Long-Acting Reversible Contraception Counseling and Use for Older Adolescents and Nulliparous Women.
The majority of pregnancies during adolescence are unintended, and few adolescents use long-acting reversible contraception (LARC) due in part to health care providers' misconceptions about nulliparous women's eligibility for the intrauterine device. We examined differences in LARC counseling, selection, and initiation by age and parity in a study with a provider's LARC training intervention.



Sexually active women aged 18-25 years receiving contraceptive counseling (n = 1,500) were enrolled at 20 interventions and 20 control clinics and followed for 12 months. We assessed LARC counseling and selection, by age and parity, with generalized estimated equations with robust standard errors. We assessed LARC use over 1 year with Cox proportional hazards models with shared frailty for clustering.



Women in the intervention had increased LARC counseling, selection, and initiation, with similar effects among older adolescent and nulliparous women, and among young adult and parous women. Across study arms, older adolescents were as likely as young adults to receive LARC counseling (adjusted odds ratio [aOR] = .85; 95% confidence interval [CI]: .63-1.15), select LARC (aOR = .86; 95% CI: .64-1.17), and use LARC methods (adjusted hazard ratio [aHR] = .94; 95% CI: .69-1.27). Nulliparous women were less likely to receive counseling (aOR = .57; 95% CI: .42-.79) and to select LARC (aOR = .53; 95% CI: .37-.75) than parous women, and they initiated LARC methods at lower rates (aHR = .65; 95% CI: .48-.90). Nulliparous women had similar rates of implant initiation but lower rates of intrauterine device initiation (aHR = .59; 95% CI: .41-.85).



Continued efforts should be made to improve counseling and access to LARC methods for nulliparous women of all ages.
Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California. Electronic address: sgibbs@jhu.edu.
Susannah E
SE
Gibbs
Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California.
Corinne H
CH
Rocca
Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon.
Paula
P
Bednarek
Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California.
Kirsten M J
KMJ
Thompson
Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California.
Philip D
PD
Darney
Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California.
Cynthia C
CC
Harper
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D037001:Directive Counseling / Q000706:statistics & numerical data*; D005193:Family Planning Services / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D057194:Intention to Treat Analysis; D000075523:Long-Acting Reversible Contraception / Q000706:statistics & numerical data*; D010298:Parity; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control*; D016016:Proportional Hazards Models; D014481:United States; D055815:Young Adult
Adolescent; Long-acting reversible contraception; Nulliparous
Am J Prev Med. 2001 Jul;21(1):60-5
11418259
Am J Public Health. 2007 Jan;97(1):150-6
17138906
Am J Obstet Gynecol. 2007 Jul;197(1):118
17618790
Contraception. 2008 Jan;77(1):10-21
18082661
Contraception. 2008 Sep;78(3):211-7
18692611
Obstet Gynecol. 2009 Dec;114(6):1434-8
20134301
MMWR Recomm Rep. 2010 Jun 18;59(RR-4):1-86
20559203
Contraception. 2010 Aug;82(2):178-82
20654760
J Adolesc Health. 2010 Sep;47(3):312-4
20708573
Contraception. 2011 May;83(5):397-404
21477680
Obstet Gynecol. 2011 Jun;117(6):1349-57
21606745
Contraception. 2011 Nov;84(5):493-8
22018123
J Pediatr Adolesc Gynecol. 2012 Feb;25(1):39-42
22051791
Am J Obstet Gynecol. 2012 Jun;206(6):526.e1-5
22425402
Obstet Gynecol. 2012 Apr;119(4):762-71
22433340
Am J Obstet Gynecol. 2012 Jun;206(6):481.e1-7
22631865
Fertil Steril. 2012 Oct;98(4):893-7
22795639
Am J Public Health. 2012 Oct;102(10):1872-8
22897549
Obstet Gynecol. 2012 Oct;120(4):983-8
22996129
Fam Med. 2012 Oct;44(9):637-45
23027156
J Pediatr Adolesc Gynecol. 2013 Apr;26(2):86-95
23287602
J Adolesc Health. 2013 Mar;52(3):372-4
23427785
Obstet Gynecol. 2013 Nov;122(5):1083-91
24104781
Prev Med. 2013 Dec;57(6):883-8
24128950
J Pediatr Adolesc Gynecol. 2013 Dec;26(6):358-65
24238267
Obstet Gynecol. 2014 Mar;123(3):585-92
24499755
Contraception. 2014 May;89(5):446-50
24560479
Contraception. 2014 Jun;89(6):572-7
24679477
Womens Health Issues. 2014 May-Jun;24(3):e281-9
24725755
Perspect Sex Reprod Health. 2014 Sep;46(3):171-5
24861029
Pediatrics. 2014 Oct;134(4):e1244-56
25266430
N Engl J Med. 2014 Oct 2;371(14):1316-23
25271604
J Pediatr Adolesc Gynecol. 2015 Aug;28(4):229-33
26024942
Lancet. 2015 Aug 8;386(9993):562-8
26091743
J Adolesc Health. 2015 Oct;57(4):381-6
26126950
Obstet Gynecol. 2015 Oct;126(4):823-9
26348177
Obstet Gynecol. 2015 Nov;126(5):917-27
26444110
Am J Obstet Gynecol. 2016 Jun;214(6):716.e1-8
26692178
Am J Public Health. 2016 Mar;106(3):541-6
26794168
N Engl J Med. 2016 Mar 3;374(9):843-52
26962904