Depot medroxyprogesterone acetate (Depo-Provera) and levonorgestrel (Norplant) use in adolescents among clinicians in Northern Europe and the United States.
OBJECTIVE
To compare attitudes and practices related to clinicians' use of depot medroxyprogesterone acetate [Depo-Provera (DMPA)] and levonorgestrel implants in adolescents in three northern European countries and the United States.


METHODS
Between the fall of 1993 and the winter of 1995, surveys eliciting clinician attitudes and practices with the two contraceptive methods were collected from practitioners who provide contraceptive care to teens in Sweden (n = 282), The Netherlands (n = 197), Great Britain (n = 108), and the United States (n = 548).


RESULTS
Clinicians in Great Britain and the United States reported prescribing of DMPA, selected DMPA in their top three choices for contraception in teens, and had patients ask about DMPA more frequently than clinicians in Sweden or The Netherlands (p < 0.0001). U.S. clinicians were more likely to report prescribing of the implants, list them as a top choice, and have patients ask for it more frequently than were providers in the other three countries (p < 0.0001). Noncompliance with previous contraceptives was the most common indication for use of either method in this age group. "Worst fears" with DMPA use included infertility, particularly among Swedish clinicians (p < 0.0001), as was pregnancy and loss to follow-up, particularly among British clinicians (p < 0.0001). Condom nonuse was a concern associated with both methods. Breakthrough uterine bleeding was a concern related to implant use, particularly among Swedish practitioners (p < 0.0001).


CONCLUSIONS
Clinicians in the United States and Great Britain display more enthusiasm toward the use of the long-term progestins in adolescents than do clinicians in Sweden or The Netherlands. Continuing education programs could be designed to educate clinicians to allay their concerns about these contraceptives in countries where teen pregnancy is considered a problem.
Department of Pediatrics, Ohio State University College of Medicine, Columbus Children's Hospital, 43205, USA.
B A
BA
Cromer
K S
KS
Berg-Kelly
J P
JP
Van Groningen
B S
BS
Seimer
L
L
Ruusuvaara
D000293:Adolescent; D016497:Adolescent Health Services / Q000706:statistics & numerical data; D000328:Adult; D001291:Attitude of Health Personnel; D003271:Contraceptive Agents, Female / Q000627:therapeutic use*; D003692:Delayed-Action Preparations; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005060:Europe; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D016912:Levonorgestrel / Q000627:therapeutic use*; D008297:Male; D017258:Medroxyprogesterone Acetate / Q000627:therapeutic use*; D010349:Patient Compliance; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D011253:Pregnancy in Adolescence; D014481:United States
D003271:Contraceptive Agents, Female; D003692:Delayed-Action Preparations; D016912:Levonorgestrel; D017258:Medroxyprogesterone Acetate