One-year contraceptive continuation and pregnancy in adolescent girls and women initiating hormonal contraceptives.
OBJECTIVE
To assess contraceptive discontinuation, switching, factors associated with method discontinuation, and pregnancy among women initiating hormonal contraceptives.


METHODS
This was a 12-month longitudinal cohort study of adolescent girls and women (n=1,387) aged 15 to 24 years attending public family planning clinics who did not desire pregnancy for at least 1 year and selected to initiate the patch, ring, depot medroxyprogesterone acetate, or pills. Participants completed follow-up assessments at 3, 6, and 12 months after baseline. Life table analysis was used to estimate survival rates for contraceptive continuation. Cox proportional hazards models were used to estimate factors associated with method discontinuation.


RESULTS
The continuation rate (per 100 person-years) at 12 months was low for all methods; however, it was lowest for patch and depot medroxyprogesterone acetate initiators, 10.9 and 12.1 per 100 person years, respectively (P≤.003); continuation among ring initiators was comparable to pill initiators, 29.4 and 32.7 per 100 person-years, respectively (P=.06). Discontinuation was independently associated with method initiated and younger age. The only factors associated with lower risk of discontinuation were greater intent to use the method and being in school or working. The pregnancy rate (per 100 person-years) was highest for patch and ring initiators (30.1 and 30.5) and comparable for pill and depot medroxyprogesterone acetate initiators (16.5 and 16.1; P<.001).


CONCLUSIONS
The patch and the ring may not be better options than the pill or depot medroxyprogesterone acetate for women at high risk for unintended pregnancy. This study highlights the need for counseling interventions to improve contraceptive continuation, education about longer-acting methods, and developing new contraceptives that women may be more likely to continue.


METHODS
II.
From the Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California; Division of Adolescent Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, California.
Tina R
TR
Raine
Anne
A
Foster-Rosales
Ushma D
UD
Upadhyay
Cherrie B
CB
Boyer
Beth A
BA
Brown
Abby
A
Sokoloff
Cynthia C
CC
Harper
D000293:Adolescent; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D055118:Medication Adherence; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage; D011247:Pregnancy; D018873:Pregnancy Rate; D055815:Young Adult
D003271:Contraceptive Agents, Female; D017258:Medroxyprogesterone Acetate
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