One-Year Contraceptive Continuation and Pregnancy in Adolescent Girls and Women Initiating Hormonal Contraceptives

Abstract

OBJECTIVE To assess contraceptive discontinuation, switching, factors associated with method discontinuation, and pregnancy among women initiating hormonal contraceptives. METHODS This was a 12-month longitudinal cohort study of adolescent girls and women (n=1,387) aged 15 to 24 years attending public family planning clinics who did not desire pregnancy for at least 1 year and selected to initiate the patch, ring, depot medroxyprogesterone acetate, or pills. Participants completed follow-up assessments at 3, 6, and 12 months after baseline. Life table analysis was used to estimate survival rates for contraceptive continuation. Cox proportional hazards models were used to estimate factors associated with method discontinuation. RESULTS The continuation rate (per 100 person-years) at 12 months was low for all methods; however, it was lowest for patch and depot medroxyprogesterone acetate initiators, 10.9 and 12.1 per 100 person years, respectively (P≤.003); continuation among ring initiators was comparable to pill initiators, 29.4 and 32.7 per 100 person-years, respectively (P=.06). Discontinuation was independently associated with method initiated and younger age. The only factors associated with lower risk of discontinuation were greater intent to use the method and being in school or working. The pregnancy rate (per 100 person-years) was highest for patch and ring initiators (30.1 and 30.5) and comparable for pill and depot medroxyprogesterone acetate initiators (16.5 and 16.1; P<.001). CONCLUSION The patch and the ring may not be better options than the pill or depot medroxyprogesterone acetate for women at high risk for unintended pregnancy. This study highlights the need for counseling interventions to improve contraceptive continuation, education about longer-acting methods, and developing new contraceptives that women may be more likely to continue.

Correlates and Barriers of Dual-Method Contraception among College Youths in Nigeria

“…For instance, younger age has been extensively linked with increased DMC use [43,44,46,71,72]; however, such link was not found here. Though a critical scrutiny reveals a disproportionately small number of under 20-year-olds among respondents, the homogeneity of a university sample might also be a contributing factor; particularly since higher education has also been strongly linked with DMC [73,74].…”

“…In this line, DMC practice is known to be commoner in the developed world and amongst high-risk groups. In addition, individuals are known to be more likely to use DMC if they were younger [43,44]; educated [45,46]; perceived themselves at risk of STIs/pregnancies [39,47]; or perceived themselves to be selfefficacious in terms of using the methods [48,49]. Also, individuals who had relationships of recent onset or short duration [47,50], those who communicate with their partners about contraception [51,52], and those who had multiple partners [53,54] were more likely to combine methods.…”

Variables sociodemográficas relacionadas con embarazos no planificados en jóvenes de 13 a 24 años

“…En nuestra población, al igual que se refleja en otros estudios 3,12,30 , las adolescentes y jóvenes utilizan con cierta frecuencia el coitus interruptus o incluso mantienen relaciones sexuales coitales sin ningún método de prevención. Los resultados de la investigación indican que este tipo de comportamiento no siempre está asociado con EnoP y, por otra parte, con el uso de los métodos anticonceptivos considerados seguros se han registrado fallos y se produjeron embarazos no planificados.…”

Linking Changes in Contraceptive Use to Declines in Teen Pregnancy Rates

“…These methods provide high levels of protection when used perfectly (0.3% failure rate), although typical use pregnancy rates are higher (9%) [7][8][9], and many women ultimately switch off of these methods [32][33][34], highlighting the importance of consistent and sustained method use. In the LARC/injectable method category, our study found a decline in injectable method use since the early 2000s.…”