Immediate postpartum insertion of etonogestrel implant: impact on continuation and satisfaction at 12 months

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Abstracts / Contraception 90 (2014) 298–351

Public health campaigns to reduce teen pregnancy require better understanding of sociocultural barriers to family planning. Our objective was to explore attitudes and practices toward contraception among American Indian and Alaska Native women from North Dakota. Methods: Semistructured, in-depth face-to-face interviews were conducted on an American Indian reservation in rural North Dakota. A convenience sample of 40 American Indian and Alaska Native women aged 18–45 (mean age 23.5) were interviewed from August 2013 to September 2013 and stratified by age: 18–24 (n=22) and 25–45 (n=18). Interviews were audiorecorded, transcribed and entered into Atlas-ti software. All of the interviews were independently coded by two team members and reconciled. Results: Seventy percent of the participants had been pregnant, and the median age of first pregnancy was 18 (range 15–24). All participants had access to free contraception through their health care plan, yet only 59% of the women who were not currently pregnant or recently postpartum were using a method. Three themes emerged: a lack of understanding of contraception; pregnancy ambiguity; and community acceptance of early parenting. These factors helped determine whether women initiated and continued contraceptive use. Conclusions: Teen pregnancy and low contraceptive adherence derived from knowledge, attitudinal and social barriers. Public health strategies to reduce teen pregnancy among American Indian and Alaska Native women must improve contraceptive knowledge and address tribe-specific cultural norms that sometimes disempower women and girls. http://dx.doi.org/10.1016/j.contraception.2014.05.088

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HIGHLY EFFECTIVE CONTRACEPTIVE USE MORE LIKELY AMONG NATIVE HAWAIIAN WOMEN THAN NON-HAWAIIAN WOMEN AT TITLE X CLINICS IN HAWAI‘I Soon R University of Hawai‘i John A. Burns School of Medicine, Honolulu, HI, USA Elia J, Hayes D, Harvey S, Salcedo J, Kaneshiro B Objectives: Native Hawaiians experience the highest rate of unintended pregnancy in Hawaiʻi. Our study aimed to determine whether Native Hawaiian women using contraceptives were more or less likely to choose a highly effective method than non-Hawaiian women. Methods: We conducted a database review of the Hawai‘i State Department of Health Title X program’s de-identified client visit records from 37 sites throughout Hawai‘i from 2006 to 2012. We analyzed records from the most recent visit of women aged 15–44 who were avoiding pregnancy and using contraceptives. Highly effective contraception (HEC) included the implant, IUD, and male or female sterilization. Bivariate analyses and multiple logistic regression were used to identify and control for potential confounders. Results: In this sample (n=54,513), 23.4% were Native Hawaiian. After we controlled for insurance type and visit year, Native Hawaiians were 1.37 times as likely to choose HEC compared with non-Hawaiians (95% CI 1.29– 1.46). This difference remained after stratifying by age. Among younger women (aged 15-29), after adjusting for insurance type, Native Hawaiians were 1.46 times more likely to use a highly effective method than nonHawaiians (95% CI 1.35–1.58). After adjusting for insurance type, older Native Hawaiian women (aged 30–44) were 1.69 times more likely to use HEC than older non-Hawaiian women (95% CI 1.53–1.87). Conclusions: Across all age groups, Native Hawaiian women participating in the Department of Health’s Title X program were more likely than nonHawaiian women to use HEC. These methods should be a key component of any program to reduce unintended pregnancies among Native Hawaiians.

http://dx.doi.org/10.1016/j.contraception.2014.05.089

P69 RACIAL AND ETHNIC DIFFERENCES IN YOUNG MEN’S SEX AND CONTRACEPTIVE EDUCATION Farkas AH University of Pittsburgh, Division of General Internal Medicine, Pittsburgh, PA USA Sucato G, Miller E, Akers A, Borrero S Objectives: Data indicate that young men from racial/ethnic minority groups have less knowledge about contraception than white men. We sought to determine whether black and Hispanic men receive less sexual health education. Methods: We analyzed cross-sectional data from the 2006–2010 National Survey of Family Growth, which asked males aged 15–24 if, prior to age 18, they had received any sex education on saying no to sex, birth control or STIs, either formally (at school, church or community center) or from their parents. We examined the associations between race/ethnicity and receipt of any education on sexual health and birth control, specifically using multivariable logistic regression models controlling for sociodemographic characteristics including age, poverty level, metropolitan location, education level, sexual activity, parental figures in the home, mother’s education, father’s education, religion and current insurance. Results: Ninety-seven percent of participants reported receiving some formal sexual health education. Yet, only 66% reported receiving formal education about birth control. In adjusted analysis, blacks were less likely than whites to report formal birth control education (aOR 0.71, 95% CI 0.52–0.97), while there was no difference for Hispanics. From parents, 68% reported receiving sexual health education and 50% received birth control education. Both blacks (aOR 1.44, 95% CI 1.08–1.94) and Hispanics (aOR 1.44, 95% CI 1.06–1.96) were more likely to report parental sex education overall; however, there were no differences regarding parental education about birth control. Conclusions: Nearly all young men reported some form of sexual health education, but far fewer received education about contraception either at school or at home, regardless of racial/ethnic background. More effort should be placed on educating young men about contraception. http://dx.doi.org/10.1016/j.contraception.2014.05.090

P70 IMMEDIATE POSTPARTUM INSERTION OF ETONOGESTREL IMPLANT: IMPACT ON CONTINUATION AND SATISFACTION AT 12 MONTHS Eisenberg D Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA Benzoni N, Zhao Q, Madden T, Secura G Objectives: The purpose of this study was to compare rates of continuation and satisfaction at 12 months for women who received the etonogestrel implant immediately postpartum versus women receiving an interval placement. Methods: This was a planned secondary analysis of the Contraceptive CHOICE Project. Continuation and satisfaction of the etonogestrel implant at 12 months was compared among women receiving immediate postpartum implant (IPI) versus interval placement (defined as no pregnancy in prior 2 months). Continuation rates were compared using Cox proportional hazard models and Kaplan–Meier survival analysis. Results: A total of 74 women received an IPI prior to hospital discharge after delivery and 883 women underwent interval placement. Similar rates of continuation, 93% vs. 84% (p=.18) and satisfaction, 77% vs. 80% (p=.71), were noted among women who received an IPI and those

Abstracts / Contraception 90 (2014) 298–351 who underwent interval insertion, respectively. Survival analysis demonstrated no significant difference in discontinuation between IPI and interval placement groups (HRadj 0.82, 95%, CI 0.36–1.86). Analysis of continuation stratified by age demonstrated similar continuation rates for teens (younger than 20) and women aged 20 or older regardless of timing of insertion. The most common reasons given for discontinuation were frequent or irregular bleeding and side effects. Conclusions: Immediate postpartum etonogestrel implant placement is associated with similarly high rates of continuation and satisfaction at 12 months when compared with interval placement. This further strengthens the argument that women in the immediate postpartum period ought to have access to long-acting highly-effective contraceptive methods, which in turn reduces the risk of rapid repeat pregnancy and its complications. http://dx.doi.org/10.1016/j.contraception.2014.05.091

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CLINICIAN COUNSELING EXPERIENCES AND METHOD CHOICE AMONG A SAMPLE OF WOMEN SEEKING TO INITIATE A NEW CONTRACEPTIVE METHOD Smith N Princeton University, Princeton, NJ, USA

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higher when women expect noncontraceptive benefits at initiation or perceive benefits 6 months later. Methods: A total of 243 young women aged 13–24 initiating short-acting methods in an adolescent-only family planning clinic completed postvisit surveys that included directed and open-ended questions about anticipated noncontraceptive benefits. The study participants were contacted 6 months later. We compared contraceptive continuation between those who expected benefits and those who did not, and those who reported experiencing benefits and those who did not. We examined the concordance between expectations and reported experiences. Results: Some 69.3% of women were still using their method at 6 months. Expectation of noncontraceptive benefits was not associated with 6-month continuation. The experience of any benefit (OR=2.6, 95% CI 1.1–6.0), improvement in bloating (OR=2.2, 95% CI 1.0–5.0) or less acne (OR=2.2, 95% CI 1.0–4.8) was associated with greater continuation. Concordance between expectation and perception was poor (Kappa=0.2). Conclusions: Women who did not experience noncontraceptive benefits were less likely to continue use of short-acting contraceptives. Women who expected benefits when initiating a method were not more likely to report experiencing them, and many women who didn’t expect benefits reported them, and were more likely to continue method use. These findings imply that building expectations of noncontraceptive benefits, e.g., through counseling, may not improve continuation, and that new contraceptive development should include consideration of tangible noncontraceptive benefits. http://dx.doi.org/10.1016/j.contraception.2014.05.093

Trussell J Objectives: To gain a better understanding of the influence of clinician counseling on contraceptive decision-making among women who want to begin a new method but who state no preference for a particular method. Methods: Women seeking to start a new contraceptive method who had not used any hormonal method in the past 2 months were enrolled in an online study after visiting a family planning clinic. Data were collected on selfreported experiences with clinician counseling and the method initiated, if any. Results: We analyzed data for 86 women aged 14–42 (mean age 24). Large variance existed in the range of methods covered during a typical counseling session. The majority of participants reported receiving information on the pill (79%) and condoms (59%) but far fewer received information on IUDs (25%) or the implant (23%). At the end of the visit, 47% (n=40) initiated the pill, 6% (n=5) started the vaginal ring, 5% (n=4) received the shot, 4% (n=3) had an IUD inserted, 9% (n=8) left using condoms only, 4% (n=3) were using other nonhormonal methods, and 26% (n=23) left without initiating a method. Conclusions: Women seeking to start a method are likely to initiate the pill, which is the most commonly discussed method during a counseling session. However, more information is needed to understand why almost one quarter of women left with no method. http://dx.doi.org/10.1016/j.contraception.2014.05.092

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DOES THE EXPECTATION OR PERCEPTION OF NONCONTRACEPTIVE BENEFITS LEAD TO HIGHER RATES OF CONTRACEPTIVE CONTINUATION FOR ADOLESCENTS AND YOUNG ADULT WOMEN? Lazorwitz A University of Colorado Anschutz Medical Campus, Aurora, CO, USA Sheeder J, Teal S, Guiahi M Objectives: Continuation rates of short-acting contraception among young women are low; we attempted to determine if continuation is

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AGE AS A DETERMINANT OF CONTRACEPTIVE NONUSE: AN EXAMINATION OF HAWAI‘I TITLE X DATA Elia J University of Hawai‘i John A. Burns School of Medicine, Honolulu, HI, USA Soon R, Hayes D, Kaneshiro B Objectives: To determine if age is associated with contraceptive nonuse in Title X sites in Hawaiʻi among women trying to avoid pregnancy. Methods: The Hawai‘i State Department of Health Title X database includes all visits at Hawai‘i’s 37 Title X sites between 2006 and 2012. At the end of each visit, the patient’s primary contraceptive method, if any, was recorded. The most recent visit for women aged 15–49 wanting to avoid pregnancy was analyzed. Bivariate analyses and multiple logistic regression were used. Results: Within this sample of 63,088 women, 8.5% left their last visit with no contraceptive method; 15–17-year-olds were least likely to not choose a method (6.1%) and 45–49-year-olds were most likely (20.9%). Compared with young women aged 12–19, women aged 20–29 were 1.16 times more likely to choose no method (95% CI 1.08–1.25); women aged 30–39 were 1.81 times more likely to choose no method (95% CI 1.66–1.97) and those aged 40–49 were 3.28 times more likely to choose no method (95% CI 2.99–3.59). We did not find any possible confounding variables. The proportions of women choosing no method were high among those with limited English proficiency (14.1%); non-U.S. citizens (10.7%); those with an income greater than 250% of the federal poverty level (11.7%); those with public health insurance (10.6%); Native Hawaiians (9.6%) and Pacific Islanders (15.3%). Conclusions: Nearly 1 in 10 women visiting Title X clinics in Hawai‘i to avoid pregnancy did not select a method. Older women and other demographic groups were more likely to choose no method. Further research is needed to understand contraceptive nonuse among these populations.

http://dx.doi.org/10.1016/j.contraception.2014.05.094