Contraception For Adolescents Research Articles

Characteristics of parents who think intrauterine devices or contraceptive implants are “best” for their daughter: An exploratory analysis in Dallas, Texas

ObjectiveTo explore characteristics of parents who prefer an intrauterine device (IUD) or implant compared to all other contraceptive methods. Study designParents with an adolescent daughter completed a cross-sectional survey. The outcome evaluated the parent’s perceived “best” contraceptive method for their daughter using bivariate statistics and multivariable modeling. ResultsOf 115 parents, parental willingness to use IUD or implant themselves (p = 0.014) and thinking IUD or implant is best at preventing pregnancy (p = 0.001) remained positively associated with parents thinking IUD or implant is the “best” contraceptive method for their daughter. ConclusionsClinicians can consider integrating parents’ personal experiences with IUD or implant during adolescent contraception counseling. ImplicationsCaregivers’ personal contraceptive knowledge and personal willingness to use LARC influences their preferences for their daughter’s contraception. Clinicians can assess and integrate caregivers’ perspectives during adolescent contraception counseling.

Adolescent Contraception Management: A Review of Medical Options

Disparity in access to family planning and contraceptive services remains disproportional within underserved communities. The United States ranks highest among developed countries for rates of adolescent unplanned pregnancies. This coupled with legal implications including confidentiality further contribute to a lack of access to medically appropriate, safe, and reversible contraceptive options. The nurse practitioner is a key partner in the implementation of the evidence-based recommendations by the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics. This article reviews medical options for the management of adolescent contraception.

Long-Acting Reversible Contraception for Adolescents: A Review of Practices to Support Better Communication, Counseling, and Adherence.

Long-acting reversible contraception (LARC) methods, including levonorgestrel and copper intrauterine devices (IUDs) and the subdermal contraceptive implant, are the most effective reversible forms of contraception and thus are an important aspect of adolescent pregnancy prevention. While LARC efficacy, safety, and appropriateness are supported by major medical organizations and usage rates are increasing, overall LARC uptake among United States (US) adolescents remains lower than uptake of short-acting contraceptive methods. A better understanding of the barriers affecting adolescent LARC uptake and reasons for discontinuation could help facilitate effective communication. For example, learning how to improve adolescent-centered communication, shared decision-making, and motivational counseling strategies may be the first step to improving utilization rates. This narrative review includes three sections. First, this review will describe the history, mechanisms of action, and epidemiology of adolescent LARC use in the US and globally. Next, this review will describe key factors influencing adolescent LARC uptake, reasons for discontinuation, and multilevel barriers specific to adolescent LARC use. Finally, this review will characterize communication techniques and LARC counseling strategies for adolescents in the context of a reproductive justice approach set in the health belief model framework. The distinction between moving away from a presumptive counseling approach towards an adolescent-centered, shared decision-making approach to encourage parent-adolescent sexual health communication to lay the foundation of empowering adolescent reproductive autonomy should be the underpinning of all effective reproductive communication strategies.

83. Long-acting Reversible Contraception in Gender Diverse Adolescents and Young Adults: Outcomes from a Multi-site Collaborative

83. Long-acting Reversible Contraception in Gender Diverse Adolescents and Young Adults: Outcomes from a Multi-site Collaborative

Long-Term Reversible Contraception in Adolescence: The Reality of a Tertiary Pediatric Hospital in Portugal

Contraception in adolescence is essential to prevent unwanted pregnancies, abortion and sexually transmitted diseases. The use of longacting reversible contraceptive methods (LARCs) has been highly recommended due to their efficacy since they are user independent methods. The aim of this study was to evaluate the use of LARCs in adolescence in the population of a Childhood and Adolescence Gynecology clinic, and to describe the sociodemographic characteristics of the adolescents as well as previous contraceptive practices. Retrospective analysis that included adolescents using LARCs, monitored in a Childhood and Adolescence Gynecology clinic of a Portuguese tertiary pediatric hospital, between June 2012 and June 2021. A total of 122 adolescents were included, with a median age of 16 (11 - 18) years and 62.3% (n = 76) were sexually active. The preferred method was the subcutaneous implant, placed in 82.3% (n = 101), followed by the Levonorgestrel-Intrauterine System in 16.4% (n = 20) and the copper intrauterine device in 1.3% (n = 1). The main indications for LARCs were contraceptive needs 90.2% (n = 110), abnormal uterine bleeding during puberty in 14.8% (n = 18), dysmenorrhea in 10.7% (n = 13) and need for amenorrhea in 0.8% (n = 1). The median time of implant use was 20 (1 - 48) months and of the LNG-IUS it was 20 (1 - 36) months. The 12-month adherence rate for both was 76.2% (n = 93). The removal rate for reasons besides the expiration date was 9.8% (n = 12) in adolescents who had implants, and no LNG-IUS or copper intrauterine devices were removed. There were no pregnancies after insertion of LARCs. Contraceptive needs were the main reason for choosing LARCs, followed by abnormal uterine bleeding during puberty management and dysmenorrhea. All these factors may contribute to the high rate of satisfaction and continuity of these methods.

Identifying the gaps: Knowledge, attitudes and practices of urban-based healthcare providers towards adolescent contraception in Jamaica

Abstract Objective Health care providers (HCPs) may serve as facilitators or barriers to access. We explore the knowledge, attitudes and practices of HCPs in Jamaica to identify gaps which may lead to unmet contraceptive needs for adolescents. Methods A cross-sectional study design was utilized to collect data from urban-based HCPs through a self-administered questionnaire regarding knowledge of, attitudes towards and practices in adolescent contraception. Summative knowledge and attitude scores were generated. Descriptive and inferential statistical analyses were performed. Results One hundred and forty-four HCPs participated with a female predominance (n=127; 88.2%) and median (IQR) age of 36 (20) years old. HCPs mean (SD) knowledge score 1.95 (0.81) negatively correlated with age (r= -0.279; p<0.01) and length of time working as an HCP (r= -0.287; p<0.01). Pharmacy staff had lowest mean (SD) scores, 13.4 (4.48); p<0.05. Mean attitude score did not differ significantly by marital status or religion. As HCPs’ length of time in practice increased there was a decrease in the attitude scores (β= -0.380; p<0.05). Conclusion There is need for capacity-building of HCPs to deliver active contraceptive counselling and provide modern, effective, evidence-based contraceptive services to adolescents in Jamaica. Review and revision of guidelines, policies and laws governing delivery of sexual and reproductive health services is recommended. Key words: adolescents, contraception, providers, Latin America and the Caribbean

How do conversations on social media help to explain financial barriers to family planning services for Rwandan adolescent girls within the prevailing cultural and legal context?

PurposeFinancial barriers to health services have been identified in African countries. Rwanda has a pro-poor, countrywide insurance scheme that includes a package of family planning services. However, there is lower utilisation by adolescents. This qualitative study explored conversations on social media platforms around financial barriers to family planning in Rwanda, particularly for adolescents. The study's objective was to provide direction to policy revisions to improve access to contraceptives for adolescents. MethodsA search string was used to capture conversations on social media around financing barriers to family planning services for adolescents. Key themes were identified through analysis of the content of these messages. The themes were compared with existing literature on this topic. ResultsThere is a paucity of direct postings on public sites by adolescents, reflecting social stigma related to teenage sexual activity and lack of inter-generational dialogue on this subject. Key themes identified from the conversations were: prohibitive prices for socially acceptable contraceptives in the private sector, social stigma affecting access to affordable publicly available services and backfiring of well-intentioned laws and policies. ConclusionThe financial barriers to contraceptives by adolescents are compounded by legal frameworks, social and cultural factors and the intersection between them. The ‘relationship’ between the conversations captured on social media and socio-cultural and legal context is recursive. Careful consideration to both policies and interventions is required to increase access to contraceptives for adolescents.

Caregivers of youth in foster care in Texas and their role in contraception decision-making for adolescents in care

ObjectivesThis study describes the perspectives of caregivers of youth in foster care in Texas about the caregiver’s role in adolescent contraception decision-making for adolescents in their care, particularly for long-acting reversible contraception. The study also explores how providers and foster care agencies can better support pregnancy prevention for youth in care. Study designResearchers recruited 18 caregivers of youth in care from an academic center in Texas to complete in-person, one-on-one, semistructured interviews from August to December 2019. Two independent coders identified the main concepts with thematic analysis; discrepancies were resolved by consensus. ResultsMost caregivers identified as female (88%), Black (59%), and ranged in age from 30 to 69 years old. Half (47%) reported previously caring for an adolescent who was pregnant or parenting. Themes from the interviews included the importance of building relationships before contraception conversations, the balance between adolescent autonomy and strict caregiver oversight in contraceptive decision-making, variation in beliefs about contraception for youth in care, and extreme reactions to long-acting reversible contraception in both directions. Providers and foster care agencies played an important role managing confidential expectations and providing resources or trainings about contraception. ConclusionsIn a region of the country with high rates of adolescent pregnancy, strategies that empower adolescent autonomy allow delicate caregiver oversight, provide comprehensive information about all contraceptive options, and respond to extreme long-acting reversible contraception reactions and trainings that focus on the context of contraception that should inform communication-based interventions to address teen pregnancy prevention among youth in care. ImplicationsFew studies address the experiences of caregivers of adolescents in foster care. This study highlights a range of caregiver attitudes about contraception for adolescents in care. Provider training regarding contraception should include strategies to manage caregiver beliefs and extreme reactions to contraception use among youth in care.

125. Long-acting Reversible Contraception in Gender Diverse Adolescents and Young Adults: Outcomes from a Multi-site Collaborative

125. Long-acting Reversible Contraception in Gender Diverse Adolescents and Young Adults: Outcomes from a Multi-site Collaborative

Pharmacoepidemiological Analysis of Oral Contraceptive Use in Adolescents in a German Longitudinal Cohort Study.

To assess the use of oral contraceptives (OC) in adolescents, using data from a longitudinal, population-based pediatric cohort study (LIFE Child). We also investigated associations between OC use and socioeconomic status (SES), and associations between OC use and potential adverse drug reactions such as effects on blood pressure. We included 609 female participants of the LIFE Child cohort, aged ≥13 to <21 years, who visited the study center between 2012 and 2019. Data collection compromised drug use in the past 14 days, SES, and anthropometric data such as blood pressure. An analysis of covariance was used to detect potential associations between participants' blood pressure and OC. Multivariate binary logistic regression was used to obtain odds ratios (aOR) adjusted for age and 95% confidence intervals (95% CI). The prevalence of OC use was 25.8%. OC intake was less common in participants with a high SES (aOR 0.30, 95% CI 0.15, 0.62). The mean age at OC initiation did not change between 2012 and 2019. We observed an increased use of second-generation OC (2013: 17.9%, 2019: 48.5%; p = 0.013) and a decreased use of fourth-generation OC (2013: 71.8%, 2019: 45.5%; p = 0.027). We found a higher systolic (mean: 111.74 mmHg, p < 0.001) and diastolic (69.15 mmHg, p = 0.004) blood pressure in OC users compared to non-users (systolic: 108.60 mmHg; diastolic: 67.24 mmHg). Every fourth adolescent took an OC. The share of second-generation OC increased during the study period. OC intake was associated with low SES. OC users had a slightly higher blood pressure than non-users.

What are the sources of contraceptives for married and unmarried adolescents: Health services or friends? Analysis of 59 low- and middle-income countries.

Despite the efforts to promote universal coverage for family planning, inequalities are still high in several countries. Our aim was to identify which sources of contraceptives women mostly rely on in low- and middle-income countries (LMICs). We also explored the different sources according to age and marital status. We used data from national health surveys carried out in 59 LMICs since 2010. Among all sexually active women at reproductive age, we explored inequalities in demand for family planning satisfied by modern methods (mDFPS) and in the source of modern contraceptives according to women's age, classified as: 15-19, 20-34, or 35-49 years of age. Among adolescents, mDFPS and source of method were explored by marital status, classified as married or in union and not married nor in a union. mDFPS was lower among adolescents than among adult women in 28 of the 59 countries. The lowest levels of mDFPS among adolescents were identified in Albania (6.1%) and Chad (8.2%). According to adolescents' marital status, the pattern of inequalities in mDFPS varied widely between regions, with married and unmarried adolescents showing similar levels of coverage in Latin America and the Caribbean, higher coverage among unmarried adolescents in Africa, and lower coverage among unmarried adolescents in Asia. Public and private health services were the main sources, with a lower share of the public sector among adolescents in almost all countries. The proportion of adolescents who obtained their contraceptives in the public sector was lower among unmarried girls than married ones in 31 of the 38 countries with data. Friends or relatives were a more significant source of contraceptives among unmarried compared to married adolescents in all regions. Our findings indicate lower levels of mDFPS and lower use of the public sector by adolescents, especially unmarried girls. More attention is needed to provide high-quality and affordable family planning services for adolescents, especially for those who are not married.

Contraception in Adolescents and Women with Disabilities

Contraception in Adolescents and Women with Disabilities Abstract. Around 1.8 million people with disabilities live in Switzerland, it affects every sixth adult person, every twentieth severely. Nevertheless, there is only little literature about sexuality and contraception in disabled people, it's rarely a topic in medical education and junior doctors are often untrained to deal with the special needs and risks in disabled patients. This article describes in five different cases the complex situations and different options of contraceptive counselling with regard to medical indications and contraindications, questions of hygiene and non-contraceptive benefit of hormonal therapies, but also ethical and legal issues are discussed. This article is intended to contribute to the improvement of the medical care of women with disabilities.

“She is courageous because she does not care what people think about her…”: attitudes toward adolescent contraception use among Rwandan family planning providers and adult female modern contraceptive users

IntroductionIn Rwanda, only 20% of sexually active unmarried young women use family planning as compared to 64% of married women. Adolescence is an important time of growth and development that often includes the initiation of sexual activity. Sexually active adolescents need support in accessing contraceptive services to prevent negative health outcomes. In sub-Saharan Africa, the adolescent population represents a large share of the total population and that proportion is predicted to expand over time. Adolescent contraceptive needs have largely been unmet, and with growing numbers, there is increased potential for negative health sequelae. Due to the low use of contraception by adolescents in Rwanda, and the growing population of adolescents, this study aims to explore the perspectives of family planning providers and adult modern contraceptive users on adolescent contraceptive use. Inclusion of adult community members in the study is a unique contribution, as research on adolescent contraceptive use in sub-Saharan Africa relies primarily on perspectives from adolescents and family planning providers.MethodsThis qualitative study in 2018 utilized 32 in-depth interviews with modern contraceptive users and eight focus group discussions with family planning providers. Respondents were from Musanze and Nyamasheke districts in Rwanda, the districts with the highest and lowest modern contraceptive use among married women, respectively. Coding was conducted in Atlas.ti.ResultsStigma regarding premarital sex results in barriers to adolescent access to contraceptive services. Family planning providers do provide services to adolescents; however, they often recommend secondary abstinence, offer a limited method selection, and accentuate risks associated with sexual activity and contraceptive use. Providers support adolescent clients by emphasizing the need for privacy, confidentiality, and expedient services, particularly through youth corners, which are spaces within health facilities designed to meet youth needs specifically. Modern contraceptive-using adult female community members advocate for youth access to contraception, however mothers have mixed comfort discussing sexual health with their own youth.ConclusionTo destigmatize premarital sexual activity, government efforts to initiate communication about this topic must occur at national and community levels with the goal of continued conversation within the family. The government should also train family planning providers and all health personnel interacting with youth on adolescent-friendly health services. Dialogue between community members and family planning providers about adolescent access to contraceptive services could also reduce barriers for adolescents due to community members’ generally supportive views on adolescent contraceptive use. Efforts to engage adolescent caregivers in how to talk to youth about sex could also contribute to expanded use.

Adolescent and Youth Experiences With Contraceptive Self-Injection in Uganda: Results From the Uganda Self-Injection Best Practices Project

PurposeWe used qualitative and quantitative data to evaluate the differing experiences of adolescents and adult women in the contraceptive self-injection program in primary care settings in Uganda. From these results, we assessed barriers to adolescent DMPA-SC self-injection access and continuation and provide recommendations to address them. MethodsThe Self-Injection Best Practices (2017–2019) project in four districts trained clinic-based providers and Village Health Teams to provide self-injection training in clinics, community settings, and small group meetings for adolescent girls and young women. More than 12,000 women of reproductive age received self-injection services through the program, including 2,215 under 20 years. Structured surveys (n = 1,060) and in-depth interviews (n = 36) were conducted with randomly selected adolescent participants between July and November 2018. Mixed-effects logistic regression was used to assess quantitative differences in outcomes of interest between age groups. ResultsThe study found no significant difference in self-injection proficiency or continuation between adolescents and adult women; 86.1% of adolescents self-injected independently when due for reinjection. Adolescents were significantly less likely than adults to report first hearing about self-injection from a community health worker. More adolescents expressed concern over discovery when seeking contraception at a clinic and fear of their DMPA-SC units being discovered at home. Adolescents were significantly less likely than adult women to mention convenience as a rationale for self-injecting, and more likely to mention wanting to learn a new skill and/or that friends recommended self-injection. DiscussionSelf-injection is a promising method of contraception for adolescents in Uganda, given comparable proficiency and continuation relative to adult women. Policies and programs should ensure rights-based access to a range of methods, including self-injection for this age group.

Knowledge, Attitude and Uptake of Family Planning among Adolescent Girls in Rural and Urban Areas of FCT, Nigeria

Among female adolescents, maternal deaths due to unsafe abortion and childbirth complications is a leading cause of death. Contraceptive use prevents unwanted pregnancies and reduces the need for unsafe abortion. This cross-sectional study was conducted among 174 adolescent girls, ages 15 – 19yrs, in two different settings (rural and urban). The knowledge of the adolescents on family planning, their attitude to the uptake of family planning and the actual uptake of family planning among them were assessed. A high knowledge level of 77% was observed among the respondents in rural settings and 92% among the respondents in urban settings. The respondents’ attitude was also found to be high, 78% in the rural setting and 84% in urban setting, this was linked to the high knowledge of family planning among the respondents. A low uptake level of 47% was observed among the respondents in rural setting and 67% among respondents in urban setting. The respondents’ overall uptake of family planning was observed to be 58% which is low and not commensurate with the high knowledge of family planning observed among the respondents. Therefore, to improve the uptake of family planning among the adolescents, it is important to create messages that will target their partners, parents, religious institutions, and the society to support contraceptives for adolescents. There should be youth friendly clinics that provide family planning services to adolescents in the communities, they require a comfortable environment where they could access family planning services without fear of prejudice. Keywords: Adolescents, Family planning, Rural, Urban.

Which Structural Interventions for Adolescent Contraceptive Use Have Been Evaluated in Low- and Middle-Income Countries?

Reducing adolescent childbearing is a global priority, and enabling contraceptive use is one means of achieving this. Upstream factors, e.g., gender inequalities, fertility norms, poverty, empowerment and schooling, can be major factors affecting contraceptive use. We conducted a systematic map to understand which structural adolescent contraception interventions targeting these upstream factors have been evaluated in LMICs. We searched eight academic databases plus relevant websites and a 2016 evidence gap map and screened references based on set inclusion criteria. We screened 6993 references and included 40 unique intervention evaluations, reported in 138 papers. Seventeen evaluations were reported only in grey literature. Poverty reduction/economic empowerment interventions were the most common structural intervention, followed by interventions to increase schooling (e.g., through legislation or cash transfers) and those aiming to change social norms. Half of the evaluations were RCTs. There was variation in the timing of endline outcome data collection and the outcome measures used. A range of structural interventions have been evaluated for their effect on adolescent contraceptive use/pregnancy. These interventions, and their evaluations, are heterogenous in numerous ways. Improved understandings of how structural interventions work, as well as addressing evaluation challenges, are needed to facilitate progress in enabling adolescent contraceptive use in LMICs.

Elevating the Needs of Minor Adolescents in a Landscape of Reduced Abortion Access in the United States

Elevating the Needs of Minor Adolescents in a Landscape of Reduced Abortion Access in the United States

Barriers to Fertility Regulation in Nigeria: A Literature Review

The ability of women to control their own fertility is absolutely fundamental to women’s empowerment, equality and general wellbeing. Evidence suggests that only few attempts have been made to understand the interconnections between fertility regulation and the complex tactics women must use to preserve and develop their social identities This paper discussed fertility regulation. It also examined factors hindering fertility regulations in Nigeria such as cultural norms, religion, myths and misconceptions, gender inequalities and lack of access and availability of contraceptives for adolescents. The review concluded that to achieve a holistic and equitable recovery from the current fertility issues Nigeria is facing, girls and women must be empowered as drivers of change, acknowledging the central role they play not only in the family and community but in the economy and human resource management. This is because investments that meet women’s and adolescent girls’ needs for family planning and quality reproductive health care, would improve women’s health. It also creates opportunities for broader, sustainable development. Based on the review, it was recommended among others that couples should have joint decision making towards the size of the family they need to avoid unnecessary increase in population and government should strengthen and enforce existing policies and laws to regulate population growth as rapid increase in population has significant effect on the country’s development.

Contraception in adolescents with obesity and diabetes mellitus

Today most adolescents have their first sexual experience at the age of 15-19. However, only 44% of girls and young women (15-24 years old) report about contraception at that moment. A decision on pregnancy in adolescence is a difficult choice and any scenario may cause serious medical and social problems. Complications after an artificial abortion have a negative impact on a woman's fertility. Diabetes mellitus type 1 and arterial hypertension accompanied with obesity within the metabolic syndrome are defined by the World Health Organization (WHO) as diseases, which increase risk of an unplanned pregnancy. The article consoders problems of interaction of a doctor and a teenage girl with endocrinopathy, when discussing her sexual health, the analysis of the literature reflecting the influence of contraception on the course of the underlying pathology is presented. The authors formed a list of drugs acceptable for use in diabetes and obesity based on assessment of risks and preferences from the use of different methods of fertility control. The work contains information about the procedure of starting contraception, the rules of future dynamic monitoring of the patient.

Postgraduate Training in Pediatric and Adolescent Gynecology: Trainees' Perspectives

The purpose of this study was to evaluate resident trainees' perspectives on the pediatric and adolescent gynecology (PAG) training in obstetrics and gynecology training programs in Europe. This study was a cross-sectional survey using an online questionnaire, on the basis of the PAG training in obstetrics and gynecology section of the European Board & College of Obstetrics and Gynaecology Project of Achieving Consensus in Training curriculum. We aimed to survey the national programs in 35 European Network of Trainees in Obstetrics and Gynaecology (ENTOG) member countries. Taking part in the survey was voluntary. The questionnaire was shared on the ENTOG online platforms. Ninety obstetrics and gynecology trainees in 33 of 35 countries responded to our questionnaire. Of the 35 ENTOG member countries, 33 participated in the survey, and a total of 90 responses were collected, giving a response rate of 9% of all European trainees and representing 94% of the member countries. Only 27% of trainees reported having a PAG rotation during their training program, and a PAG elective was only available to 34% of the trainees. Forty-one percent reported that PAG training was not included in their curriculum (no official rotations or lectures planned). Despite the lack of formal training, 72% of trainees felt able to diagnose and manage prepubertal vaginal bleeding and adnexal masses in children and adolescents by the end of their training. Most (58%) also confirmed that they could determine indications for treatment of vulval, vaginal, perineal, and rectal conditions. However, despite scoring positively for the management and counseling of subjects that often overlap with adult patients, such as "contraception in adolescents with health problems," "acute abdominal pain," "menstrual abnormalities," and "vaginal discharge," the study revealed poorer scores when the trainees were asked about more specific PAG topics such as "premature puberty" and "developmental disorders of the genital tract." Most core training programs across Europe do not include formal PAG training, and trainees reported a need to improve the provision of core PAG training in Europe.