Contraception For Adolescents Research Articles

Long-acting contraception in adolescents and young women with type 1 and type 2 diabetes.

Adolescent pregnancy is a major public health problem worldwide. Adolescents living with diabetes are not aware of the risks of unplanned pregnancy and the high rate of fetal and maternal complications when gestation occurs in women with significant hyperglycemia. These data highlight the significance of pregnancy prevention in young women with diabetes. Long-acting reversible contraceptives (LARCs), which include subdermal progestin implants and hormonal and nonhormonal intrauterine devices (IUDs), have been recommended by the American College of Obstetricians Gynecologists and the American Academy of Pediatrics as a first-line contraceptive option for adolescents and young women. This article reviews LARC options for adolescents and young women with type 1 (T1D) and type 2 (T2D) diabetes as well as the possible complications and side effects.

Exploring factors constraining utilization of contraceptive services among adolescents in Southeast Nigeria: an application of the socio-ecological model

BackgroundHigh rate of teenage pregnancy in Nigeria is potentially an indication of poor access to and utilization of contraceptives among this age group. This paper presents findings from in-depth exploration of perceived barriers to utilization of contraceptive services by adolescents.MethodsA qualitative study was conducted in six communities in Ebonyi state, southeast Nigeria. Eighty-one in-depth interviews and six focus group discussions were conducted. Respondents comprised policy makers, community leaders, health service providers and parents of adolescents. Pre-tested interview guides were used to collect information on perceived barriers to utilization of contraceptive services by adolescents. All interviews were audio recorded and transcribed in English. Data was analysed using thematic framework approach, and the socio-ecological model was adapted for data synthesis.ResultsIndividual level factors that limit access to contraceptives for adolescents include lack of awareness and poor knowledge, fear of side effects, low self-esteem, and inability to afford cost of services. Interpersonal (family-related) barriers to access include poor parent-child communication of sexual and reproductive health matters and negative attitude of parents towards to sexuality education for adolescents. Health systems barriers to accessing contraceptives for adolescents include lack of privacy and confidentiality, stock-out of contraceptive commodities, judgmental attitude of health workers, insufficient staff that are skilled in adolescent sexual and reproductive health. Gendered cultural norms, societal shaming and religious intolerance also preclude adolescents from accessing and using contraceptive services. Wider societal factors such as negative peer and media influence, absence of sexuality education in schools, lack of social networks in communities; and macro level factors such as poor economic conditions were also perceived to limit access to contraceptives for adolescents.ConclusionUtilization of contraception is constrained by an interplay of factors acting at various levels. Addressing these barriers could contribute to improved access to contraceptive services for adolescents, as well as reduction in unwanted teenage pregnancy.

Levonorgestrel Intrauterine Device Use for Medical Indications in Nulliparous Adolescents and Young Adults

PurposeIntrauterine devices (IUDs) are highly effective at preventing pregnancy. Levonorgestrel (LNG) IUDs also have beneficial effects on menstrual bleeding and abdominal and pelvic pain. Although there are increasing data on use of IUDs for contraception in adolescents and for medical indications in adults, there are extremely limited data on LNG IUD use for medical indications in adolescents. Our objective is to describe the characteristics and experiences of LNG IUD use in nulliparous adolescents and young women using IUDs for medical indications. MethodsWe conducted a retrospective chart review of all nulliparous patients aged 22 years and younger who underwent LNG IUD insertion at a tertiary care children's hospital between July 1, 2004 and June 30, 2014 primarily for noncontraceptive indications. Descriptive statistical analysis was performed. ResultsWe identified 231 LNG IUDs placed in 219 nulliparous women for medical indications during this time period. Mean patient age was 16.8 years (±2.2). Only 41% reported ever being sexually active. IUD continuation rate at 1 year was 86%. The amenorrhea rate at 1 year was 51%. Approximately 80% of women reported improvements in menstrual bleeding and abdominal and pelvic pain. Side effects and complications were low. ConclusionsThis study provides evidence that LNG IUDs are effective, well-tolerated, and safe menstrual management options in young nulliparous women, including younger adolescents and those who have never been sexually active. This method is an excellent first-line therapy option for adolescents and young women for both contraceptive and noncontraceptive indications, regardless of age, parity, or sexual activity.

The use of levonorgestrel-releasing intrauterine devices in adolescents - own experience.

It is estimated that 19% of adolescents in Poland begin their sexual life when they are 15 years old and more than 50% of people aged 17-19 years have already had their first sexual contact. World Health Organization recommends teenagers to use the method of 'dual protection' (condom and other method of contraception, i.e. intrauterine devices). In this study, we sought to present our own experience in the field of the use of levonorgestrel-releasing intrauterine devices in adolescents and to compare it with the experience of other researchers worldwide. Low- dose levonorgestrel-releasing intrauterine device is safe and effective method of contraception in adolescents. It is also an alternative treatment used in heavy chronic abnormal uterine bleeding. It can be also used as an alternative in women with cyanotic heart disease who have contraindications for standard contraception. Gynecologists and pediatricians should be well informed in the topic of intrauterine device use among adolescents and they should provide them reliable knowledge in this field.

Openness of fathers and mothers toward adolescent contraception in Mexico: a case study from a socio-demographic perspective

Se analizan las actitudes de los padres y madres respecto de la sexualidad y la anticoncepción adolescente en México, mediante el caso de Tijuana, B.C. Se examinan los niveles de apertura de los padres de ambos sexos en favor de proporcionar información al respecto a los adolescentes de ambos sexos. Este es un estudio socio-demográfico y de tipo descriptivo basado en informa-ción de una encuesta a 2,547 padres y madres con hijos en escuelas secundarias públicas. Los resultados indican interesantes diferencias de género significativas, donde las madres presentan índices de apertura mayores que los padres. Otras variables significativas son la escolaridad y el tener antecedentes de maternidad adolescente en la historia reproductiva de las madres y de las esposas o compañeras de los padres varones.

Providing Long-acting Reversible Contraception to Adolescents: A Review.

Unintended teen pregnancy continues to be a problem in the United States which has the highest rate of adolescent pregnancy among developed nations. Long-acting reversible contraception (LARC) has much higher continuation rates compared with moderately effective reversible contraception; however, moderately effective reversible contraception is more commonly used by adolescents. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists recommend LARC as first-line contraception for adolescents. Clinicians providing contraception to adolescents should be knowledgeable of LARC indications, side effects, initiation guidelines, management of adverse reactions, and adolescent specific issues regarding LARC counseling, initiation, and continuation.

Prevention of birth defects in East Africa: A review of national policies

Close to 8 million children are born annually with a serious birth defect, accounting for 5% of all newborn deaths globally. Many birth defects are associated with folic acid insufficiency, non-communicable diseases (NCDs), teenage or advanced age pregnancies, short birth intervals, and exposure to harmful substances. The majority of countries with the highest birth defects prevalence are in Africa, and the East African Community has made important commitments to improving reproductive, child, and adolescent health and nutrition. The aim of this review was to identify the advances and gaps in national policies addressing birth defect risk factors in the East African Community (Burundi, Kenya, Rwanda, Tanzania, and Uganda) in order to inform additional actions. National laws, regulations and policies were reviewed from the East African Community countries related to grain fortification and supplementation with folic acid; reducing too-early, unwanted and rapid successive pregnancies; and addressing NCDs and exposure to tobacco. All five countries have adopted a policy of mandatory folic acid fortification of wheat and maize flour. However, only in Kenya and Tanzania, are the folic acid levels in line with international recommendations. And, only Uganda has a policy requiring folic acid supplementation administration in the preconceptional period. The East African Community countries have made efforts to reduce too-early, unwanted and rapid successive pregnancies. All countries have banned child marriage and three of five countries have introduced laws to allow unrestricted access to contraception for adolescents. With regards to promoting prevention and control of NCDs and reducing populations’ exposure, compliance with World Health Organization (WHO) guidelines is limited. Only two countries have developed multi-sectoral policies for NCDs and no countries comply fully with the recommendations of the Framework Convention on Tobacco Control. Much work remains in ensuring that opportunities for prevention of birth defects are fully realized in the East African Community countries. This review revealed that all countries in the East African Community have, to some extent, adopted policies that are conducive to reducing the risk of birth defects in the region, but significant gaps remain in some key areas of either policy development or implementation. Key words: Congenital abnormalities, Folic acid, Family planning services, Child marriage, Non-communicable Diseases

Current Issues and Options for Hormonal Contraception in Adolescents and Young Adult Women With Sickle Cell Disease: An Update for Health Care Professionals.

Women with sickle cell disease (SCD) are of particular concern regarding the significantly increased risk of pregnancy-related morbidity, mortality, and adverse outcomes. They have limited knowledge of pregnancy and childbirth risks, as well as of the benefits and risks of contraceptives. Thus, there is an urgent need for appropriate information about reproductive family planning to reduce unintended pregnancy. Any decision regarding the use of contraceptives has to be based on the efficacy and risk/benefit ratio of the method used. Both the World Health Organization (WHO) and the Centers for Disease Control (CDC) have developed, published, and updated evidence-based guidelines for medical providers for the use of contraceptives in patients with specific medical chronic conditions. This article provides an overview of the present knowledge on the use of contraceptives in women with SCD. We believe that the collaboration between health care professionals (hematologists, obstetricians, endocrinologists, and primary care providers) can play a major role in identifying the safer contraceptive method to abolish the risks of unintended pregnancy and preserve the health status of patients with SCD.

Birth control options for teenage girls

Considered a taboo subject a few years ago, contraception in adolescents represents one of the priorities of the healthcare system. Romania holds one of the first places in teenage pregnancies; correctly using contraception prevents unwanted pregnancy and sexually transmitted diseases (STD) in adolescents. Deciding on a method of contraception in an adolescent depends on several aspects, such as personal, cultural, social, economic factors, parity (previous unwanted pregnancies), frequency of sexual activity and the number of sexual partners, along with medical contraindications. Sex education should begin from school and high school and it will be addressed to all social categories and especially to ethnic minorities, because they have the highest number of pregnancies among adolescents aged between 12 and 14 years old. The systematic use of condoms, the free distribution in high-risk groups and sex education will result in a decreased risk of sexually transmitted diseases and unwanted pregnancies. Several recommendations include training staff in schools and high schools, providing adequate anonymous counseling, and developing family planning centers. Oral contraceptive pills (OCPs) are the first choice of contraception among adolescents, while IUDs (intrauterine devices) can be used for adolescents with certain indications. Overall, contraception in adolescents has its peculiarities that need to be well known for choosing an appropriate contraceptive method.

Venous Cerebral Infarction Caused by Intake of Hormonal Contraceptives in Adolescents with Congenital Thrombophilia

In recent years, an increase in dysmenorrhea among adolescents has been observed worldwide. Oral contraceptives are used in gynaecological practice to correct this condition. However, the prescription of drugs belonging to this group often misses the risk of developing vascular complications, such as cerebral venous thrombosis and cerebral venous infarction. Due to the growing percentage of patients with congenital genetic mutations, it is relevant and reasonable to consider the risk factors and clinical signs of venous infarction in adolescents. First, it is necessary to exclude congenital thrombophilia, factor V Leiden and prothrombin G20210A gene mutations, and deficiency of proteins C, S and antithrombin. Of particular notice are the young patients and adolescents with complaints of a first-time, intense, poorly treatable headache (or headache in anamnesis), changes in the eye fundus (edematous, hyperemic optic disks; dilated, plethoric veins in the fundus of the eye). In such cases, a thorough medical history is extremely important, including, in particular, detection of an infectious process, traumatic brain injury, venous thrombosis of any localization; the use of drugs (especially hormonal ones) that can provoke the development of a hypercoagulable state; and investigation of the family history. These measures will help to prevent development of a cerebral venous circulation disorder (venous infarction).

Long-acting reversible contraceptives for adolescent females: a review of current best practices.

This review will address the need for adolescent contraception, compare the benefits of long-acting reversible contraceptives (LARC) with non-LARC methods, discuss unique barriers to LARC for adolescents, and provide physicians with latest recommendations for counseling adolescents on contraception. The United States has the highest adolescent birth rate of any developed country at 18.8 births per 1000 females aged 15-19 years. This rate is more than double the rate in France (9/1000) and Spain (9/1000), and nearly 1.6× the rate in the United Kingdom (12/1000). As the most effective and user-independent methods of contraception, LARC have the potential to notably lower the adolescent birth rate. However, despite higher rates of patient satisfaction and continuation with LARC, adolescent LARC usage remains low. Just 4.3% of all American females aged 15-19 years who reported using some form of contraception between 2006 and 2010 used an intrauterine device (IUD) or subdermal implant, compared with 96% who used the male condom and 56% who used the oral contraceptive pill (OCP). Barriers to adolescent LARC usage include patient and provider misinformation, high upfront costs, and issues of confidentiality and consent. LARC methods are recommended by most reproductive and adolescent healthcare organizations as the most effective contraceptive options for adolescent females. Pediatricians should provide their adolescent patients with up-to-date information on all options for contraception, including risks and benefits. It is important for them to remove their own personal biases when counseling patients and work to reduce barriers to LARC for adolescent females.

Cost Minimization Analysis of Same-Day Long-Acting Reversible Contraception for Adolescents

Long-acting reversible contraception (LARC) is considered first-line contraception for adolescents but often requires multiple clinic visits to obtain. To analyze Indiana Medicaid's cost savings associated with providing adolescents with same-day access to LARC. An economic evaluation of cost minimization from the payer's (Medicaid) perspective was performed from August 2017 through August 2018. The cost model examined the anticipated outcome of providing LARC at the first visit compared with requiring a second visit for placement. The costs and probabilities of clinic visits, devices, device insertions and removals, unintended pregnancy, and births, according to previously published sources, were incorporated into the model. The participants were payers (Medicaid). The outcomes were the cost of same-day LARC placement vs LARC placement at a subsequent visit in US dollars, and rates of unintended pregnancy and abortion. One-way sensitivity analysis was done. Same-day LARC placement was associated with lower overall costs ($2016 per patient over 1 year) compared with LARC placement at a subsequent visit ($4133 per patient over 1 year). Compared with the return-visit strategy, same-day LARC was associated with an unintended pregnancy rate of 14% vs 48% and an abortion rate of 4% vs 14%. Providing same-day LARC could save costs for Medicaid, largely by preventing unintended pregnancy. Expected cost savings could be used to implement policies that make this strategy feasible in all clinical settings.

Follow-Up Care and 6-Month Continuation Rates for Long-Acting Reversible Contraceptives in Adolescents and Young Adults: A Retrospective Chart Review.

Describe follow-up care patterns and continuation rates during the first 6months after initiating a long-acting reversible contraceptive (LARC) device among adolescent and young adult women. Retrospective chart review among patients who had an intrauterine device (IUD) or subdermal implant placed between January 2015 and December2016. Urban adolescent specialty care clinic. Women ages 13-23years. Follow-up encounters were defined as scheduled and unscheduled phone calls, outpatient clinic visits, or emergency department visits during the 6months after device placement. Continuation was defined as not having the device removed or expelled during the 6months after initiation. Frequencies were calculated, and logistic regression was used to determine predictors of follow-up encounters and continuation. Among the 177 patients, 180 LARC devices were placed. Most were 13-17years of age (56%), non-Hispanic black (64%), publicly insured (57%), and had an IUD placed (57%). Most (86%) had 1 or more clinical encounters during the 6months: 70% attended a scheduled encounter and 53% had an unscheduled encounter. Approximately half (45%) attended the scheduled 2-week office visit; only 6% attended the 6-month office visit. The 6-month LARC continuation rate was 92% (n=166), with most discontinuations among IUD users (n=12; 7%). LARC continuation rates were high in our study population. Most adolescent and young adult women have at least 1 follow-up encounter in the 6months after LARC placement. Clinical practices should be prepared to address issues that arise during follow-up encounters, whether in person or by phone.

Accessibility of emergency contraception for adolescents in Quebec community pharmacies.

Access to effective contraceptives, including emergency contraception (EC), is critical to reducing unintended adolescent pregnancy. This study evaluates the accessibility of Ln-EC (levonorgestrel EC) for adolescents in Quebec community pharmacies. We conducted an anonymous self-administered electronic survey of Quebec community pharmacists between June 1, 2016 and October 31, 2016. Pharmacists were asked about the availability of Ln-EC in their pharmacy, whether they prescribed Ln-EC, and their experience with adolescents who requested Ln-EC. Five hundred and ninety-one pharmacists responded, with representation from across the province. Ninety-five per cent had Ln-EC in stock. Most pharmacists (90%) reported being comfortable prescribing Ln-EC, though they were less comfortable prescribing to adolescents than to adults (*P<0.001). Pharmacists also reported that cost and confidentiality are barriers to accessing Ln-EC for some adolescents. This study indicates that availability and pharmacist comfort are not likely to be barriers to Ln-EC use for adolescents. On the other hand, cost and/or confidentiality do represent a barrier for some adolescents. This study lays the groundwork for a national study examining the accessibility of EC for adolescents.

Contraception for Adolescents: Knowledge and Practices in Portugal

Adolescents are a target group for reproductive health intervention. Family physicians, gynecologists and pediatricians are the main providers of contraceptive counseling. Correlational, cross-sectional study, approved by the ethics committee of Leiria Hospital, Portugal. Data was collected through a validated online questionnaire (Cronbach's alpha and Exploratory Factorial Analysis) using a semantic differential scale (1 - Totally Agree; 5 - Totally Disagree). Higher scores were indicative of greater knowledge or suitability concerning the matter in question. Results were compared by gender, specialty, years of career and rank: consultant or resident. We received 338 responses (51% family physicians, 29% pediatricians, 20% gynecologists), 66% were specialists, 36% had been working for less than 5 years and 17% for more than 20 years. Awareness of national recommendations was higher in gynecologists [4.38 (1.09)] and in the female gender [3.65 (1.41)] with statistically significant differences. Gynecologists had more recent training [3.79 (1.42)] and considered themselves to be up-to-date [4.41 (0.70)], p < 0.001. The questionnaire showed reliability and validity. Gynecologists were more familiarized with adolescent contraception; pediatricians and young clinicians highlighted the need for an update on this matter. Gynecologists had more training and considered themselves up-to-date, so training in this area seems to have a positive impact. Knowledge about contraceptive counseling is not yet sufficient, so it is very important to invest in the continuous medical education of clinicians.

91. ASSESSING PEDIATRIC RESIDENT READINESS TO SCREEN MOTHERS OF YOUNG CHILDREN FOR FAMILY PLANNING NEEDS

Background The postpartum period is a high risk period for unintended pregnancies which can be associated with negative outcomes for mother and infant. Effective contraception is important during this time and thus the AAP advises pediatricians to ask mothers about family planning by the two-month visit. Previous work has shown family planning screening can be implemented in a pediatric resident clinic, with residents providing referrals to needed services. Objective To assess resident knowledge, attitudes and confidence around discussing family planning with mothers of their young patients. Methods Anonymous surveys were administered to pediatric residents in an inner city pediatric residency program. Group comparisons were made using Fisher's exact test and chi-square test. Results 39 residents completed the survey for a response rate of 65%. 39% of respondents were in their 1st year of residency, 36% were in the 2nd year, and 25% were in their 3rd year or higher. More than half (55%) of respondents felt knowledgeable or very knowledgeable about guidelines around providing contraceptive care for adolescents. These residents were more likely to be farther along in residency (p=0.04) and to correctly identify first line contraception for adolescents (p=0.006). Respondents who felt knowledgeable about providing contraceptive care for adolescents were more likely to feel confident speaking with mothers about their contraceptive needs (p Conclusions While most residents surveyed were not aware of guidelines recommending screening mothers of young children for family planning needs, they felt pediatricians have a role in such discussions. These data highlight resident willingness to screen mothers of infants for family planning needs and the opportunity to build on their current knowledge and practices.

Availability of Long Acting Reversible Contraceptives for Adolescents in Urban vs Rural West Virginia Counties

The study objective was to evaluate long acting reversible contraceptive (LARC) method availability and access for adolescents in rural and urban counties in West Virginia (WV). A cross-sectional survey of Title X family planning providers throughout WV was conducted from January 2016-July 2017. This survey was sent to 226 family planning providers in WV to assess patterns of LARC availability. The survey assessed provider training level, LARC services provided and frequency, clinical practice, referral patterns, and comfort level providing adolescent LARC services. Survey results were analyzed by providers’ rural vs urban status, based on US census county codes. Survey responses yielded 127 total responders, 65 (51.2%) were urban, and the remaining 62 (48.8%), were rural. Urban providers had a larger representation of medical doctors, while rural providers were primarily nurse practitioners (p

Access to contraceptives for adolescents in northern Nigeria – a cross-sectional study from three secondary health facilities in Kaduna metropolis, Kaduna

Background: In 2015, the United Nations Development Programme (UNDP) noted that countries will need to meet the increasing demand for contraceptives by the over 600 million 15- to 19-year-olds around the world. Although the unmet need for contraception for Women of Child Bearing Age (WCBA) in Nigeria is 12.7%, the value is higher (35.3%) among adolescents aged 15 – 19 years. Additionally, the unmet need for family planning (FP) among WCBA in Kaduna state is 5.8%, with 33.3% of women aged 20-24 years in Kaduna reported to have had a live birth before the age of 18 years. This study sought to evaluate adolescent contraceptive use in three referral health facilities of Kaduna metropolis. Methods: This is a descriptive cross-sectional desk review of 5543 FP clients that attended three referral centers between 2014 and 2016. Data on their age, parity and the use of contraceptives were collected from the clinic registers and analyzed using SPSS 22. Results: The FP client age ranged from 12 to 57 years, of which only 3.6% were adolescent. The annual proportion of adolescent contraceptive users ranged from 3.1 – 4.1%. More than 96% of the adolescents had given birth to at least one child. Around 62% of the adolescents used injectable contraceptives but there was no IUD use reported by any adolescent. Conclusions: The low proportion of adolescent contraceptive users and their limited choice of contraceptive methods, emanating from multiplicity of client and provider bias, calls for innovative interventions to meet the contraceptive needs of adolescents.

Adolescent Contraception in the Emergency Department: Abnormal Uterine Bleeding and Beyond

The emergency department (ED) is a frequent and important site for gynecologic care, and many women present to the ED for reproductive health concerns such as abnormal menses. Due to early menstrual age and increased incidence of sexually transmitted infections, adolescents are particularly prone to abnormal menses, but are also disproportionately affected by unintended pregnancy. While EDs have long been used for the evaluation and initial management of abnormal uterine bleeding, general contraceptive provision in the ED is a novel approach to addressing unmet contraceptive needs among adolescent women. We review normal menstruation and the evaluation and management of abnormal uterine bleeding in adolescents, including the use of combined oral contraceptives. Expanding on this established indication for contraceptive use in the ED, we present attitudes, barriers, and approaches to ED provision of contraceptives for adolescent pregnancy prevention.

Adolescent demand for contraception and family planning services in low- and middle-income countries: A systematic review

ABSTRACTAn estimated 23 million adolescent girls age 15–19 in low- and middle-income countries (LMICs) have an unmet need for contraception. Despite the recognised importance of expanding access to appropriate methods of contraceptives for adolescents in LMICs, the evidence base on their total demand for contraception is limited, and there is no consensus on how to measure this important phenomenon. The aim of this study was to review the published literature in order to better understand the level of adolescent demand for contraception in LMICs and to explore what demand-related indicators are being measured. A total of 1375 articles were identified and 18 met the inclusion criteria. Included studies reported findings from 29 LMICs, revealing high adolescent demand for contraception. The demand for contraception among adolescents and young women ranged from 22% among married adolescents in Azerbaijan to 98% in Peru. However, measures of this phenomenon were limited, with most studies only reporting current contraceptive use or unmet need. Most studies relied on cross-sectional data, and young, unmarried, and male adolescents were largely excluded. We make several recommendations for alternative approaches for a more comprehensive understanding of adolescent demand for contraception in LMICs.