Incidence of Discontinuation of Long-Acting Reversible Contraception Among Adolescent and Young Adult Women Served by an Urban Primary Care Clinic

Overview

Journal J Pediatr Adolesc Gynecol

Specialties Gynecology & Obstetrics
Pediatrics

Date 2016 Jul 18

PMID 27423766

Citations 17

Authors

Katharine K Sznajder

Kathy S Tomaszewski

Anne E Burke

Maria Trent

Affiliations

Soon will be listed here.

Abstract

Study Objective: To estimate long-acting reversible contraception (LARC) discontinuation rates. Secondary aims were to determine risk factors for discontinuation, describe reasons for discontinuation, evaluate complications related to placement, and estimate pregnancy rates after discontinuation.

Design: We conducted a retrospective cohort study of LARC method use through review of electronic medical record data.

Setting: Our program is housed in an academic primary care pediatric and adolescent clinic in Baltimore, Maryland.

Participants: One hundred sixty women ages 12-24 years who received an intrauterine device or subdermal implant through our program between December 10, 2012 and December 10, 2015.

Interventions: None.

Main Outcome Measures: Complications from LARC insertion, device discontinuation, reason(s) for discontinuation, pregnancies resulting from device failure, and occurrence of pregnancy within 1 year of discontinuation.

Results: Thirty-five women discontinued their LARC method. The 6-month discontinuation rate was 11.3% and the 12-month rate was 21.9%. Discontinuation was associated with history of sexually transmitted infection (adjusted hazard ratio, 3.21; 95% confidence interval, 1.49-6.90). The most common reason for discontinuation was bleeding for the implant and expulsion for the intrauterine device.

Conclusion: Our results support the safety and low discontinuation rates of LARC provision to adolescents and young adult women in a primary care setting. Discontinuation rates and reasons are consistent with those described in other studies.

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Prevalence of modern contraceptive discontinuation and associated factors among married reproductive age group women in Debre Berhan town, Ethiopia: a community-based cross-sectional study.

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Bakesiima R, Gemzell-Danielsson K, Beyeza-Kashesya J, Cleeve A, Larsson E, Nabirye R Open Access J Contracept. 2023; 14:169-180.

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Five-year Contraceptive Use of 52-mg Levonorgestrel Releasing Intrauterine System in Young Women, Menstrual Patterns, and New Contraceptive Choice.

Oliveira E, Rocha A Rev Bras Ginecol Obstet. 2023; 45(11):e654-e660.

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References

Miller W, Trent M, Chung S . Ambivalent childbearing motivations: predicting condom use by urban, African-American, female youth. J Pediatr Adolesc Gynecol. 2014; 27(3):151-60. DOI: 10.1016/j.jpag.2013.09.009. View

Wong R, Bell R, Thunuguntla K, McNamee K, Vollenhoven B . Implanon users are less likely to be satisfied with their contraception after 6 months than IUD users. Contraception. 2009; 80(5):452-6. DOI: 10.1016/j.contraception.2009.03.021. View

. Committee opinion no. 539: adolescents and long-acting reversible contraception: implants and intrauterine devices. Obstet Gynecol. 2012; 120(4):983-8. DOI: 10.1097/AOG.0b013e3182723b7d. View

ONeil-Callahan M, Peipert J, Zhao Q, Madden T, Secura G . Twenty-four-month continuation of reversible contraception. Obstet Gynecol. 2013; 122(5):1083-1091. PMC: 4012225. DOI: 10.1097/AOG.0b013e3182a91f45. View

Secura G, Madden T, McNicholas C, Mullersman J, Buckel C, Zhao Q . Provision of no-cost, long-acting contraception and teenage pregnancy. N Engl J Med. 2014; 371(14):1316-23. PMC: 4230891. DOI: 10.1056/NEJMoa1400506. View

Harvey C, Seib C, Lucke J . Continuation rates and reasons for removal among Implanon users accessing two family planning clinics in Queensland, Australia. Contraception. 2009; 80(6):527-32. DOI: 10.1016/j.contraception.2009.05.132. View

Mestad R, Secura G, Allsworth J, Madden T, Zhao Q, Peipert J . Acceptance of long-acting reversible contraceptive methods by adolescent participants in the Contraceptive CHOICE Project. Contraception. 2011; 84(5):493-8. PMC: 3505875. DOI: 10.1016/j.contraception.2011.03.001. View

Branum A, Jones J . Trends in long-acting reversible contraception use among U.S. women aged 15-44. NCHS Data Brief. 2015; (188):1-8. View

Rosenstock J, Peipert J, Madden T, Zhao Q, Secura G . Continuation of reversible contraception in teenagers and young women. Obstet Gynecol. 2012; 120(6):1298-305. PMC: 4037699. DOI: 10.1097/aog.0b013e31827499bd. View

10.

Finer L, Henshaw S . Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health. 2006; 38(2):90-6. DOI: 10.1363/psrh.38.090.06. View

11.

Deans E, Grimes D . Intrauterine devices for adolescents: a systematic review. Contraception. 2009; 79(6):418-23. DOI: 10.1016/j.contraception.2008.12.009. View

12.

Beilenson P, Miola E, Farmer M . Politics and practice: introducing Norplant into a school-based health center in Baltimore. Am J Public Health. 1995; 85(3):309-11. PMC: 1614858. DOI: 10.2105/ajph.85.3.309. View

13.

Crosby R, DiClemente R, Wingood G, Davies S, Harrington K . Adolescents' ambivalence about becoming pregnant predicts infrequent contraceptive use: a prospective analysis of nonpregnant African American females. Am J Obstet Gynecol. 2002; 186(2):251-2. DOI: 10.1067/mob.2002.120081. View

14.

Jaccard J, Dodge T, Dittus P . Do adolescents want to avoid pregnancy? Attitudes toward pregnancy as predictors of pregnancy. J Adolesc Health. 2003; 33(2):79-83. DOI: 10.1016/s1054-139x(03)00134-4. View

15.

. U.S. Selected Practice Recommendations for Contraceptive Use, 2013: adapted from the World Health Organization selected practice recommendations for contraceptive use, 2nd edition. MMWR Recomm Rep. 2013; 62(RR-05):1-60. View

16.

Schwartz A, Peacock N, McRae K, Seymour R, Gilliam M . Defining new categories of pregnancy intention in African-American women. Womens Health Issues. 2010; 20(6):371-9. DOI: 10.1016/j.whi.2010.06.005. View

17.

Obijuru L, Bumpus S, Auinger P, Baldwin C . Etonogestrel Implants in Adolescents: Experience, Satisfaction, and Continuation. J Adolesc Health. 2016; 58(3):284-9. DOI: 10.1016/j.jadohealth.2015.10.254. View

18.

Bruckner H, Martin A, Bearman P . Ambivalence and pregnancy: adolescents' attitudes, contraceptive use and pregnancy. Perspect Sex Reprod Health. 2005; 36(6):248-57. DOI: 10.1363/psrh.36.248.04. View

19.

Martinez G, Copen C, Abma J . Teenagers in the United States: sexual activity, contraceptive use, and childbearing, 2006-2010 national survey of family growth. Vital Health Stat 23. 2012; (31):1-35. View

20.

Peipert J, Zhao Q, Allsworth J, Petrosky E, Madden T, Eisenberg D . Continuation and satisfaction of reversible contraception. Obstet Gynecol. 2011; 117(5):1105-1113. PMC: 3548669. DOI: 10.1097/AOG.0b013e31821188ad. View