Long-acting reversible contraceptive use in postpartum and postabortion adolescents: initiation, predictors, and continuation outcomes

Information from the abstract

Adolescent pregnancy remains a significant global public health issue. Thailand enacted the Act on Prevention and Solution to the Adolescent Pregnancy Problem and implemented a public health policy that provides free long-acting reversible contraceptives (LARCs) access to adolescents. At our institution, a structured, adolescent-focused protocol was developed to improve contraceptive counselling and access for postpartum and postabortion adolescents. This study aimed to determine the LARC initiation rate following implementation of this practice. Continuation rates and factors associated with LARC initiation and early discontinuation were also analyzed. This retrospective study was conducted at a tertiary referral university hospital. Thai adolescents aged under 20 years at the time of delivery or abortion at our hospital were included. Demographic and clinical data were collected, including selected contraceptive method, LARC insertion and removal dates, and follow-up data for up to 36 months. Independent sample t-tests, Mann–Whitney U tests and chi-square tests were used as appropriated. The primary outcome was reported as frequency and percentages. Kaplan–Meier survival analysis assessed continuation rates, while logistic regression and Cox proportional hazards models identified factors associated with initiation and early discontinuation (defined as LARC removal before 3 years), respectively. Of 1,081 postpartum and post-abortion adolescents, 839 (77.6%) participants initiated LARC. Of these, 91.7% initiated LARC before hospital discharge. The most commonly chosen methods were the 2-rod levonorgestrel implant (44.2%) and the 1-rod etonogestrel implant (32.9%), while 0.6% chose the copper intrauterine device. Significant factors of LARC initiation included younger maternal age (adjusted odds ratio [aOR] 0.598; 95% CI: 0.518–0.691; p < 0.001), being employed (aOR 2.233; 95% CI: 1.050–4.751; p = 0.037), and younger partner age (aOR 0.966; 95% CI: 0.935–0.998; p = 0.035). The cumulative LARC continuation rates were 98.1% at 1 year, 93.0% at 2 years, and 79.7% at 3 years. The most commonly reasons for early removal were bleeding disturbances (40.7%), weight changes (18.5%) and desire for pregnancy (13.0%). Thailand’s health policy of free LARC access, combined with a tailored structured adolescent protocol, resulted in high LARC initiation and continuation rates, demonstrating the effectiveness of integrated clinical and policy interventions in reducing adolescent pregnancy. Teenage pregnancy is a major health and social issue in many countries, including Thailand. To help prevent repeated pregnancies in teenagers, the Thai government has made long-acting birth control methods available for free to adolescents. These methods are safe, effective and don’t require daily attention, making them a good option for teenagers. At our hospital, we created a special program to support teenagers after giving birth or having an abortion. This includes supportive counselling and access to free long-acting birth control methods before leaving the hospital. We found that most teenagers chose to use a long-acting birth control method, especially implants. Almost all of them had it inserted before leaving the hospital. Most continued using it for at least a year or longer. A few stopped early, mainly due to side effects or wanting to become pregnant again. Our study shows that when teenagers are given respectful counselling and easy access to long-acting birth control method, they are more likely to use it and avoid unplanned pregnancies.

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Related topics: Reproductive Health and Contraception · Adolescent Sexual and Reproductive Health · Global Maternal and Child Health