Context: Even in intensive, adolescent-oriented programs, in which access to highly effective contraceptives is guaranteed, repeat adolescent pregnancies commonly occur.
Methods: To assess whether adoption of the contraceptive implant would lower the rate of repeat pregnancy, contraceptive use and pregnancy outcomes were tracked among 309 adolescent mothers--171 "early" implant users who began use within six months of delivery and 138 who either adopted another method or had used no method. Participants were interviewed at delivery and at six-month intervals through the second year postpartum. Multivariate logistic regression analyses were conducted to ascertain the likelihood of a repeat pregnancy within the first and second year postpartum.
Results: During the first year postpartum, although 7% of the early implant users had their implants removed, pregnancy rates were significantly (p < .0001) lower among early implant users (less than 1%) than among the other adolescent mothers in the sample (20%). By the end of the second year postpartum, 37% of early implant users had discontinued use. Nevertheless, their two-year pregnancy rate (12%) remained significantly lower (p < .0001) than that of the other adolescent mothers (46%). The multivariate analysis showed that early implant use was the only independent predictor of a repeat pregnancy within the first year postpartum, while early use, parity and number of risk factors for repeat pregnancy were independently associated with the likelihood of another pregnancy in the second year postpartum.
Conclusions: Although early implant insertion significantly decreased the rate of rapid, repeat adolescent pregnancies, the rates of removal and of pregnancy by the end of the second year postpartum were high. Thus, health care providers need to address the motivational components of adolescent pregnancy even among those who accept ostensibly long-term methods.
PIP: More widespread use by US adolescents of contraceptive implants could reduce the number of repeat adolescent pregnancies--a common problem even when adolescent mothers participate in comprehensive, multidisciplinary programs aimed at eliminating barriers to contraceptive use. The impact of such a strategy was assessed in a 2-year prospective study of 309 adolescent mothers enrolled in the Colorado (US) Adolescent Maternity Program in 1992-93. 171 of these young mothers began implant use within 6 months of delivery; the remaining 138 adopted another method or used no method. Implant acceptors were significantly more likely than women in the second group to have experienced side effects with past methods (63% vs. 51%) and significantly less likely to be Black (23% vs. 33%), to be giving birth for the first time (79% vs. 91%), or to want another child within 2 years (1% vs. 6%). During the first postpartum year, 12 of the implant users (7%) discontinued the method. There was only 1 pregnancy (0.6%) in this group (a discontinuer) compared with 26 pregnancies (20%) among users of other methods or nonusers. During the second postpartum year, an additional 48 (30%) of the 161 early implant users for whom data were available discontinued method use. Nonetheless, the 2-year pregnancy rate remained significantly lower among implant users (20 women, 12%) than in the other group (57 women, 46%) (p 0.001). In the multivariate analysis, early implant use was the only independent predictor of repeat pregnancy in the first postpartum year, while implant use, parity, and number of psychosocial and demographic risk factors were significant in the second postpartum year. These findings point to the importance of addressing the motivational components of repeat adolescent pregnancy, even among acceptors of ostensibly long-term methods.