Abstract
Objective To determine methods of contraception used by adolescents before and after pregnancy. Methods A cross-sectional study was performed, and data were collected from medical records of all teens in puerperal consultation at the Hospital da Mulher - José Aristodemo Pinotti (Caism), Universidade Estadual de Campinas (CAISM), São Paulo, Brazil, between July 2011 and September 2013. The inclusion criterion was being 10 to 19 years old, and the exclusion criterion was having a first consultation 90 days after childbirth. Statistical analyses were performed with averages, standard deviations, percentages, correlations and Fisher's exact tests using the SAS program, version 9.4. Results A total of 196 adolescents in postpartum consultation were included (44 days after childbirth on average). The majority was older than 14 years (89%), with an average age of 16.2 years, and the most were exclusively breast-feeding (70%). Before pregnancy, the use of any contraceptive methods was mentioned by 74% adolescents; the most frequent use was combined oral contraceptive followed by condom. The main reason for abandoning the use of contraception was the occurrence of an unintended pregnancy (41%), followed by reports of side effects (22%), behavior issues (18%) and desire for pregnancy (16%). A positive correlation was found between the age of the adolescent at the moment of childbirth, the age of menarche (r = 0.3), and the first sexual intercourse (r = 0.419). Vaginal delivery occurred in 76% of the cases. After birth, depot medroxyprogesterone acetate (DMPA) was the contraception method most frequently used (71%), followed by oral contraceptives (11.8%) and intrauterine devices (IUDs, 11.2%). Conclusions The most prescribed contraceptive method before pregnancy in adolescents who had childbirth was combined oral contraceptives. Many of the study participants had an unintended pregnancy. After childbirth, the most used contraceptive method was DMPA. To improve contraception and reduce the chance of unintended pregnancies among adolescents, we should promote the use of long-acting reversible contraceptives (LARCS).
Highlights
About 16 million girls aged 15 to 19, and around 1 million girls under 15, give birth every year in the world
Contraception before pregnancy was used by 74% of these adolescents
Among adolescents with two or more deliveries, 57% reported the use of COCs, and 22% used depot medroxyprogesterone acetate (DMPA)
Summary
About 16 million girls aged 15 to 19, and around 1 million girls under 15, give birth every year in the world. More than 13% of adolescents have used emergency contraception, and 15% have used periodic abstinence.[4] Frequent follow-up is important to maximize adherence for all methods of contraception, and to promote and reinforce healthy decision-making.[5,6] regularly scheduled contraceptive follow-up visits should address use, adherence, adverse effects, and complications.[5,6] An opportune time to introduce or to talk about contraceptive methods with adolescents is the postpartum period. The aim of this study was to determine which methods of contraception are used before and after pregnancy among adolescents who have had children
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