Acceptability of immediate postpartum and post‐abortion long‐acting reversible contraception provision to adolescents: A systematic review

Abstract

Introduction Long‐acting reversible contraception (LARC) methods are safe for adolescents and provide the greatest assurance against rapid repeated pregnancy when inserted during the immediate postpartum (IPP) and immediate post‐abortion (IPA) period. Despite increasing enthusiasm for IPP/IPA LARC insertion, adolescents’ preferences and experiences have seldom been examined. The objective of this review was to examine the attitudes of adolescents (aged 10–19 years) towards IPP/IPA LARC, their experiences and perceptions around having an LARC device fitted IPP/IPA and the factors involved in decision‐making to use, not use or discontinue IPP/IPA LARC. Material and methods In January 2021, we searched seven bibliographic databases for original research articles published in English, from the year 2000. Studies of any design focused on IPP/IPA LARC were eligible for inclusion. Three of the authors assessed articles for eligibility and extracted data relevant to the outcomes of the review. Joanna Briggs Institute Critical Appraisal Tools were used to assess methodological quality. Key themes emerging from the data were synthesized and reported narratively. Results We identified 10 relevant articles, four of which were entirely adolescent‐focused. Only three addressed IPA LARC. IPP availability was important for ensuring access to LARC postpartum. Attitudes towards LARC IPP were associated with adolescents’ sociodemographic characteristics and positive perceptions related to the long duration of action. Determinants of discontinuation and nonuse included poor‐quality contraceptive counseling, intolerable side effects and subsequent distress, misconceptions about LARC safety IPP and the influence of partners and community on autonomy. No factors involved in IPA LARC decision‐making were available. Limited evidence demonstrated that adolescents may favor contraceptive implants over intrauterine devices, and in certain contexts may face greater barriers to IPA LARC access than adult women do. Conclusions Immediate insertion of LARC postpartum appears acceptable to adolescents who do not experience side effects and those with the opportunity to make autonomous contraception decisions. This important topic has been addressed in few studies involving an entirely adolescent population. Very limited evidence is available on IPA LARC. Further research on adolescents’ lived experiences of IPP/IPA LARC access and use is necessary to inform the provision of person‐centered care when assisting adolescents’ contraceptive choice following pregnancy.

Understanding women’s views of and preferences for accessing postpartum contraception: a qualitative evidence synthesis

“…In contrast with other reviews,21–24 this paper focuses on women’s perspectives from high-income countries. Other reviews have focused on specific demographic groups such as adolescents,21 22 low-income countries23 24 or individual methods of contraception 21.…”

“…In contrast with other reviews,21–24 this paper focuses on women’s perspectives from high-income countries. Other reviews have focused on specific demographic groups such as adolescents,21 22 low-income countries23 24 or individual methods of contraception 21. These reviews demonstrated that patient education, including a higher level of education achievement,21 24 and specific contraception education,22–24 increases contraception uptake.…”

“…Other reviews have focused on specific demographic groups such as adolescents,21 22 low-income countries23 24 or individual methods of contraception 21. These reviews demonstrated that patient education, including a higher level of education achievement,21 24 and specific contraception education,22–24 increases contraception uptake. However, they did not investigate women’s preferences for mode and provider of counselling, which was explored in this review.…”

“…We were interested in better understanding women’s views and preferences regarding access to postpartum contraception. Although several relevant global systematic reviews were identified, these focused on specific priority groups or low-income countries 21–24. We therefore conducted a qualitative evidence synthesis (QES) focusing on women’s views and preferences for accessing postpartum contraception in high-income countries in order to provide greater clarity on the experiences, barriers, enablers and preferences of women—identifying opportunities for service provision and areas of future research.…”

Long-Acting Reversible Contraception for Adolescents: A Review of Practices to Support Better Communication, Counseling, and Adherence

“… 1 Immediate postabortion LARC insertion is generally acceptable to adolescents and nulliparous women, although rates of LARC uptake in these groups may be lower than in parous and adult women. 71 , 72 Importantly, immediate LARC initiation does not increase the risk of medication-induced abortion failure. 73 Rates of IUD complications and expulsions following first-trimester uterine aspiration and medication-induced abortions are low.…”