Molly Richards

Adolescents: Their Futures and Their Contraceptive Decisions.

PURPOSE Pregnancy prevention counseling addresses future goals as a motivator for contraceptive use, but this is often unsuccessful. This study investigated how adolescent females define success and whether they believe teen childbearing will be a barrier to their success. METHODS A racially and ethnically diverse group of 84 nulliparous, high-risk adolescent females in teen clinics completed a survey asking about how they define success, future plans, and barriers to their success and future plans. RESULTS Most respondents defined a successful person as one who has a higher education (73%) and/or a good job (73%). Most saw themselves finishing high school (70%), in college (62%), or working at a job (75%) in 3-5 years. Participants who left with a prescription contraceptive method were not more likely to feel that education/career were important for success. Most reported that having a child would have no (52%) or a positive effect (30%) on their education. The majority felt childbearing would have a negative impact on many aspects of their life. But feeling their finances would be negatively affected was the only predictor of obtaining contraception. CONCLUSIONS We found that high-risk adolescents did not differ in conventional goals and aspirations regardless of their contraceptive choice. Although most girls felt that education/career was important, many of them felt that childbearing would not be a barrier to or may even improve their educational attainment. This challenges counseling that uses conventional goals as a motivator to remain non-pregnant. Further study of novel motivators for contraceptive use is needed.

Risk of luteal phase pregnancy with any-cycle-day initiation of subdermal contraceptive implants

OBJECTIVES To determine rates of luteal phase pregnancy (LPP) in young women initiating subdermal implants on any day of the menstrual cycle. STUDY DESIGN We assessed a retrospective cohort of young women receiving contraceptive implants at an adolescent Title-X clinic. Patients with negative pregnancy tests were eligible for same-day insertion, regardless of cycle day, contraceptive use, or last intercourse. We computed LPP rates for those within manufacturer guidelines for insertion (≤5 days of menstrual onset or ≤7 days post-discontinuing hormonal contraception) and outside these guidelines. We reviewed medical records for last menstrual period (LMP), current hormonal contraception, emergency contraception (EC) provision, and pregnancy tests ≤12 weeks post-implant placement, or later evidence of pregnancy. For patients with positive pregnancy tests or reports, we used standard obstetrical dating (LMP and ultrasound) to determine if conception occurred ±2 weeks of implant placement. RESULTS Of 3180 insertions, 1868 (58.8%) were outside recommended guidelines. Women with insertions within-guidelines were older (20.2 vs. 19.3 years; p<0.001) and more likely to be white (40.4% vs. 29.5%; OR=1.6, 95% CI: 1.4-1.9). Definitive pregnancy data was documented for 1726 patients: 660 (50.3%) in the within guidelines group, and 1066 (57.0%) in the outside guidelines group. Rates of LPP were 0.3% (2/660; 95% CI=0.0-1.1%) in the within guidelines group and 0.9% (10/1066; 95% CI=0.5-1.7%) in the outside guidelines group. CONCLUSION The risk of LPP following any-cycle-day insertion of contraceptive implants with negative pregnancy testing is low, regardless of menstrual cycle timing, recent contraceptive use or use of EC. IMPLICATIONS Adopting a protocol of contraceptive implant placement that includes insertion on any cycle day with a negative pregnancy test, and EC as indicated, does not increase the risk of luteal phase pregnancies, even in a young population with complex reproductive behaviors and challenging historical narratives.

Update on Adolescent Contraception

ly and plan for the future. Providers can have more in-depth conversations about healthy and safe relationships, STI prevention and screening, intentions for child bearing, and the importance of contraception in meeting their