Adolescent Contraception Before and After Pregnancy—Choices and Challenges for the Future

 

 Permissions and Reprints

Abstract

Objective To determine methods of contraception used by adolescents before and after pregnancy.

Methods A cross-sectional study was performed, and data were collected from medical records of all teens in puerperal consultation at the Hospital da Mulher – José Aristodemo Pinotti (Caism), Universidade Estadual de Campinas (CAISM), São Paulo, Brazil, between July 2011 and September 2013. The inclusion criterion was being 10 to 19 years old, and the exclusion criterion was having a first consultation 90 days after childbirth. Statistical analyses were performed with averages, standard deviations, percentages, correlations and Fisher's exact tests using the SAS program, version 9.4.

Results A total of 196 adolescents in postpartum consultation were included (44 days after childbirth on average). The majority was older than 14 years (89%), with an average age of 16.2 years, and the most were exclusively breast-feeding (70%). Before pregnancy, the use of any contraceptive methods was mentioned by 74% adolescents; the most frequent use was combined oral contraceptive followed by condom. The main reason for abandoning the use of contraception was the occurrence of an unintended pregnancy (41%), followed by reports of side effects (22%), behavior issues (18%) and desire for pregnancy (16%). A positive correlation was found between the age of the adolescent at the moment of childbirth, the age of menarche (r = 0.3), and the first sexual intercourse (r = 0.419). Vaginal delivery occurred in 76% of the cases. After birth, depot medroxyprogesterone acetate (DMPA) was the contraception method most frequently used (71%), followed by oral contraceptives (11.8%) and intrauterine devices (IUDs, 11.2%).

Conclusions The most prescribed contraceptive method before pregnancy in adolescents who had childbirth was combined oral contraceptives. Many of the study participants had an unintended pregnancy. After childbirth, the most used contraceptive method was DMPA. To improve contraception and reduce the chance of unintended pregnancies among adolescents, we should promote the use of long-acting reversible contraceptives (LARCS).

Resumo

Objetivo Conhecer os métodos contraceptivos utilizados por adolescentes antes e após a gravidez.

Métodos Estudo transversal, os dados foram coletados de prontuários médicos de todas as adolescentes em consulta puerperal do Hospital da Mulher – José Aristodemo Pinotti (CAISM), Unicamp, São Paulo, Brasil, entre julho de 2011 e setembro de 2013. O critério de inclusão foi idade entre 10 e 19 anos, e o critério de exclusão foi primeira consulta com mais de 90 dias após o parto. As análises estatísticas foram realizadas com médias, desvios-padrão, porcentagens, correlações e teste exato de Fisher utilizando o pro grama SAS, versão 9.4.

Resultados Um total de 196 adolescentes em consulta pós-parto foram incluídas (em média 44 dias após o parto). A maioria tinha mais do que 14 anos (89%), com idade média de 16,2 anos, e estava em aleitamento exclusivo (70%). Antes da gravidez, o uso de quaisquer métodos anticoncepcionais foi mencionado por 74% das adolescentes; o mais frequente foi contraceptivo oral combinado seguido de preservativo. A principal razão para abandonar o uso de contracepção foi a ocorrência de gravidez indesejada (41%), seguido por relatos de efeitos colaterais (22%), problemas comportamentais (18%) e desejo de gravidez (16%). Uma correlação positiva foi encontrada entre a idade da adolescente no momento do parto, a idade da menarca (r = 0,3), e a primeira relação sexual (r = 0,419). O parto vaginal ocorreu em 76% dos casos. Após o nascimento, acetato de medroxiprogesterona de depósito (DMPA) foi o método de contracepção mais utilizado (71%), seguido do contraceptivo oral (11,8%) e do dispositivo intrauterino (DIU) (11,2%).

Conclusões O método anticoncepcional mais prescrito antes da gravidez em adolescentes que tiveram parto no serviço foi contraceptivo combinado oral. Muitas participantes do estudo tiveram uma gravidez indesejada. Após o parto, o método contraceptivo mais utilizado foi DMPA. Para melhor contracepção e reduzir a chance de gravidez indesejada entre adolescentes, devemos promover e estimular o uso de contraceptivos reversíveis longa ação.

• References

• 1 World Health Organization [Internet]. Adolescent pregnancy. Sep 2014 [cited 2015 Apr 21]. Available from: < http://www.who.int/mediacentre/factsheets/fs364/en/
  PubMedGoogle Scholar
• 2 Meade CS, Ickovics JR. Systematic review of sexual risk among pregnant and mothering teens in the USA: pregnancy as an opportunity for integrated prevention of STD and repeat pregnancy. Soc Sci Med 2005; 60 (4) 661-678
  CrossrefPubMedGoogle Scholar
• 3 Santelli JS, Lindberg LD, Finer LB, Singh S. Explaining recent declines in adolescent pregnancy in the United States: the contribution of abstinence and improved contraceptive use. Am J Public Health 2007; 97 (1) 150-156
  CrossrefPubMedGoogle Scholar
• 4 Ott MA, Sucato GS ; Committee on Adolescence. Contraception for adolescents. Pediatrics 2014; 134 (4) e1257-e1281
  CrossrefPubMedGoogle Scholar
• 5 Committee on Adolescence. Contraception for adolescents. Pediatrics 2014; 134 (4) e1244-e1256
  CrossrefPubMedGoogle Scholar
• 6 Sedlecky K, Stanković Z. Contraception for adolescents after abortion. Eur J Contracept Reprod Health Care 2016; 21 (1) 4-14
  CrossrefPubMedGoogle Scholar
• 7 Thiel de Bocanegra H, Chang R, Menz M, Howell M, Darney P. Postpartum contraception in publicly-funded programs and interpregnancy intervals. Obstet Gynecol 2013; 122 (2 Pt 1): 296-303
  CrossrefPubMedGoogle Scholar
• 8 Centers for Disease Control and Prevention (CDC).. Vital signs: Repeat births among teens - United States, 2007-2010. MMWR Morb Mortal Wkly Rep 2013; 62 (13) 249-255
  PubMedGoogle Scholar
• 9 Bruno ZV, Feitosa FE, Silveira KP, Morais IQ, Bezerra MdeF. [Subsequent pregnancy among adolescents]. Rev Bras Ginecol Obstet 2009; 31 (10) 480-484 Portuguese.
  CrossrefPubMedGoogle Scholar
• 10 Amorim MM, Lima LdeA, Lopes CV , et al. [Risk factors for pregnancy in adolescence in a teaching maternity in Paraíba: a case-control study]. Rev Bras Ginecol Obstet 2009; 31 (8) 404-410 Portuguese.
  CrossrefPubMedGoogle Scholar
• 11 Dozier AM, Nelson A, Brownell EA, Howard CR, Lawrence RA. Patterns of postpartum depot medroxyprogesterone administration among low-income mothers. J Womens Health (Larchmt) 2014; 23 (3) 224-230
  CrossrefPubMedGoogle Scholar
• 12 Committee on Gynecologic Practice Long-Acting Reversible Contraception Working Group. Committee Opinion No. 642: increasing access to contraceptive implants and intrauterine devices to reduce unintended pregnancy. Obstet Gynecol 2015; 126 (4) e44-e48
  CrossrefPubMedGoogle Scholar
• 13 Lotke PS. Increasing use of long-acting reversible contraception to decrease unplanned pregnancy. Obstet Gynecol Clin North Am 2015; 42 (4) 557-567
  CrossrefPubMedGoogle Scholar
• 14 Reeves MF, Zhao Q, Secura GM, Peipert JF. Risk of unintended pregnancy based on intended compared to actual contraceptive use. Am J Obstet Gynecol 2016; 215 (1) 71.e1-71.e6
  CrossrefPubMedGoogle Scholar
• 15 Secura GM, Madden T, McNicholas C , et al. Provision of no-cost, long-acting contraception and teenage pregnancy. N Engl J Med 2014; 371 (14) 1316-1323
  CrossrefPubMedGoogle Scholar
• 16 Winner B, Peipert JF, Zhao Q , et al. Effectiveness of long-acting reversible contraception. N Engl J Med 2012; 366 (21) 1998-2007
  CrossrefPubMedGoogle Scholar
• 17 Birgisson NE, Zhao Q, Secura GM, Madden T, Peipert JF. Preventing unintended pregnancy: the Contraceptive CHOICE Project in review. J Womens Health (Larchmt) 2015; 24 (5) 349-353
  CrossrefPubMedGoogle Scholar
• 18 Han L, Teal SB, Sheeder J, Tocce K. Preventing repeat pregnancy in adolescents: is immediate postpartum insertion of the contraceptive implant cost effective?. Am J Obstet Gynecol 2014; 211 (1) 24.e1-24.e7
  CrossrefPubMedGoogle Scholar
• 19 Centers for Disease Control and Prevention (CDC). U S. Medical Eligibility Criteria for Contraceptive Use, 2010. MMWR Recomm Rep 2010; 59 ( RR-4( 1-86
  PubMedGoogle Scholar
• 20 Dodson NA, Gray SH, Burke PJ. Teen pregnancy prevention on a LARC: an update on long-acting reversible contraception for the primary care provider. Curr Opin Pediatr 2012; 24 (4) 439-445
  CrossrefPubMedGoogle Scholar
• 21 Córdova Pozo K, Chandra-Mouli V, Decat P , et al. Improving adolescent sexual and reproductive health in Latin America: reflections from an International Congress. Reprod Health 2015; 12: 11
  CrossrefPubMedGoogle Scholar
• 22 Blanc AK, Winfrey W, Ross J. New findings for maternal mortality age patterns: aggregated results for 38 countries. PLoS One 2013; 8 (4) e59864
  CrossrefPubMedGoogle Scholar
• 23 Ganchimeg T, Ota E, Morisaki N , et al; WHO Multicountry Survey on Maternal Newborn Health Research Network. Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study. BJOG 2014; 121 (Suppl. 01) 40-48
  PubMedGoogle Scholar