IUDs and Adolescents—An Under-Utilized Opportunity for Pregnancy Prevention

Yen, Sophia; Saah, Tammy; Hillard, Paula J. Adams

doi:10.1016/j.jpag.2009.09.004

Cited by 35 publications

(16 citation statements)

References 26 publications

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“…Adolescents do not routinely use LARC methods despite their demonstrated effectiveness,(6) and the reasons for this are not well understood. One recent study showed that over 60% of adolescent women choose to contracept using LARC after receiving evidence-based contraceptive counseling and in the absence of financial barriers.…”

Section: Introductionmentioning

confidence: 99%

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Factors Associated With Provision of Long-Acting Reversible Contraception Among Adolescent Health Care Providers

Greenberg

Makino

Coles

2013

Journal of Adolescent Health

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Purpose To identify provider and practice characteristics associated with long-acting reversible contraception (LARC – progesterone contraceptive implants or IUDs [intrauterine devices]) provision among adolescent health care providers. Methods We analyzed physician characteristics and self-reported provision of LARC using chi-square analyses. Multivariate logistic regressions identified factors predicting provision of any form of LARC, as well as progesterone contraceptive implants or IUDs specifically. Results In logistic regressions, residency training in obstetrics/gynecology or family medicine (rather than internal medicine/pediatrics) was the strongest predictor of LARC provision, particularly for IUDs. Practicing in suburban (rather than urban) and hospital-based (rather than private) settings was associated with lower and higher likelihoods of providing LARC respectively. Conclusions Exposure to procedural women’s health training was the strongest predictor LARC provision. Increasing the number of providers offering this type of contraception may have broad reaching consequences for adolescent pregnancy prevention, and may be most easily accomplished via contraceptive implants.

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Section: Introductionmentioning

confidence: 99%

“…Lack of clinicians training and comfort in placing these devices for adolescent patients may be another factor perpetuating underutilization. (6)…”

Section: Introductionmentioning

confidence: 99%

Factors Associated With Provision of Long-Acting Reversible Contraception Among Adolescent Health Care Providers

Greenberg

Makino

Coles

2013

Journal of Adolescent Health

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“…With increasing duration of use, the IUD becomes even more cost-effective [5]. Despite these benefits, only 5.5% of US contraceptive users rely on an IUD to prevent pregnancy [6], and IUD use is even less common among adolescents and nulliparous women [6–8], who are at highest risk of unintended pregnancy [9]. …”

Section: Introductionmentioning

confidence: 99%

Duration of use of a levonorgestrel IUS amongst nulliparous and adolescent women

Behringer

Reeves²,

Rossiter

et al. 2011

Contraception

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Background Intrauterine devices (IUDs) are cost-effective if used for two or more years. Early discontinuation may lead to reduced cost-effectiveness of this method and unintended pregnancy if other contraceptives are not used. This study sought to examine rates and reasons for discontinuation of IUS use in adolescents versus older women and nulliparous versus parous women, as these groups may be more likely to discontinue use. Study Design Retrospective cohort study of women receiving a levonorgestrel IUS between June 2005 and April 2008. Medical records were reviewed for all visits following placement of the IUS; rates and reasons for IUS discontinuation were calculated and categorized. Data were examined under two scenarios: (1) assuming that all women not seen for follow-up continued IUS use and (2) Only including women with follow-up visits. Cox regression was used to control for age, parity, race, and marital status in comparing rates of IUS discontinuation and expulsion in nulliparous versus parous women and adolescents versus older women. Results Of the 828 women included in this analysis, 104 (12.6%) were nulliparous, and 131 (15.8%) were <=20 years of age. Nulliparous women were not more likely than parous women to have expelled their IUS [HR 1.40, 95% CI (0.57, 3.43)]. Adolescent women were more likely to experience expulsion than older women, although this did not reach statistical significance [HR 1.49 (0.76, 2.92)]. When we looked at reasons for IUS removal, we found that nulliparous women were not more likely than parous women to have their IUS removed because of dissatisfaction with the contraceptive method (6.7% vs. 11.5%, p=0.15) or desire to become pregnant (1.9% vs. 2.6%, p=0.50). Similarly, adolescents were not more likely than older women to have their IUS removed because of dissatisfaction with the contraceptive method (10.7% vs. 10.9%, p=0.94) or desire to become pregnant (3.1% vs. 2.4%, p=0.43). Conclusions Adolescents and nulliparous women are not more likely to prematurely discontinue use of their IUS than adult or parous women.

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“…A significant contributor to unintended pregnancy in this age group is the incorrect or inconsistent use of contraception (3). Therefore, long-acting reversible contraceptives, such as intrauterine contraception (IUC), may play an important role in meeting the public health imperative to reduce unintended pregnancy among adolescents, as they are highly effective and have a low risk of user misuse (4). …”

mentioning

confidence: 99%

Identifying Counseling Needs of Nulliparous Adolescent Intrauterine Contraceptive Users: A Qualitative Approach

Brown

Auerswald

Eyre

et al. 2013

Journal of Adolescent Health

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Purpose To describe the Intrauterine Contraception (IUC) adoption process among nulliparous adolescents and to identify the role of the medical provider in this trajectory. Methods We conducted semi-structured interviews with a clinic-based sample of twenty nulliparous adolescents (ages 15-24 years) with a history of IUC use. Interviews were analyzed using modified grounded theory and cross-case analysis to reveal a process model for IUC adoption with a focus on the role of the medical provider. Results The model includes the following stages: awareness, initial reaction, information gathering, adoption, and adjustment and reassessment. It is influenced by personal preferences and experiences, friends, family, sexual partner(s), and medical providers. Interactions with medical providers that study participants found helpful in navigating the adoption process included the use of visuals; tailored counseling to address specific contraceptive needs; assurance that IUC discontinuation was an option; information on a wide range of side effects; medical provider self-disclosure regarding use of IUC; and addressing and validating concerns both before and after IUC insertion. Conclusions Nulliparous adolescents in this study described a complex IUC adoption process in which the medical provider plays a substantial supportive role. Findings from this study may be used to counsel and support future nulliparous adolescents regarding IUC use. Implications and Contribution Summary Little is known about nulliparous adolescent use of IUC and the counseling needs of this population. This study offers counseling suggestions for medical providers that they may use to support nulliparous adolescents as they make decisions about IUC use.

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IUDs and Adolescents—An Under-Utilized Opportunity for Pregnancy Prevention

Cited by 35 publications

References 26 publications

Factors Associated With Provision of Long-Acting Reversible Contraception Among Adolescent Health Care Providers

Factors Associated With Provision of Long-Acting Reversible Contraception Among Adolescent Health Care Providers

Duration of use of a levonorgestrel IUS amongst nulliparous and adolescent women

Identifying Counseling Needs of Nulliparous Adolescent Intrauterine Contraceptive Users: A Qualitative Approach

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