Long acting reversible contraception in postpartum adolescents: early initiation of etonogestrel implant is superior to IUDs in the outpatient setting

Abstract

Study objective: To evaluate the outpatient initiation of postpartum long-acting reversible contraception (LARC).

Design: Prospective cohort study of pregnant adolescents' prenatal contraceptive intentions and successful postpartum initiation of LARC.

Setting: Urban, university hospital-affiliated, adolescent outpatient clinic.

Participants: Adolescents attending an integrated prenatal and postpartum maternity clinic.

Interventions: Data were collected via the electronic medical record and telephone interview.

Main outcome measures: Contraceptive intentions during the third trimester, contraceptive methods used postpartum, timing of LARC initiation, timing of resumption of intercourse.

Results: 116 patients were enrolled; 75% intended LARC use postpartum. Of 38 implant-intenders, 14 received it within 14 days postpartum. All reported abstinence pre-placement. Mean time to insertion was 18±13 days. Of 37 IUD-intenders, only two received one by 8 weeks postpartum. By 14 weeks postpartum, 43% received one. Over half reported intercourse prior to insertion; the only method of contraception used was condoms. Mean time to insertion was 70±11 days. Resumption of intercourse prior to initiation of the intended LARC method was significantly higher in IUD recipients compared to those who intended and received the implant (RR 8.8; CI 1.3-57.5).

Conclusion: In postpartum teens attending a clinic that prioritizes contraceptive use, the implant is far more likely to be received prior to resumption of sexual activity than the IUD. This may be due to more and earlier opportunities for placement, or waning commitment with time since delivery. Post-placental IUDs may be needed to equal the success of the implant in this patient population. Short-acting, reliable contraceptive methods should be implemented for postpartum adolescents preferring to wait for IUD insertion.