title: Adolescent mothers' postpartum contraceptive use: a qualitative study.
abstract: BACKGROUND
  Effective contraceptive use among first-time adolescent mothers can reduce the risk of a rapid repeat pregnancy and associated negative maternal and child health outcomes. Many adolescent mothers begin using a highly effective method after delivery; however, their rates of contraceptive discontinuation are high. Little research has explored the factors that influence adolescents' postpartum contraceptive use.
  
  
  METHODS
  In-depth interviews were conducted with 21 black, white and Latina adolescent first-time mothers from rural and urban areas of North Carolina between November 2007 and February 2009. In addition, interviews were conducted with 18 key informants-professionals who work closely with adolescent mothers. Interviews explored adolescent mothers' health behaviors, including contraceptive use, before and after pregnancy. Content analysis was used to identify key themes and patterns.
  
  
  RESULTS
  Teenagers' use of contraceptives, particularly injectables, IUDs and implants, increased postpartum. Reasons for this improvement included improved clarity of intention to avoid pregnancy and improved contraceptive knowledge, support and access after delivery. However, this increased access often did not continue long after delivery, and levels of method switching were high. Among the barriers to postpartum contraceptive use that key informants cited were lack of information and parental support, as well as the loss of Medicaid and continuity of care.
  
  
  CONCLUSIONS
  Ongoing follow-up may help reduce adolescent mothers' risk of contraceptive discontinuation postpartum. Increasing use of long-acting methods also may help reduce their vulnerability to gaps in contraceptive use and discontinuation, which increase the risk of unintended pregnancy.
authors.affiliation: RTI International, Research Triangle Park, NC, USA. ewilson@rti.org
authors.forename: Ellen K
authors.initials: EK
authors.lastname: Wilson
authors.forename: Ghazaleh
authors.initials: G
authors.lastname: Samandari
authors.forename: Helen P
authors.initials: HP
authors.lastname: Koo
authors.forename: Christine
authors.initials: C
authors.lastname: Tucker
mesh_terms: D000293:Adolescent; D003267:Contraception / Q000706:statistics & numerical data*; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D009657:North Carolina; D010287:Parent-Child Relations; D049590:Postpartum Period; D011247:Pregnancy; D011253:Pregnancy in Adolescence; D012424:Rural Population; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D014505:Urban Population