Search

Purpose The purpose of the study was to identify factors associated with uptake of contraceptive implants or intrauterine devices (IUDs) by adolescents and young women. Methods For this prospective cohort study, we recruited English-speaking female contraceptive initiators aged 14–24 years attending a Title X-supported, youth-focused clinic. Immediately prior to their visits, participants completed surveys assessing demographic and reproductive characteristics and awareness of, interest in, and intent to initiate specific contraceptive methods. Participants also answered questions about their social contacts' contraceptive experiences. Following the visit, participants reported the method initiated and the perceived importance of provider counseling. We used a multivariable regression model to ascertain factors associated with initiation of an IUD, an implant, or a short-acting reversible method. Results We enrolled 1,048 contraceptive initiators: 277 initiated short-acting methods, 384 IUDs, and 387 implants. High previsit personal acceptability of the method was associated with choosing that method for both implants and IUDs. Knowing someone who uses a specific method and likes it was predictive of personal acceptability of that method (IUD adjusted odds ratio: 10.9, 95% confidence interval: 3.8–31.1; implant adjusted odds ratio: 7.0, 95% confidence interval: 2.3–21.0). However, 10.4% of those initiating IUDs and 14.2% of those initiating implants had never heard of the method before their appointment. Even women with previsit intent to initiate a specific method found importance in contraceptive counseling. Conclusions Previsit personal acceptability, which was associated with social contacts' experiences, was the strongest predictor of specific method uptake in our study. However, counseling informed the decisions of those with low previsit awareness and supported patients with formed intent.

Purpose To describe changes in receipt of immediate postabortion long-acting reversible contraception (LARC) by adolescent and nulliparous women in New Zealand. Methods Nationally collected data on immediate postabortion receipt of an intrauterine method (intrauterine device [IUD]/intrauterine system [IUS]) or contraceptive implant were analyzed to describe proportions and demographic characteristics of women receiving LARC between 2007 and 2013. Changes in uptake over time were presented for adolescent, nulliparous, and parous women. Results Postabortion LARC uptake increased between 2007 and 2013, rising from 7.9% to 42.7% for adolescents and from 8.8% to 36.9% for nulliparous women. The increase was highest among nulliparous adolescents with a seven-fold increase in LARC uptake between 2007 and 2013. Adolescents had a five-fold increase and nulliparous women (of all ages) a four-fold increase. In 2013, IUD/IUS use was lowest among adolescents (22.4%) and increased with increasing age (43% by ages 40+ years), whereas implant use was highest among adolescents (20.3%) and decreased with increasing age (to 4.6% by age 40+ years). Nulliparous women had the lowest use of both IUD/IUS and implants in 2013, with 24.6% receiving an intrauterine method (compared with 43.2% for para 3+), and 12.3% an implant (compared with 17.5% for para 3+). Conclusions Despite an overall trend toward increased uptake of postabortion LARC by adolescent and nulliparous women, uptake in these groups still lags behind that of parous and older women. Reasons for differential uptake need to be explored and addressed if necessary to ensure all women have equitable access to the most effective methods of contraception.

Case reports of pregnancies with inadvertent etonogestrel contraceptive implant exposure in the first-trimester have not demonstrated teratogenic risks or adverse pregnancy outcomes. We report the clinical observations of a 15-year-old nulligravida who continued her etonogestrel contraceptive implant throughout pregnancy and delivery, without any adverse maternal or neonatal outcomes. The patient then continued her contraceptive implant as a reliable postpartum contraceptive method. Although her favorable outcomes are consistent with available pharmacologic literature, more data is needed regarding maintenance of a contraceptive implant during a desired pregnancy.

Repeat pregnancy within 2 years of a previous birth or abortion occurs in approximately 35% of recently pregnant female adolescents. The majority of these pregnancies are classified as unintended with about half ending in births and the remainder in abortions. Rapid repeat pregnancy (RRP) is associated with increased maternal and neonatal morbidity and continues a cycle of economic deprivation for young women and their families. Immediately following a pregnancy, most young women report an intention to avoid pregnancy in the near future, but many change their minds or become ambivalent within months. Lack of contraceptive use is more common among those teens that resume sexual intercourse earlier, live with a male partner, had a preterm delivery, or had an intended teen pregnancy. Adolescents who do not initiate a long-acting reversible contraceptive (LARC) method (intrauterine device or contraceptive implant) have up to a 35 times increased risk of RRP compared with their peers using LARC. Risk of RRP is decreased when LARC methods are initiated earlier after an abortion or within the postpartum period. This review will focus on the prevalence of RRP, the risk factors for RRP, and the effectiveness of strategies to reduce unintended RRP including counseling and early initiation of long-acting contraceptive methods.

Purpose To identify provider and practice characteristics associated with long-acting reversible contraception (LARC, either progesterone contraceptive implants or intrauterine devices [IUDs]) provision among adolescent health care providers. Methods We used data from a previously conducted survey of US providers on reproductive health to predict provision of any form of LARC as well as progesterone contraceptive implants or IUDs specifically using Chi-square and multivariate logistic regressions. Results One third of providers reported any LARC provision. In logistic regressions, residency training in obstetrics/gynecology or family medicine (rather than internal medicine/pediatrics) was the strongest predictor of LARC provision, particularly for IUDs. Conclusions A minority of providers reported offering IUDs or contraceptive implants, most of whom had received procedural women's health training. Increasing the number of providers offering this type of contraception may help to prevent adolescent pregnancies and may be most easily accomplished via training in contraceptive implant provision.

CORRELATES OF CONSISTENT USE OF EFFECTIVE CONTRACEPTIVE METHODS AMONG MALE AND FEMALE ADOLESCENT AND YOUNG ADULT SOLDIERS IN TRAINING Stephanie Adrianse, MD, Lance M. Pollack, PhD, Cherrie B. Boyer, PhD. University of California, San Francisco. Purpose: Over 50% of pregnancies among adolescents and young adults in the US are unintended. Similar to civilians, the high rates of unintended pregnancy (UIP) in Army soldiers are, in part, attributed to ineffective and inconsistent use of contraceptive methods. This study aimed to identify the sociodemographic, psychosocial, and behavioral factors associated with consistent use of effective contraceptive methods (consistent-effective use) in male and female soldiers in training. Methods: This cross-sectional study reflects baseline data of a randomized-controlled intervention trial to prevent sexually transmitted infections and UIP in Army soldiers, aged 17-36 years, during their first year of military service. Participants completed a self-administered baseline questionnaire, including measures on sociodemographic factors (gender, age, race/ethnicity, marital status, education), psychosocial factors (condom and UIP knowledge, condom and UIP attitudes, perceptions of vulnerability for UIP, and perceptions of self-efficacy, behavioral skills and behavioral intentions for preventing UIP) and behavioral risk factors (age at coitarche, number of sexual partners, history of prior unintended or intended pregnancies, and type and frequency of contraceptive method(s) used). Bivariate logistic regression analyses were performed to determine variables for entry into the multivariate analyses. Iterative implementation of a two-block hierarchical logistic regression model identified statistically significant correlates of consistent-effective use (i.e., use of any of the following during each sexual encounter: condoms, contraceptive pills, contraceptive patch, contraceptive ring, contraceptive implant, contraceptive injection, intrauterine device, sterilization, avoidance of vaginal sex, and sex with only same-sex partner). Results: Only participants who reported a history of sexual experience (n ¼ 672, 93.5%) were included in this research. Participants were young (mean age ¼ 21), male (86.2%), racially/ethnically diverse (51.8% white, 22.2% black, 16.4% Hispanic, 9.6% other) and unmarried (87.2%). Overall, 26.6% reported a prior pregnancy of which 76.9% reported an UIP and 22.2% were consistent-effective users. Compared with non-consistent-effective users, consistenteffective users were significantly more likely to report: higher condom (OR ¼ 1.90, CI ¼ 1.16-3.12) and UIP knowledge (OR ¼ 1.82, CI ¼ 1.18-2.80), more positive condom attitudes (OR ¼ 1.36, CI ¼ 1.05-1.75), disagreement that their sexual behaviors place them at high UIP risk (OR ¼ 0.36, CI ¼ 0.14-0.95), neutral agreement that UIP would hurt their career (OR ¼ 1.85, CI ¼ 1.09-3.15), higher levels of behavioral skills (OR ¼ 2.53, CI ¼ 1.42-4.51), greater behavioral intentions for preventing UIP (women only; OR ¼ 7.91, CI ¼ 1.86-33.65), and no prior unintended (OR ¼ 0.30, CI ¼ 0.10- 0.93) or intended pregnancies (OR ¼ 0.56, CI ¼ 0.32-0.97). Conclusions: Consistent-effective contraceptive use is associated with having knowledge, positive condom attitudes, lower perceived UIP risk, and behavioral skills to prevent UIP. With the exception of behavioral intentions for preventing UIP, no gender differences were found. UIP prevention interventions to increase consistent-effective use in adolescents and young adults are still warranted. Sources of Support: U.S. Army Medical Research and Material Command, Fort Detrick, MD, and the Health Resources and Services Administration/Maternal and Child Health Bureau, Leadership Education in Adolescent Health Training Grant.

This study develops a clinical profile of urban teens who selected Norplant for contraception; determines which variables identify the subjects most likely to be compliant with the method; and determines the most common reasons for early termination of use.Demographic and health history data and reasons for termination of use were collected prospectively for 122 inner city teens who received Norplant. Life table analysis and the Mantel-Haenszel procedure were used to investigate differences between Norplant retainers and terminators.The sample consisted of black and Hispanic teens between the ages of 13-19 years, the majority of whom had one or more children and were in school. One and two year retention rates were 71% and 62%. The highest removal rates occurred during the 3-6 month interval after insertion. A significant finding was that teens who have experienced induced abortion were more likely to retain Norplant. Common reasons for termination of use included general and social concerns, including pregnancy desire.Norplant retention rates for this teen sample were greater than the compliance rates reported for other conventional methods. Similar to noncompliance with oral contraceptives, discontinuance of the method was most likely to occur in the first 6 months of use. A history of induced abortion identifies those teens most likely to retain Norplant, suggesting that these teens might evaluate contraceptive risks and benefits differently than those with no abortion history. Pregnancy desire was a common reason for terminating Norplant use.This prospective study of 122 Black and Hispanic inner-city adolescent Norplant users recruited from a teen clinic in Rochester, New York, was the first to include a two-year follow-up period. The study period extended from June 1, 1991, to June 30, 1993. The mean age of Norplant acceptors was 17.4 years; 76% had a parity of at least one. Recorded was a one-year retention rate of 71% and a two-year rate of 62%. The greatest number of removals occurred in the first three months after insertion. There was no association between Norplant retention and age, weight, race, parity, or school status. The only significant predictor of Norplant continuation was a history of at least one induced abortion. The reasons most frequently cited by the 30 adolescents who discontinued Norplant were headache, fatigue, hair loss, nausea, weight changes, breast symptoms, and appetite changes. Menstruation irregularities were reported only by terminators in the 3-6 month use interval. Considering the high continuation rates recorded in this survey and the method's proven effectiveness, Norplant has the potential to widen substantially the birth interval between adolescent pregnancies.

Purpose: Multiple national organizations recommend LARC as first-line contraception for adolescents (ACOG, CDC, SAHM). Despite this, adolescent use remains low. The CDC recently documented adolescent contraceptive implant use (Nexplanon) at 4.3% among Title IX Family Planning Clinics (1). Studies looking at LARC in adolescents have documented increased continuance rates versus patch/pill/ring/injection and uptake/continuance rates similar to adult women (2). When choosing among LARC methods, adolescents more often opt for a contraceptive implant versus an IUD, compared to adults (3). However, irregular vaginal bleeding is a common cause of discontinuation among all implant users. To date, published studies have primarily been done on adolescents in STD and Family Planning Clinics with a focus on uptake and continuance rates. This study will examine patterns of implant use in a general academic adolescent medicine clinic, particularly focused on side effects and reasons for discontinuation. Methods: Retrospective chart review of 184 adolescents who chose Nexplanon insertion in an adolescent medicine clinic in Nashville, TN. SPSS software was used to calculate continuance rates over a 12month period. Patient identified reasons for removal were documented. Additional factors analyzed included sexual history, previous contraceptive use, and post-insertion bleeding. Results: Average at age insertion was 16.9 years. More than 20% of users (n1⁄438) were not sexually active at the time of insertion, but more than 50% of those intended to use Nexplanon for pregnancy prevention. Almost 30% were naive to hormonal contraception prior to Nexplanon insertion. 50% of prior contraceptive users had tried pills and 28.8% Depo-Provera. Six users were repeaters and had Nexplanon removal and reinsertion on the same day, after three continuous years of use. 16.8% (n1⁄431) discontinued Nexplanon during the study period, with an average duration of use of 238 days. Of those who used Nexplanon for more than 12 months (n1⁄496), the continuation rate was 74%. Problematic bleeding was reported by 33% (n1⁄462), but only half required medical intervention. Post-insertion bleeding was treated with estrace in 44% of cases, NSAIDs in 25%, oral contraceptive pills in 22%, and 9% required more than one method. Seven users opted for removal prior to any medical intervention. Bleeding was the most common reason for removal (50%) but additional complaints included headache, weight gain, anxiety, and pain. Conclusions: Adolescents are good candidates for LARC, particularly Nexplanon. Users have good continuation rates, side effects are minimal, and may even choose the method despite being sexually abstinent. Sources of Support: None References: 1) Romero L, Pazol K, Warner L et al. Vital signs: trends in use of long-acting reversible contraception among teens aged 15-19 years seeking contraceptive servicesdUnited States, 2005-2013. MMWR. 2015. 64(13):363-9. 2) Rosenstock JR, Peipert JF, Madden T et al. Continuation of reversible contraception in teenagers and young women. Obstet Gynecol. 2012. 120(6):1298-305. 3) Mestad R, Secura G, Allsworth JE et al. Acceptance of long-acting reversible contraceptive methods by adolescent participants in the Contraceptive CHOICE Project. Contraception. 2011. 84:493-498.