One-Year Contraceptive Continuation and Pregnancy in Adolescent Girls and Women Initiating Hormonal Contraceptives

Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA.
Obstetrics and Gynecology (Impact Factor: 5.18). 02/2011; 117(2 Pt 1):363-71. DOI: 10.1097/AOG.0b013e31820563d3
Source: PubMed


To assess contraceptive discontinuation, switching, factors associated with method discontinuation, and pregnancy among women initiating hormonal contraceptives.
This was a 12-month longitudinal cohort study of adolescent girls and women (n=1,387) aged 15 to 24 years attending public family planning clinics who did not desire pregnancy for at least 1 year and selected to initiate the patch, ring, depot medroxyprogesterone acetate, or pills. Participants completed follow-up assessments at 3, 6, and 12 months after baseline. Life table analysis was used to estimate survival rates for contraceptive continuation. Cox proportional hazards models were used to estimate factors associated with method discontinuation.
The continuation rate (per 100 person-years) at 12 months was low for all methods; however, it was lowest for patch and depot medroxyprogesterone acetate initiators, 10.9 and 12.1 per 100 person years, respectively (P≤.003); continuation among ring initiators was comparable to pill initiators, 29.4 and 32.7 per 100 person-years, respectively (P=.06). Discontinuation was independently associated with method initiated and younger age. The only factors associated with lower risk of discontinuation were greater intent to use the method and being in school or working. The pregnancy rate (per 100 person-years) was highest for patch and ring initiators (30.1 and 30.5) and comparable for pill and depot medroxyprogesterone acetate initiators (16.5 and 16.1; P<.001).
The patch and the ring may not be better options than the pill or depot medroxyprogesterone acetate for women at high risk for unintended pregnancy. This study highlights the need for counseling interventions to improve contraceptive continuation, education about longer-acting methods, and developing new contraceptives that women may be more likely to continue.

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Available from: Ushma D Upadhyay, Jun 09, 2014
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    • "The high failure rate of short-acting contraceptive methods indicates a need to recommend LARC to young women, which once inserted can be forgotten.37,38 Many adolescent and nulliparous women prefer the IUD over non-LARC methods when they are properly informed about the advantages over short-acting methods. "
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    • "While LARC method used has increased recently in the US, most of the increase is among parous women (Finer et al., 2012; Kavanaugh et al., 2011). Although young women relying on user-dependent methods have elevated failure and pregnancy rates (Raine et al., 2011), these results showed that NPs often do not view adolescent and nulliparous women as IUD candidates, due to overly restrictive views of eligibility (Centers for Disease Control and Prevention, 2010; Deans and Grimes, 2009). Integrating long-acting contraception into NPs' counseling and clinical practice can help to prevent pregnancy and also rapid subsequent pregnancy among adolescent mothers and young women (Waggoner et al., 2012). "
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