Contraception for adolescents

How Can Unintended Pregnancies Be Prevented among Adolescents Who Engaged in Sexual Intercourse at Earlier Ages? The Role of Female Education and Partner Age Difference

Several studies have identified explicative factors for adolescents' sexual risk behaviors and related outcomes such as unintended pregnancy; however, less is known about the mechanisms through which such factors act. Our study explored the role of female education and partner age difference as explicative mechanisms of the association between age at first sexual intercourse (AFSI) and unintended pregnancy while controlling for the role of other contextual factors (i.e., socioeconomic status, ethnicity, religious beliefs, and place of residence) and sexual-related mechanisms (i.e., number of sexual partners) that are known to be associated with adolescent pregnancy. The sample consisted of 613 sexually experienced female adolescents who did not intend to become pregnant: 349 were pregnant for the first time, and 264 had never been pregnant. Mediation and moderation analyses were performed. An earlier AFSI was associated with unintended pregnancy 1-6 years after first sexual intercourse by increasing the adolescents' likelihood of having less education and being involved with partners older than themselves. There was no significant direct effect of AFSI on pregnancy occurrence after controlling for the mediators. Our findings bring to light nonsexual mechanisms that must be considered in public health interventions aimed at preventing unintended pregnancies among adolescents who engaged in sexual intercourse at early ages. Specific implications are discussed.

Postpartum contraception in adolescents: data from a single tertiary clinic in southeast of Turkey

Aim:

We aimed to evaluate the postpartum contraception preferences of adolescent women in this study.

Material and Method:

This descriptive study was prepared after a retrospective analysis of file records of primigravida women who had given birth at the Adiyaman University School of Medicine Training and Research Hospital Department of Obstetric and Gynecology between January 2010 and June 2012. More than 12 months had passed after birth. The adolescents who were included in the study and the control group women were called by phone and invited to our clinic. A total of 506 adolescents and 1,046 control group women came to the clinic and were evaluated. The control group was formed of women between the age of 20-35 years who gave given birth in our clinic during the same period and were randomly selected. Postpartum obstetric history, contraception methods and data of these patients were recorded.

Results:

The mean age was 18.3±0.4 years and 28.2±4.9 years in the adolescent group and control group respectively. No contraception other than lactation amenorrhea was used by 256 women of the adolescent group (50.6%) and 345 women of the control group (33%). The most commonly used contraceptive method in both groups other than lactation amenorrhea was condoms (160 women (64%) and 230 women (32.8%) respectively). The annual contraceptive failure rate was 3.95% in the adolescent group and 1.72% in the control group. The highest failure rate was with lactation amenorrhea in both groups.

Discussion:

Adolescent women mostly use contraceptive methods with low reliability such as lactation amenorrhea and the calendar method in the postpartum period. Providing adequate contraceptive education is therefore important. On the other hand, starting such training starting in the early postnatal period will prevent recurring adolescent pregnancies with a short pregnancy interval.

Postpartum contraceptive use among adolescent mothers in seven states

PURPOSE

To describe postpartum contraceptive use among adolescent mothers and assess the hypothesis that receipt of prenatal contraceptive counseling or a postpartum checkup is associated with the use of more effective methods.

METHODS

Data are from the Pregnancy Risk Assessment and Monitoring System for seven states and the city of New York for the years 2006-2008. The sample comprises 3,207 adolescent mothers aged 15-19 years. We conducted descriptive and multinomial logistic regression analyses. The outcome measure was the type of contraceptive method used at the time of the survey.

RESULTS

Nineteen percent of adolescent mothers, more than half of whom were sexually active, were using no contraception at the time of the survey. The remaining 81% were using a contraceptive method. Use of long-acting reversible contraception (LARC) was low-11% were using an intrauterine device, and only 1% were using an implant. Receipt of prenatal contraceptive counseling and receipt of a postpartum checkup were both associated with a decreased likelihood of having sex without contraception. A postpartum checkup was also associated with an increased likelihood of using medium-acting contraceptives (injectables, ring, or patch) and a decreased likelihood of relying on condoms. Prenatal contraceptive counseling was also associated with an increased likelihood of pill use.

CONCLUSIONS

Given the demonstrated association between LARC use and decreased rates of rapid repeat pregnancy, efforts should be made to increase adolescent mothers' access to LARC. Enhancing the scope and quality of prenatal contraceptive counseling and increasing the proportion of adolescent mothers who return for a postpartum checkup may also improve postpartum contraceptive use.

Adolescent mothers' postpartum contraceptive use: a qualitative study

CONTEXT

Effective contraceptive use among first-time adolescent mothers can reduce the risk of a rapid repeat pregnancy and associated negative maternal and child health outcomes. Many adolescent mothers begin using a highly effective method after delivery; however, their rates of contraceptive discontinuation are high. Little research has explored the factors that influence adolescents' postpartum contraceptive use.

METHODS

In-depth interviews were conducted with 21 black, white and Latina adolescent first-time mothers from rural and urban areas of North Carolina between November 2007 and February 2009. In addition, interviews were conducted with 18 key informants-professionals who work closely with adolescent mothers. Interviews explored adolescent mothers' health behaviors, including contraceptive use, before and after pregnancy. Content analysis was used to identify key themes and patterns.

RESULTS

Teenagers' use of contraceptives, particularly injectables, IUDs and implants, increased postpartum. Reasons for this improvement included improved clarity of intention to avoid pregnancy and improved contraceptive knowledge, support and access after delivery. However, this increased access often did not continue long after delivery, and levels of method switching were high. Among the barriers to postpartum contraceptive use that key informants cited were lack of information and parental support, as well as the loss of Medicaid and continuity of care.

CONCLUSIONS

Ongoing follow-up may help reduce adolescent mothers' risk of contraceptive discontinuation postpartum. Increasing use of long-acting methods also may help reduce their vulnerability to gaps in contraceptive use and discontinuation, which increase the risk of unintended pregnancy.

'The real deal': a feasibility study of peer-led sex education for early school leavers

OBJECTIVES

To explore female early school leaver's experience of sexual activity and sex education, and to assess the feasibility and potential impact of a peer-led sex education intervention.

METHODS

Forty five young female early school leavers and ten peer educators participated in the study. The ten peer educators, early school leavers who were teenage mothers, were trained to deliver the peer-led education intervention. Both quantitative (self-completed questionnaire) and qualitative (focus groups) research methods were used to evaluate the intervention.

RESULTS

The average age of participants was 17.5 years. The average age at leaving school was 15 years. Many participants were smokers and took alcohol on a regular basis. Over three quarters of the young women were sexually active. Although most used contraception in the past, over 30% had not the last time they had sex. While participants' knowledge around sexual issues showed some improvement following the pilot intervention, there was little change in attitudes to sexual behaviour.

CONCLUSIONS

This feasibility study was very well received by both peer educators and participants. To assess the effectiveness of the intervention we recommend that a larger randomised control trial be conducted.

Contraception knowledge and sexual behaviour in secondary school students

AIM

To analyse the level of knowledge about contraception and the sexual behaviour in high school students from different educational institutions (public and private).

METHODS

A cross-sectional survey was conducted in three high schools in an urban school district. Participants were 136 boys and 145 girls from a school-based contraception and sexually transmitted infections (STI) screening programme. Participants completed a structured, self-administered, confidential questionnaire about their health behaviours, contraception knowledge and sexuality.

RESULTS

A total of 21% of the students from the low socioeconomic group did not have enough knowledge about contraception, 45% had already had their first sexual intercourse when they were between 12 and 15 years old, 67% had not used in this occasion any kind of contraceptive method and about 37% continued being sexually active. In contrast, all the students (100%) in the high and 63% in the middle socio-economic group had used contraceptive methods in their first sexual relation. Parents, community members, and friends were the most important sources of information. Condoms (99%) and pills (95%) were the most well-known contraceptive methods.

CONCLUSIONS

We found that substantial numbers of youths from the public school, with the lowest incomes, received less information and had insufficient general information on contraception, knew less about the role of condoms in the prevention of STI and referred not knowing or thinking it was not necessary to have a medical control before starting to use oral contraceptives.