Examining the Role of the Pediatric Emergency Department in Reducing Unintended Adolescent Pregnancy

Abstract

Objectives To determine pregnancy risk and receptiveness to emergency department (ED)-based pregnancy prevention interventions among adolescents accessing care in the ED. Study design Cross-sectional electronic survey of adolescent females in a pediatric ED used to calculate the pregnancy risk index (PRI), a validated measure estimating the annual risk of becoming pregnant based upon recent sexual activity, contraceptive method(s), and method-specific contraceptive failure rates) and interest in receipt of ED-based contraceptive services. Results Of 229 participants, 219 were non-pregnant, and 129 reported sexual experience. 72.4% (n=166) endorsed negative pregnancy intentions. The overall PRI for the 219 non-pregnant participants was 9.6 (95% CI 6.8, 12.4), and was 17.5 (95% CI 12.8, 22.2) for the 129 sexually experienced participants. A PRI above the national average of 5 was associated with older age (aOR 3.0; 95% CI 1.5, 5.85), non-private insurance (aOR 7.1; 95% CI 1.6, 32.1), prior pregnancy (aOR 2.7; 95% CI 1.2, 6.0), and chief complaint potentially related to a reproductive health concern (aOR 2.6; 95% CI 1.4, 5.1). 85.1% (n=194) believed that the ED should provide information about pregnancy prevention, the majority of whom (64.9%; n=148) believed that pregnancy prevention services should be offered at all ED visits. Conclusion This study demonstrates a high unintended pregnancy risk among adolescents accessing care in the ED. Adolescents report interest in receiving pregnancy prevention information and services in the ED, regardless of reason for visit. Strategies to successfully incorporate the provision of reproductive health services into ED care should be explored.

A Research Agenda for Emergency Medicine–based Adolescent Sexual and Reproductive Health

“…Since the ED visit may be the only contact with a medical clinician for many adolescents, EDs represent a key site for STI prevention and treatment. However, while adolescent patients and their parents have repeatedly demonstrated acceptance of sexual health discussion and HIV/STI testing, clinicians have reported less acceptance of directly providing this care . Further, racial disparities have been demonstrated in ED‐based STI testing, with black females nearly four times more likely to be tested than nonblack females .…”

“…Despite declines in adolescent pregnancy rates over the past several decades, the United States has one of the highest rates in the industrialized world, and reduction of adolescent pregnancy remains a top priority for both the CDC and the U.S. Department of Health and Human Services . The risk of unintended pregnancy among adolescent females seeking care in the pediatric ED setting is more than three times greater than the national average . Frequent ED utilization and lacking a primary provider or private insurance are associated with higher risk for unintended pregnancy .…”

“…The risk of unintended pregnancy among adolescent females seeking care in the pediatric ED setting is more than three times greater than the national average . Frequent ED utilization and lacking a primary provider or private insurance are associated with higher risk for unintended pregnancy . Thus, interventions that identify females in EDs at high risk for unintended pregnancy are critically needed.…”

“…Among adolescent ED patients, rates of infection with chlamydia and gonorrhea are up to seven times higher than those in the general adolescent population . Furthermore, female adolescents accessing the ED for care have a risk of pregnancy within the next 12 months that is three times greater than that in adolescents in the general population …”

A Pediatric Emergency Department Intervention to Increase Contraception Initiation Among Adolescents

“…In one study conducted in an urban PED, nearly one‐third of adolescent females ages 15 to 19 were either pregnant or at high risk of becoming pregnant in the next year . Studies have also shown that adolescent females seeking care in the PED would welcome contraception counseling at the time of the PED visit . However, it is unclear if contraceptive counseling in the PED is an effective mechanism for increasing contraception initiation.…”