Reena, as you say, lecture, okay, so I’ll generally say lectures are not a great way to transmit conversation and information to teenagers. I mean, they’re basically like, how do I get out of the room? I’m trying to end this. At the same time, we also have data showing that when parents clarify their own values, that changes kids’ behaviors. So I do think there’s a lot of room for back and forth. I also think if parents have very clear sense of what their values are, so let’s just stick with intercourse. Intercourse happens in the context of marriage or in the context of an ongoing relationship or in the context of adulthood or in the context of having been on a date, whatever. You can make your own rules. Every family gets to have their own values. Go ahead and share those with your kid too. So you can say, here’s what we want when you have intercourse, here’s how we want you to go about it to take good care of yourself and your partner. But also here’s our values around when an intercourse happens, okay? The kid will roll their eyes, be like, are you done already? But it’s worth it. We know from the data that kids actually changed their behavior. In light of those conversations.

Reena Ninan:
You came armed with statistics. So I am not squeamish anymore. I get it, I get it. I proudly will have no problem talking, having this conversation, but there’s going to be a 90 second time limit on it.

Dr. Lisa Damour:
For everybody. And you can even literally get out your phone and be like, start the timer. Here I go. Kids appreciate it. They just want it to be over. But that doesn’t mean they don’t want good information from people who love and know them.

Reena Ninan:
I love it. So what do you have for us, Lisa, for Parenting to Go?

Dr. Lisa Damour:
So when parents are trying to talk to their kids about sex and their kids are shutting them down, one misstep I’ve seen parents make is that when a kid finally asks a question about sex and maybe a very circumscribed one, the parent goes barging through the door with every other thing they ever wanted to say to the kid, and the kid really is so sorry that you opened the door at all. So another thing that parents can do in the context of these conversations is say, look, here’s what I want you to know from me. Now here’s something else. If you ever have questions about sex, you can come to me. I will answer the question you asked and nothing further. I promise I will leave it at that. And then you have to be good on your promise. But I have found if teenagers realize like, oh, I can really ask this one question and you will just control yourself. They do come to us with questions and we want them asking us questions.

Reena Ninan:
So keep it short. Allow for almost no judgment, walk away and potentially they might have some questions and come back to you.

Dr. Lisa Damour:
And come back to you if you promise to only answer the question they’ve asked.

Reena Ninan:
Well, Lisa, thanks for this conversation and for walking me through the squeamishness of it all and why it’s really not necessary.
Next week, we’re going to talk about how do you get your teen to spend more time with you? I can tell you, here’s a hint, don’t have this conversation.

Dr. Lisa Damour:
Exactly. Don’t try to talk about sex every time you see them. This would be the episode about how to get teenagers to avoid you all day.

Reena Ninan:
But I look forward to that. I know so many parents struggle and they know as the years move on and they’re getting closer to college, they want to figure that out. So I’ll see you next week.

Dr. Lisa Damour:
I’ll see you next week.