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

Abstract

To determine methods of contraception used by adolescents before and after pregnancy. 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),, 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. 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%). 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).

Empowering Adolescent Mothers in the Choice of Contraceptive Methods at the Postpartum Period: Avoiding a Subsequent Pregnancy

“…Therefore, we compared our actual rates of use of IUCs and DMPA with previous results in the same setting prior to the semistructured group interventions. 10…”

“…A previous study conducted by our group among postpartum adolescents in the same setting showed that only 11% chose IUCs as a contraceptive method (we do not have implants to offer at no cost) and depotmedroxyprogesterone acetate (DPMA) injection was chosen by 71%. 10 Furthermore, a large US-based study with more than 21,000 adolescents showed that, at the postpartum period, 15% chose IUCs and 7% chose implants as a contraceptive method. 9 With the aim to increase the use of LARC methods among adolescents that do not want to get pregnant, since 2014 we have been performing educational semistructured group interventions with counseling during the prenatal care of the adolescent and immediately before the postpartum consultation.…”

Sociodemographic Factors Associated with the Knowledge and Use of Birth Control Methods in Adolescents before and after Pregnancy

“…Nevertheless, these women do not opt for using an effective method of birth control. There are reasons that may explain this phenomenon: Low educational level [5]; lack of variety in birth control methods; limited access to birth control methods, especially for the adolescents younger than 15 years of age, for women from a low socioeconomic status, and for single women; fear of the adverse effects; religious or cultural beliefs regarding contraception; gender barriers; and poor-quality medical services [6,7,8]. A poor level of knowledge about birth control methods could be associated with unplanned pregnancy.…”

ENG-releasing subdermal implants in postpartum teenagers – an open-label trial study protocol

“…UP among teenagers is a consequence to improper and/or lack of use of contraceptive methods [7]. LARC methods, which include subdermal implants and intrauterine contraceptives (IUCs) are the first line for this age group [8][9][10].…”