Adolescent motherhood in the Lake Patzcuaro Basin, México: social contexts of parenting and perceptions of social support and family planning

Abstracts / Contraception 86 (2012) 173–186 of action, though no significant difference was found in pain scores between these drugs in our interim analysis. Results suggest improved pain control with drug B.

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instructions are essential to ensure completion of the abortion and to confirm contraceptive choice. A18

A16 ORAL LNG VS. COPPER T 380 IUD: UNDERSTANDING USE OF AN EC IN RELATION TO TIMING FROM LMP

IS THERE A GROUP OF WOMEN WHO ARE AT INCREASED RISK FOR RETAINED PRODUCTS OF CONTRACEPTION AFTER INDUCED ABORTION?

Dermish A University of Utah, Salt Lake City, UT, USA

Gold A Christiana Care Health Systems, Newark, DE, USA

Jacobson J, Murphy P, Torres L, Turok D, Ward K

Hochman M, Maiden K, Merriam A

Objectives: There is increased interest in use of the copper intrauterine device (IUD) for emergency contraception (EC). This study aims to describe the menstrual cycle day of use for oral levonorgestrel (LNG) and the copper IUD among women presenting for EC and the resulting pregnancies in the first month. Method: Data were obtained from a trial comparing women who selected the copper IUD or oral LNG for EC. Patients were considered eligible for EC at any time in their menstrual cycle as long as the urine pregnancy test was negative. Cycle day was calculated based on last menstrual period (LMP). Results: Among the 356 women for whom LMP data were available, 140 chose the copper IUD and 216 chose oral LNG for EC. For oral LNG users, the mean, median and mode menstrual cycle day of use was 15 (±7.9), 14 (±11) and 14, respectively. For IUD users, these values were 16 (±8.0), 16 (±11) and 14. In the first month, two pregnancies occurred in the oral LNG group in patients presenting for EC on cycle days 15 and 22. There were no pregnancies in the first month among IUD users. Cycle day of insertion was not significantly associated with either IUD expulsion [odds ratio (OR) 1.04, 95% confidence interval (CI) 0.97–1.12, p=.26] or removal (OR 0.94, 95% CI 0.86–1.02, p=.11). Conclusions: These data suggest that the copper IUD can be used for EC regardless of the menstrual cycle day.

Objectives: Retained products of conception (RPOC) are a risk of surgical or medical abortion that can potentially lead to significant morbidity. Identifying a group of patients who are at increased risk of RPOC would likely change postprocedure follow-up and potentially change counseling about abortion method. We sought to identify risk factors associated with RPOC following induced abortion. Method: All postabortion patients who returned for a follow-up visit to a large, referral academic practice between January 2008 and November 2010 were included. Retained products of conception were defined as a thickened endometrial stripe (N1 cm), irregular endometrial stripe or identified continuing pregnancies (i.e., gestational sac or fetal parts still in uterine cavity) on follow-up posttermination ultrasound. We abstracted race, age, gravidity, parity, gestational age, and type and location of abortion from the patient charts. Institutional review board approval was obtained prior to the initiation of the study. Results: Three hundred seventy-one women were included in the analysis. A total of 31 women (8.4%) had RPOC. On univariable or multivariable analysis, no variable was associated with an increased risk of RPOC. However, multiparity trended towards an increased rate of RPOC, and surgical abortion trended toward a lower rate of RPOC. Conclusions: Our rate of RPOC is consistent with rates quoted in the literature. None of the factors were statistically associated with an increased rate of retained products of conception. There was a trend towards increased rates of RPOC in multiparous patients and toward decreased rates after surgical abortion. A larger trial could demonstrate these trends more clearly.

A17 WHAT FACTORS AFFECT POSTOPERATIVE VISIT COMPLIANCE AFTER INDUCED ABORTION? Gold A Christiana Care Health Systems, Newark, DE, USA Hochman M, Maiden K, Merriam A Objectives: Postprocedure visits are an important part of patient care. Unfortunately, reported rates of attendance at postabortion visits are approximately 50%. We sought to determine which factors effected attendance at the postprocedural visit after an induced abortion. Method: All patients who had records available and had an elective abortion through a large, academic referral practice between January 2008 and November 2010 were included. Information about race, patient's age, gravidity, parity, gestational age at the time of the procedure, and type and location of abortion were abstracted from the medical record. Institutional review board approval was obtained prior to the initiation of the study. Results: A total of 594 women met criteria for inclusion in the study. The overall follow-up visit attendance was 62.5%. Multigravidity [odds ratio (OR) 0.859, confidence interval (CI) 0.784–0.942], parity (OR 0.779, CI 0.673–0.901), surgical abortion (OR 0.137, CI 0.062–0.304) and previous induced abortion (OR 0.751, CI 0.612–0.921) were associated with decreased rate of attendance at the postprocedure visit. Race, patient's age, gestational age, previous spontaneous abortion and location of abortion were not associated with attendance at the postprocedure visit. Conclusions: Women of higher gravidity and parity, who have had previous induced abortions and who had a surgical abortion are less likely to attend the posttermination follow-up visit. Counseling these women about the importance of the postprocedural visit and clear discharge

A19 ADOLESCENT MOTHERHOOD IN THE LAKE PATZCUARO BASIN, MÉXICO: SOCIAL CONTEXTS OF PARENTING AND PERCEPTIONS OF SOCIAL SUPPORT AND FAMILY PLANNING Horowitz K Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA Guadamuz TE, Rosenthal O Objectives: Our qualitative study aimed to elucidate how young Mexican mothers from an underserved region adapted/transitioned to motherhood, perceived family planning and experienced social support. Method: We conducted focus group discussions (FGDs) and participant observations in Erongarícuaro, México, in June 2011. Twenty women from five towns comprised three FGDs, each meeting twice. Participants were 18 to 27, with 80% having given birth to their first child before 20. Questions related to adolescent and present conceptions of motherhood, family/community reactions, sexual health confidants, family planning, gender meanings and social support were discussed. Audiorecorded data were transcribed and analyzed using a developmental, strengths-based approach. Results: Emergent themes included constructions of social identities of being a mother/wife, joy of being with their children, coping with violence and substance abuse in the home, decision-making around marriage and negotiating community expectations. Participants felt strong social support around logistical needs, especially childcare, but at the same time felt emotionally isolated. Many reported desires to plan their families, but there

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Abstracts / Contraception 86 (2012) 173–186

is lack of information on or access to contraception. Sex is only discussed with peers. Conclusions: With nuanced understandings of the challenges, experiences and adaptive mechanisms of young mothers, we can better intervene both to prevent pregnancy in adolescence and to support pregnant and parenting teens. Public health interventions have underutilized a specific developmental perspective in approaching adolescent health. Enriching understandings of adolescent transition to motherhood in varying international contexts will strengthen our efforts to help improve reproductive and psychosocial outcomes of adolescents and their children. A20 TRENDS IN RATES OF STERILIZATION AND INSERTION OF INTRAUTERINE DEVICES IN WOMEN BETWEEN 2006 AND 2010 Howard B Teva Global Branded Products R&D, Inc., North Wales, PA, USA

Results: Twenty-three participants were recruited. Most were Black, non-Hispanic and had completed high school. Thirteen percent (3/23) had used an implant before, while 70% (16/23) had never heard of implantable contraception. The median number of correct responses at baseline was 5 (range 0–8). The median number of correct responses postintervention was 8 (range 4–8). The median increase in correct answers was 2 (0–6). The proportion of respondents answering correctly increased for every question, with the largest increases noted for location of the implant (53%), efficacy relative to pills (41%), safety during nursing (35%), failure rate (32%) and duration of use (32%). Similar proportions of respondents considered the informational handout, visual model and individualized question session to be the most useful. Conclusions: This short, simple educational intervention was able to increase knowledge of implantable contraception in this small sample of young women presenting for obstetric or gynecologic visits. A22

Lage M Objectives: To determine time trends in sterilization and intrauterine device (IUD) insertion rates in women. Method: Data from claims between January 1, 2006, and December 31, 2010, were obtained from the i3 Invision™ Data Mart database in women aged 12 to 55 years who were continuously insured in the index calendar year. Procedure codes identified patients sterilized by tubal ligation (TL)/tubal occlusion (TO) or who underwent IUD insertion (TL/TO: CPT 58600, 58605, 58611, 58615; IUD insertion: CPT 58300). Patients were also subcategorized by year of procedure to determine annual trends. Mean IUD and TL/TO costs were assessed. Results: The percentage of women who underwent TL/TO decreased from 0.29% (8084/2,834,632) in 2006 to 0.25% (7065/2,874,830) in 2010 (pb.0001). Rates of IUD insertion increased from 0.65% (18,394/2,834,632) in 2006 to 1.14% (34,320/3,021,733) in 2009 but decreased to 1.04% (29,964/2,874,830) in 2010 (pb.0001 for trend). Mean TL/TO costs decreased from $297 in 2006 to $228 in 2010 (pb.001), while mean IUD insertion costs ranged from $117 to $127 between 2006 and 2009, but increased to $228 in 2010 (pb.00001). Conclusions: Significant decreases in sterilization rates and increases in IUD insertion rates were observed between 2006 and 2010. Wholesale acquisition cost increased for both types of IUDs [from $392 to $460 (14.79%) with the copper IUD and from $468 to $703 (33.43%) with the levonorgestrel-releasing IUD] over the course of 2010, which may explain the decrease in IUD insertion rates between 2009 and 2010. A21 EDUCATING YOUNG WOMEN ABOUT LONG-ACTING REVERSIBLE IMPLANTABLE CONTRACEPTIVE Joyner A Medical University of South Carolina, Charleston, SC, USA Dempsey A Objectives: Measure the change in knowledge after an educational intervention among women aged 18–21 presenting to an outpatient clinic. Method: English-speaking women aged 18–21 were recruited during their outpatient gynecologic visit. We administered a baseline questionnaire to collect demographic information and assess knowledge of implantable contraception (eight questions). Our intervention had three components: provision of an established Association of Reproductive Health Professionals information sheet about the contraceptive implant, an opportunity to view and feel a model of the implant, and an opportunity to ask individualized questions of a provider. Following the intervention, we repeated the knowledge questionnaire. We performed descriptive analysis using frequencies and medians.

INCREASED COMPLIANCE WITH A LOW-DOSE COMBINATION CONTRACEPTIVE PATCH (AG200-15) COMPARED WITH A LOW-DOSE COMBINATION ORAL CONTRACEPTIVE (COC) IN A PHASE 3 CLINICAL TRIAL Kaunitz A University of Florida College of Medicine, Jacksonville, FL, USA Archer DF, Foegh M Objectives: Contraceptive effectiveness depends on compliance, but studies indicate that many women using combination oral contraceptives (COCs) are noncompliant. This study evaluated compliance with AG20015, a new contraceptive patch containing low-dose ethinyl estradiol and levonorgestrel, versus a COC, Levlite® (ethinyl estradiol 20 mcg, levonorgestrel 0.1 mg). Method: In an open-label, randomized, parallel-group, multicenter study, subjects were treated for 1 year (13 cycles) with Patch (Patch group) or for six cycles with COC followed by seven cycles of Patch (Pill group). Subjects recorded patch application and pill-taking on diary cards. Cycles with perfect compliance were defined as cycles with 21 days of patch wear without missed days or any patch worn for N7 days or cycles with 21 days of pill-taking without days of missed pills. Results: Of 1328 women (mean age, 26.4 years; 60% new hormonal contraceptives users; 46% non-Caucasian; 33% obese), 998 received Patch and 330 received COC for the first six study cycles. Over the first six cycles, percentage of cycles with perfect compliance was significantly higher in the Patch versus the Pill group (90.5% vs. 78.8%, pb.001). Compliance with Patch improved over the six treatment cycles, while compliance with Pill worsened over the six cycles. Obese versus nonobese women showed no difference in perfect compliance with either Patch or Pill. However, perfect compliance varied by race/ethnicity for both Patch and Pill, and by age and education for Pill. Conclusions: In this study, subjects randomized to a contraceptive patch demonstrated increased compliance compared with subjects treated with COC. A23 POSITIVE ROLE OF MEN IN MATERNAL HEALTH IN POST CONFLICT SOUTH SUDAN Khalil A Reproductive and Child Health Research Unit at University of Medical Sciences and Technology, Khartoum, Sudan Elmusharaf K, Mekki H