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BARRIERS TO RECEIVING LONG-ACTING REVERSIBLE CONTRACEPTION IN THE POSTPARTUM PERIOD
Abstracts / Contraception 88 (2013) 433–473 difficulty in obtaining contraception and greater accessibility of condoms vs. other contraceptive methods; (4) a primary motivation to prevent sexually transmitted infections (STIs) in sexual relationships, with pregnancy prevention considered a shared or female-centric responsibility; and (5) very low awareness of long-acting reversible methods of contraception. Conclusions: African-American adolescent men in our study population tended to view their responsibility as varying by relationship type, and were primarily motivated by STI prevention, rather than pregnancy prevention. Further research and practice might also focus on increasing awareness of and access to other contraceptive methods.
O12 NO-COST CONTRACEPTION RESULTS IN SUBSTANTIAL REDUCTIONS IN TEEN PREGNANCY, BIRTH AND ABORTION Secura G Washington University in St. Louis, St. Louis, MO, USA
437
aged 18–44 who wanted to delay childbearing for at least 24 months were eligible for the study and completed interviews following delivery and at 3 and 6 months postpartum. At each interview, participants were asked what contraceptive method they would like to be using, as well as what method they were actually using. In the first two interviews, the preferred method was referenced to 6 months after delivery. We also inquired about barriers women encountered accessing contraception. Results: At 6 months postpartum, 15% of women were using an IUD or implant, and 18% were sterilized or had a partner who had had a vasectomy. Twenty-three percent used hormonal methods, and 43% relied on less effective methods, such as condoms and withdrawal. However, 78% reported that they would like to be using either a long-acting reversible contraceptive method (LARC) or sterilization, and 44% said they would use LARC if available at no cost. Conclusions: This study shows a considerable interest in LARC and permanent methods. However, there is substantial discordance between method preference and actual use. At 6 months postpartum, many more women would like to be using a highly effective method than are doing so.
Madden T, Mullersman J, Buckel C, Zhao Q, Peipert J Objectives: Although births among US teenagers continue to decline, the United States has one of the highest teen birthrates among developed countries. Our objective was to compare unintended pregnancy and outcomes among teens enrolled in the Contraceptive CHOICE Project (CHOICE) with national estimates. Methods: The study included 1404 teens aged 14–19 years enrolled in CHOICE. All teens were provided no-cost contraception and followed for 2–3 years. We calculated annual rates of pregnancy, birth and abortion among CHOICE teens, averaged over a five-year period (2008–2012), and compared CHOICE rates with the latest published data from the 2008 National Survey of Family Growth (NSFG). We report rates (outcomes per 1000 teens) and percentage reduction observed between CHOICE and two NSFG comparison groups. Results: Seventy-two percent of teens in CHOICE chose a long-acting reversible contraceptive (LARC) method, and 98% were sexually experienced. Pregnancy, birth and abortion rates among CHOICE teens were 29.6, 16.3 and 9.1, respectively. When compared with rates observed among all teens nationally (sexually experienced and inexperienced)—67.8, 40.2, and 17.8—we observed reductions of 56% in pregnancy, 59% in births and 49% in abortions. Corresponding national rates among sexually experienced teens were 158.5, 94.0 and 41.5, reflecting reductions of 81%, 83% and 78%, respectively. Conclusions: Through increased knowledge and access to no-cost contraception, including the most effective LARC methods, teens in CHOICE had dramatically lower rates of unintended pregnancy and related outcomes, compared with national estimates. No-cost contraception and increased LARC uptake among teens has the potential to reduce teen pregnancies, births and abortions.
O14 BARRIERS TO RECEIVING LONG-ACTING REVERSIBLE CONTRACEPTION IN THE POSTPARTUM PERIOD Tang J University of North Carolina, Chapel Hill, NC, USA Stuart G
UNMET DEMAND FOR HIGHLY EFFECTIVE POSTPARTUM CONTRACEPTION IN TWO CITIES IN TEXAS
Objectives: The primary objective of this study was to assess the reasons that postpartum women who desire to use long-acting reversible contraception (LARC) do not receive it in the postpartum period. The secondary objective was to assess which contraceptives they were using instead. Methods: This study is a sub-analysis of a randomized controlled trial of 800 postpartum women in North Carolina who were randomized to receive or not receive an educational script about LARC during their postpartum hospital admission. Participants completed a follow-up survey by phone after their six-week postpartum visit and were asked about their interest in using LARC, the reasons they were not using it if interested and which contraceptives they were using instead. Results: Of the 738 women who completed the follow-up survey, 114 (15.4%) were using LARC and 210 (28.5%) were interested in LARC but not using it. Among these 210 women, the most common reasons given for not using LARC were that they were told to come back for another visit to have it inserted (44.8%), they missed their postpartum visit (27.1%) and they could not afford it (11.9%). The most common contraceptive methods being used instead of LARC among these women were barrier methods (42.9%) and abstinence (19.5%); 19.1% used no contraceptive method. Conclusions: Many postpartum women who desire to use LARC do not receive it in the postpartum period and use less effective contraceptive methods instead. Increasing access to immediate postpartum insertion of LARC and eliminating two-visit protocols for LARC insertion may enable more postpartum women to receive LARC.
Potter JE University of Texas at Austin, Austin, TX, USA
O15
O13
Hopkins K, Aiken A, White K, Stevenson A, Lopez C Hubert, Grossman D Objectives: We assess women's contraceptive preferences and use in the first 6 months after delivery. The postpartum period represents a key opportunity for women to learn about and obtain effective contraception, especially since 50% of unintended pregnancies occur within 2 years of a previous birth. Methods: We conducted a prospective cohort study of 800 postpartum women recruited from three hospitals in Austin and El Paso, TX. Women
IMMEDIATE POSTPARTUM LARC IN ADOLESCENTS: IMPLANTS VERSUS IUDS Tocce K University of Colorado School of Medicine, Aurora, CO, USA Sheeder J, Arango N, Teal S Objectives: To compare 1-year continuation rates of immediate postpartum implants to intrauterine devices (IUDs) in adolescents.
O12 NO-COST CONTRACEPTION RESULTS IN SUBSTANTIAL REDUCTIONS IN TEEN PREGNANCY, BIRTH AND ABORTION Secura G Washington University in St. Louis, St. Louis, MO, USA
437
aged 18–44 who wanted to delay childbearing for at least 24 months were eligible for the study and completed interviews following delivery and at 3 and 6 months postpartum. At each interview, participants were asked what contraceptive method they would like to be using, as well as what method they were actually using. In the first two interviews, the preferred method was referenced to 6 months after delivery. We also inquired about barriers women encountered accessing contraception. Results: At 6 months postpartum, 15% of women were using an IUD or implant, and 18% were sterilized or had a partner who had had a vasectomy. Twenty-three percent used hormonal methods, and 43% relied on less effective methods, such as condoms and withdrawal. However, 78% reported that they would like to be using either a long-acting reversible contraceptive method (LARC) or sterilization, and 44% said they would use LARC if available at no cost. Conclusions: This study shows a considerable interest in LARC and permanent methods. However, there is substantial discordance between method preference and actual use. At 6 months postpartum, many more women would like to be using a highly effective method than are doing so.
Madden T, Mullersman J, Buckel C, Zhao Q, Peipert J Objectives: Although births among US teenagers continue to decline, the United States has one of the highest teen birthrates among developed countries. Our objective was to compare unintended pregnancy and outcomes among teens enrolled in the Contraceptive CHOICE Project (CHOICE) with national estimates. Methods: The study included 1404 teens aged 14–19 years enrolled in CHOICE. All teens were provided no-cost contraception and followed for 2–3 years. We calculated annual rates of pregnancy, birth and abortion among CHOICE teens, averaged over a five-year period (2008–2012), and compared CHOICE rates with the latest published data from the 2008 National Survey of Family Growth (NSFG). We report rates (outcomes per 1000 teens) and percentage reduction observed between CHOICE and two NSFG comparison groups. Results: Seventy-two percent of teens in CHOICE chose a long-acting reversible contraceptive (LARC) method, and 98% were sexually experienced. Pregnancy, birth and abortion rates among CHOICE teens were 29.6, 16.3 and 9.1, respectively. When compared with rates observed among all teens nationally (sexually experienced and inexperienced)—67.8, 40.2, and 17.8—we observed reductions of 56% in pregnancy, 59% in births and 49% in abortions. Corresponding national rates among sexually experienced teens were 158.5, 94.0 and 41.5, reflecting reductions of 81%, 83% and 78%, respectively. Conclusions: Through increased knowledge and access to no-cost contraception, including the most effective LARC methods, teens in CHOICE had dramatically lower rates of unintended pregnancy and related outcomes, compared with national estimates. No-cost contraception and increased LARC uptake among teens has the potential to reduce teen pregnancies, births and abortions.
O14 BARRIERS TO RECEIVING LONG-ACTING REVERSIBLE CONTRACEPTION IN THE POSTPARTUM PERIOD Tang J University of North Carolina, Chapel Hill, NC, USA Stuart G
UNMET DEMAND FOR HIGHLY EFFECTIVE POSTPARTUM CONTRACEPTION IN TWO CITIES IN TEXAS
Objectives: The primary objective of this study was to assess the reasons that postpartum women who desire to use long-acting reversible contraception (LARC) do not receive it in the postpartum period. The secondary objective was to assess which contraceptives they were using instead. Methods: This study is a sub-analysis of a randomized controlled trial of 800 postpartum women in North Carolina who were randomized to receive or not receive an educational script about LARC during their postpartum hospital admission. Participants completed a follow-up survey by phone after their six-week postpartum visit and were asked about their interest in using LARC, the reasons they were not using it if interested and which contraceptives they were using instead. Results: Of the 738 women who completed the follow-up survey, 114 (15.4%) were using LARC and 210 (28.5%) were interested in LARC but not using it. Among these 210 women, the most common reasons given for not using LARC were that they were told to come back for another visit to have it inserted (44.8%), they missed their postpartum visit (27.1%) and they could not afford it (11.9%). The most common contraceptive methods being used instead of LARC among these women were barrier methods (42.9%) and abstinence (19.5%); 19.1% used no contraceptive method. Conclusions: Many postpartum women who desire to use LARC do not receive it in the postpartum period and use less effective contraceptive methods instead. Increasing access to immediate postpartum insertion of LARC and eliminating two-visit protocols for LARC insertion may enable more postpartum women to receive LARC.
Potter JE University of Texas at Austin, Austin, TX, USA
O15
O13
Hopkins K, Aiken A, White K, Stevenson A, Lopez C Hubert, Grossman D Objectives: We assess women's contraceptive preferences and use in the first 6 months after delivery. The postpartum period represents a key opportunity for women to learn about and obtain effective contraception, especially since 50% of unintended pregnancies occur within 2 years of a previous birth. Methods: We conducted a prospective cohort study of 800 postpartum women recruited from three hospitals in Austin and El Paso, TX. Women
IMMEDIATE POSTPARTUM LARC IN ADOLESCENTS: IMPLANTS VERSUS IUDS Tocce K University of Colorado School of Medicine, Aurora, CO, USA Sheeder J, Arango N, Teal S Objectives: To compare 1-year continuation rates of immediate postpartum implants to intrauterine devices (IUDs) in adolescents.