Maternal influence on the decision to adopt Norplant

The Role of Reproductive Autonomy in Adolescent Contraceptive Choice and Acceptance of Long-acting Reversible Contraception

STUDY OBJECTIVE

To examine the association between reproductive autonomy and adolescent receptivity toward long-acting reversible contraceptive (LARC) methods.

DESIGN

A survey to assess sexual history and contraceptive practices/knowledge/attitudes was administered. Reproductive autonomy was measured with an adapted validated scale.

SETTING

Adolescent medicine clinic in an urban academic medical center in the Midwestern United States.

PARTICIPANTS

Girls ages 14-21 years who presented for well or contraceptive visits.

INTERVENTIONS AND MAIN OUTCOME MEASURES

Primary outcome was a favorable rating toward the question "How much do you like the idea of LARC for yourself?" The primary independent variable was the reproductive autonomy decision-making subscale score (higher score indicating increased autonomy).

RESULTS

Eighty-nine participants with a mean age of 16 years completed surveys. Almost all (92%) identified as African American. At study enrollment 56.2% were using Depo-Provera (Pfizer), 15.7% oral contraceptives, 3.4% implants, and 24.7% no method. Only 13.5% of participants liked the idea of LARC for themselves. The mean score on the decision-making subscale was 9 (range, 4-12). In bivariable analysis, age was associated with decision-making subscale score, but was not retained as a confounder in multivariable analysis. The odds of liking LARC decreased by 30% with each unit increase in the autonomy decision-making subscale score (odds ratio, 0.70; 95% confidence interval, 0.52-0.94; P = .02).

CONCLUSION

Our findings suggest that adolescents with higher reproductive autonomy, measured according to their score on the decision-making subscale, were less likely to favor LARC. Further research should explore participants' perceptions of autonomy and the relational dynamics between adolescents and their parents/partners in contraceptive choice.

Factors influencing uptake of intrauterine devices among postpartum adolescents: a qualitative study

OBJECTIVE

We assessed barriers and facilitators to uptake of the intrauterine device (IUD) among primiparous African American adolescent mothers.

STUDY DESIGN

Twenty participants who expressed IUD desire completed 4-5 qualitative interviews during the first postpartum year as part of a larger longitudinal study. Transcripts were analyzed for salient themes using a grounded theory approach to content analysis.

RESULTS

Twelve participants did not obtain IUDs and instead used condoms, used no method, or intermittently used hormonal methods, resulting in 3 repeat pregnancies. Outdated IUD eligibility requirements, long wait times, lack of insurance coverage, and fear of IUD-related side effects precluded or delayed uptake. Facilitators to IUD uptake included strong recommendations from providers or family members, planning for IUD during pregnancy, and perceived reproductive autonomy.

CONCLUSION

Postpartum adolescents may reduce their risk of rapid repeat pregnancy by using IUDs. Providers and members of adolescents' support networks can be instrumental in method adoption.

Adolescent issues associated with knowledge of and access to topical microbicides

PURPOSE

Topical microbicides could be a female-controlled method for prevention of sexually transmitted diseases (STDs). Microbicides could offer girls a potential preventive option, if they are able to access them. The purpose of this investigation was to evaluate girls', mothers', experienced healthcare providers', and medical students' views on adolescent girls' obtaining information about and acquiring microbicides and where adolescent girls would keep or carry a microbicide.

METHODS

Focus groups were conducted and videotaped with each group of individuals. The videotapes were transcribed, and the transcriptions were coded for relevant themes.

RESULTS

Participants anticipated that adolescents would learn about microbicides from a variety of sources and that specific educational efforts for each of these sources (mothers, healthcare providers, and school-based sexuality education) would be needed. Healthcare providers stressed the importance of enhancing access by having both prescription and over-the-counter (OTC) options. For nonprescription products, the participants felt that the microbicide should be in stores and venues to which adolescents typically go by themselves. A microbicide that was girl-friendly and adolescent-friendly consistently was highlighted by the participants. Participants thought this would increase discretion and decrease embarrassment. The location of keeping and carrying the microbicide was anticipated to be dependent on parents' knowledge of their adolescent's sexuality and the likelihood that parents search their adolescent's belongings.

CONCLUSIONS

Consideration of the adolescent-specific issues in the design of microbicides and marketing strategies may be crucial for adolescent adoption of this female-controlled method.

Topical Microbicide Use by Adolescent Girls

BACKGROUND AND OBJECTIVES

Adolescent girls could benefit from topical microbicide use if the product is acceptable to them.

GOAL

The goal was to evaluate girls', mothers', experienced healthcare providers', and medical students' views on timing of use, efficacy, and safety of topical microbicide use by adolescents.

STUDY DESIGN

Focus groups were conducted with girls, mothers, healthcare providers, and medical students. All groups were videotaped, transcribed, and coded for relevant themes.

RESULTS

A delay between insertion and coitus presented a problem, and pre- and postcoital use had advantages depending on the group. Efficacy was evaluated by timing of use, smell, ability to feel the product, and confidence that it would spread sufficiently. There were concerns about physical side effects and the impact on normal vaginal flora.

CONCLUSION

This study demonstrated the importance of understanding the unique needs and perspectives of adolescent girls and the adults who have an influence on their use.

Attitudes of mothers toward their daughters' use of contraceptives in Israel

The objective of the study was to examine mothers' knowledge about contraception, their attitudes to their daughters' use of contraception, and their communication with their daughters on the subject. A 20-item questionnaire was distributed in gynecological clinics throughout Israel for completion by women who had daughters over the age of 14 years. The questionnaire covered the mothers' demographic data, use of contraception, knowledge of contraception, attitude to their daughters' contraceptive use and sexual relationships, and communication with their daughters about contraception. Only 36% of the women received contraceptive information from physicians. Almost half felt their daughter should begin sexual relations when she felt she was ready; over two-thirds felt she should begin using contraception before or at the time of beginning sexual relations. Over three-quarters spoke with their daughters about contraception. Higher educational level of the mother was associated with high rate use of contraception by the mother, her support of earlier use of contraception by her daughter, a greater likelihood of her discussing contraception with her daughter, and a lesser likelihood to view contraceptives as dangerous to one's health. It is concluded that mothers of teenage daughters in Israel are involved in their daughters' decisions to begin sexual relations and the use of contraceptives. Their knowledge of contraception is adequate, although some gaps are still apparent. Clear correlation is found between higher educational level of the mothers and a more liberal attitude toward their daughters' sex life.

Contraceptive outcomes among adolescents prescribed Norplant implants versus oral contraceptives after one year of use

OBJECTIVE

Our goal was to evaluate both the continuation and pregnancy rates and the side effects experienced during the first year of use by adolescents who selected Norplant implants as compared with those who chose oral contraceptives for contraception. Furthermore, side effects experienced at 6 versus 12 months among Norplant implant users were compared to determine whether they diminished with continued use of this method.

STUDY DESIGN

We conducted a case-control study of 56 adolescents < or = 18 years old who selected implants as compared with 56 age-matched controls who chose oral contraceptive pills during the same time period.

RESULTS

Only 34% of patients prescribed oral contraceptives as compared with 91% of Norplant implant patients were still using their chosen method 1 year later. As a result 25% of oral contraceptive users became pregnant within 12 months as compared with none who selected Norplant implants. Side effects were reported by > 80% of patients in both groups, with menstrual irregularities reported more often by Norplant implant users than by oral contraceptive users (73% vs 5%, p = 0.01). Furthermore, Norplant implant users gained more weight than oral contraceptive users (8.7 vs 4.2 pounds) and were twice as likely to have an abnormal Papanicolaou smear. Finally, little diminution in side effects was observed during the second 6 months of Norplant implant use.

CONCLUSIONS

These data confirm that Norplant implants provide better protection against unintended pregnancy in an adolescent population but may be associated with more side effects. Clinicians should be aware of these findings so they can adequately counsel young patients about these two methods of contraception.