Original research articleImplanon as a contraceptive choice for teenage mothers: a comparison of contraceptive choices, acceptability and repeat pregnancy☆
Introduction
Repeat teenage pregnancy is common in the United Kingdom [1] and United States [2]; one fifth of teenage pregnancies will involve those who already have a child. Compared to first teenage birth, a second almost triples the risk of preterm delivery and stillbirth [3]. Teenage mothers are more likely to come from poor families [4], [5], [6] and to be living in areas of socioeconomic disadvantage [7], [8]. The occurrence of rapid repeat pregnancy (within 2 years of the first) [9] compounds this social inequality as participation in education and work/training is repeatedly delayed and less likely to ever be attained [10], [11], [12].
Most programs aimed at preventing rapid repeat teenage pregnancy have had limited success [9], [12], [13], [14]. Exceptions are those that have incorporated the contraceptive implant, the Norplant [15], [16] and the injectable contraceptive, depot medroxyprogesterone acetate (DMPA) [17], [18]. The success of these contraceptive methods could be attributable to the fact they are long acting and are less likely to be used inconsistently or be discontinued as easily as pills or condoms [19]. This is particularly the case with contraceptive implants, which require removal by an experienced health care provider.
Nearly all studies of efficacy and acceptability of implantable contraceptives in teenagers have focused on Norplant [15], [16], [20], [21], which is no longer available. No published studies have specifically evaluated the efficacy and acceptability of Implanon in relation to delaying/reducing the rate of rapid repeat teenage pregnancy. Implanon is a single rod, nonbiodegradable implantable contraceptive containing etonogestrel [22]. Implanon is easier to insert and remove than Norplant [23] and is a highly effective reversible contraceptive that can be left in situ for 3 years [24], [25]. However, Implanon does have potential side effects, with irregular uterine bleeding being the most common, often leading to discontinuation in adult women [23].
The aim of the present study was to measure contraceptive acceptability, continuation rates and rapid repeat pregnancy among Implanon users compared to nonusers in teenage mothers (aged 18 years or younger). We hypothesized that Implanon users would be less likely to experience a rapid repeat pregnancy than those using other contraceptive methods.
Section snippets
Methods
This prospective cohort study was approved by the ethics committee at King Edward Memorial Hospital (KEMH), Perth, Western Australia. KEMH is the sole tertiary maternity hospital in Western Australia, with around 6000 deliveries per annum and which has a dedicated adolescent antenatal clinic. Teenagers who attend the antenatal adolescent clinic at KEMH are encouraged to attend KEMH at 6 weeks postpartum. Here, they receive contraceptive counseling from clinicians, with expertise in
Results
Of the 289 teenagers approached for recruitment, 189 (65%) agreed to participate in the study and signed a written consent form. Of those recruited, eight teenagers were withdrawn since they did not complete the recruitment questionnaire; 27 agreed to complete the recruitment questionnaire but not to postpartum follow-up; and a further 17 withdrew or were withdrawn from the study for reasons including stillbirth, apprehension of their child by social services, being too busy with work/school to
Discussion
This is the first prospective study comparing the acceptability, continuation and repeat pregnancy rate of Implanon with other contraceptive methods conducted among teenage mothers. Our findings suggest that Implanon has advantages over other contraceptive methods for this population, as it was acceptable and effective in reducing repeat pregnancy within 24 months postpartum and had a higher rate of continuation at 24 months postpartum.
Our study suggests that teenagers who select Implanon show
Conclusions
The present study suggests that an effective way clinicians can help teenage mothers to avoid rapid repeat pregnancy is to encourage them to use Implanon in the early postpartum period. However, we also observed that a number of teenage mothers were planning a further pregnancy. Since having a second child as a teenager has such profound medical, social, educational and financial consequences for the mother and her children, health care providers should ensure that they specifically inquire
Acknowledgments
We are grateful for the database construction and maintenance, and biostatistical support provided by James Humphreys and Angela Jacques.
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This study was supported by a Princess Margaret Hospital for Children Clinical Research Scholarship, Western Australia, The Women and Infants Research Foundation, Western Australia, and a Raine Medical Research Foundation Priming Grant, University of Western Australia.