Reasons for Ineffective Contraceptive Use Antedating Adolescent Pregnancies Part 1: An Indicator of Gaps in Family Planning Services

Purpose Identify new ways to increase the impact of pregnancy prevention interventions on the number of children born to adolescents. Methods The study participants, a racially/ethnically diverse group of 1,568, pregnant 13–18 year olds, reported why they had not used contraception at the time of conception. Their explanations were sorted into categories. The frequency with which each category was endorsed, the stability of these endorsements (Kappa statistic), and differences between adolescents who endorsed each category (stepwise logistic regression) were examined at two points in gestation. Results “Not ready to prevent pregnancy” was the most frequently endorsed category; it was often the only category endorsed. Logistical barriers and misperceptions about the need for contraception were the least frequently endorsed categories. The reasons individual patients gave for not using contraception changed (K ≤ 0.4) during gestation. Yet, adolescents who were not ready to prevent conception consistently differed from those who were; they were more apt to be Hispanic, to live in non-chaotic environments with an adult father of the child rather than their parents, and to have goals compatible with adolescent childbearing. Conclusions The most expedient way to strengthen the impact of pregnancy prevention programs on adolescent childbearing is to shift the focus of intervention from overcoming logistical barriers and misperceptions about the need for contraception, to helping young women develop goals that make adolescent childbearing a threat to what they want in life. This means intervening actively enough to ensure that goal setting translates into an internal desire to postpone childbearing beyond adolescence.     

Contraceptive use and risk of unintended pregnancy in California

California is home to more than one out of eight American women of reproductive age. Because California has a large, diverse and growing population, national statistics do not necessarily describe the reproductive health of California women. This article presents risk for pregnancy and sexually transmitted infections among women in California based on the California Women's Health Survey. Over 8900 women of reproductive age who participated in this survey between 1998 and 2001 provide estimates of access to care and use of family-planning methods in the state. We find that 49% of the female population aged 18-44 in California is at risk of unintended pregnancy. Nine percent (9%) of women at risk of an unintended pregnancy are not using any method of contraception, primarily for method-related reasons, such as a concern about side effects or a dislike of available contraceptive methods. Among women at risk for unintended pregnancy, we find disparities by race/ethnicity and education in use of contraceptive methods.     

Contraceptive implants in Kenya: current status and future prospects

BACKGROUND: Since introducing Norplant over 20 years ago in Kenya, demand for contraceptive implants has remained high and implant costs are dropping substantially. METHODS: An assessment of the Kenyan experience with implants was conducted to understand level of demand, capacity to provide services and reproductive health impact of possible increased use. Interviews were conducted with 35 key Kenyan informants. By modeling increases in national implant use (at the expense of oral contraceptives), reductions in the annual number of unintended pregnancies were estimated. RESULTS: Kenya has an unmet need for implants and the current network of trained providers appears ready to increase the volume of services. If 100,000 users of oral contraceptives switch to implants, then an estimated 26,000 unintended pregnancies can be averted over a 5-year period. CONCLUSION: With increased purchases of implants by international donor agencies, Kenya can reduce reliance on short-term hormonal methods and reduce the 45% prevalence rate of unintended pregnancy.     

Contraceptive nonuse among US women at risk for unplanned pregnancy

BACKGROUND: This study was conducted to assess risk factors for contraceptive nonuse among a nationally representative sample of US women and explored the influence of future pregnancy intentions on contraceptive nonuse. STUDY DESIGN: Using data from the 2002 National Survey of Family Growth (NSFG), we analyzed 12 months of contraceptive behavior among 3687 women at risk for unplanned pregnancy. RESULTS: Compared with contraceptive users, contraceptive nonusers were more likely to be older than 40 years (OR 6.3, 95% CI 2.7-14.7), black (OR 1.8, 95% CI 1.2-2.8), less educated (OR 2.4, 95% CI 1.4-4.0), uninsured (OR 1.6, 95% CI 1.1-2.4), Medicaid recipients (OR 1.9, 95% CI 1.2-2.9) or having infrequent intercourse (OR 3.8, 95% CI 2.7-5.3). We found no significant association between future pregnancy intentions and contraceptive behavior. CONCLUSIONS: While family planning efforts have traditionally focused on disadvantaged women, older women and women who have infrequent sex are also at high risk for nonuse. Future pregnancy intentions, as currently assessed by the NSFG, is not a useful indicator of contraceptive behavior.     

Contraceptive method use in the United States: trends and characteristics between 2008, 2012 and 2014

Objective

The objective was to examine levels of, correlates of and changes in the use of individual and grouped methods of contraception among US females aged 15–44 from 2008 to 2014.

Having the Best Intentions is Necessary but not Sufficient: What would Increase the Efficacy of Home Visiting for Preventing Second Teen Pregnancies?

Objective: Identify ways to increase the impact a well-known home-based intervention—the Nurse Family Partnership (NFP)—has on conception rates among teenage mothers. Methods: Secondary analysis of data collected on 111, 13-to-19 years old, primiparas who were visited in their homes by nurses during, and for 2 years after pregnancy. Data bearing on assistance with family and career planning were culled from the nurses’ records. These were graded on a 3-point scale. Higher scores reflected more active, therapeutic interventions. The primary outcome was repeat pregnancy. Results: The pregnancy rate at 6, 12, and 24 months was 8.3%, 18.4%, and 28.1%. Teenagers who conceived were less likely to have used contraceptives during the previous six months than those who did not. Almost everyone received the recommended number of visits. However, discussions and active interventions related to lapses in contraceptive use were only documented during 30% of visits. Those who conceived had as many visits and discussions of this type as those who did not. Nurses rarely involved boyfriends and family. Other differences between teens that did and did not conceive support the NFP theoretical framework. Conclusions: Contrary to the stated aims of the intervention, the nurses rarely documented therapeutic interventions that could make repeated childbearing fit less harmoniously into the teenagers’ lives. The best way to strengthen the impact of this program on teen pregnancy rates is to deepen the nurses’ training so that they are able to intervene actively enough to bring about behavioral change in family planning.     

我国城乡居民对给未婚青少年提供避孕知识和避孕药具的态度

目的 探讨我国城乡居民对给未婚青少年提供避孕知识和药具的态度和提供避孕知识及避孕服务的可接受性和可行性。方法 取自2000年国家计生委组织开展的“预防艾滋病宣传教育项目基线调查”资料。在全国选择2个城市市区和5个农村乡镇采用分层随机抽样方法,调查15－49岁人群,包括已婚和未婚的男性和女性,结果 本次调查共获得7053份问卷,其中有效问卷7022份。调查结果显示,赞成向未婚青少年开展性教育和艾滋病教育的比例,城区和乡镇分别为83.9%、74.6%;89.2%、78.9%,认为在初中开始进行为宜占62.9%。赞成让未婚青少年了解避孕知识,城区占80.4%,乡镇占74.2%,女性赞成人数低于男性（P＝0.000）。对向未婚青少年提供避孕药具所持,人为应提供的城市和乡镇分别为41.7%和32.6%;认为视具体情况而定的分别为22.2%和9.6%,城市高于乡镇（P＝0.000）,男性高于女性（P＝0.000）,未婚高于已婚（P＝0.000）。结论 在我国应对未婚青少年进行避孕知识教育,并结合国情适时和适当地开展和提供相应服务。     

The relationship between body mass index and unintended pregnancy: results from the 2002 National Survey of Family Growth

BACKGROUND: The study was conducted to characterize the relationship between body mass index (BMI) and unintended pregnancy, contraceptive use patterns, and perceived fertility. METHODS: This study employed a cross-sectional, nationally representative database (2002 National Survey of Family Growth). Unintended pregnancy was compared among BMI groups [normal (<25 m/kg(2)), overweight (25-30 m/kg(2)) and obese (>30 m/kg(2))]. Analyses also evaluated the association between demographic, socioeconomic, behavioral and health-related variables and BMI. Multiple logistic regression with adjustment for sampling design was used to measure associations of interest. RESULTS: BMI data were available from 6690 nonpregnant women. Of these, 3600 (53.6%) were normal weight, 1643 (25%) were overweight and 1447 (21.4%) were obese. Compared to women with normal BMIs, the risk of unintended pregnancy in the last 5 years did not differ among overweight [adjusted OR 0.95 (95% CI 0.77-1.17)] or obese [adjusted OR 0.87 (95% CI 0.70-1.09)] women. There were no differences in contraceptive use patterns or perceived fertility among BMI groups. CONCLUSION: Data from the 2002 NSFG do not support an association between obesity and unintended pregnancy.     

Preventing Unintended Pregnancies and Improving Contraceptive Use Among Young Adult Women in a Rural,Midwestern State: Health Promotion Implications

Despite high rates of unintended pregnancy among women aged 18 to 30 years, little research has been conducted to understand the factors associated with their contraceptive use. Eighteen focus groups were conducted with young adult women (N = 106) who were mostly white, non-Hispanic. Results suggested that contraceptive use was negatively affected by low contraceptive knowledge; use of alcohol; a lack of planning for sex; a misperception of the likelihood of pregnancy; forgetting to use contraceptives; and concerns about side effects, cost, and confidentiality. Women liked the peace of mind that using contraceptives gave them and the benefits of regular periods from some hormonal methods. Implications for reducing unintended pregnancies through interventions are offered.     

Social Disadvantage as a Risk for First Pregnancy Among Adolescent Females in the United States

Purpose

Differences in underlying determinants of pregnancy at different stages of adolescent development have implications for prevention strategies. We sought to determine whether social disparities in rates of adolescent pregnancy vary between early, middle, and late adolescence. We hypothesized that as age increases, racial and socioeconomic disparities in rates of teen conception decrease.

Methods

Data were obtained from the National Survey of Family Growth cycle 6. Outcome variables indicated whether respondents had a first pregnancy at ages <15 years, 15–17 years, or 18–19 years. Independent variables were race and maternal education level. Logistic regression was used to calculate the relative odds of first conception in a given age range by race and maternal education level.

Results

The disparity in odds of pregnancy between black and white teens is maximal in early adolescence (odds ratios <15 years: 3.9) and decreased by nearly 50% in late adolescence (odds ratios 18–19 years: 2.0, p < .01). After stratifying by maternal education level, the same trends are seen.

Conclusions

In accordance with our hypothesis, we found that social disparities in pregnancy rates decrease between early and late adolescence. Although pregnancy prevention efforts often target those at social risk including poor minority youth, fewer acknowledge and target the risks associated with development of sexuality in all teens. Efforts to better define the nature of healthy adolescent sexual development may lead to pregnancy prevention interventions focused on developmental risk that can apply to a wider set of adolescents.     

Factors Affecting Contraceptive Use in Ethiopian: A Generalized Linear Mixed Effect Model

BackgroundEthiopia is the second most populous nations in Africa. Family planning is a viable solution to control such fast-growing population. This study aimed to assess the prevalence of contraceptive use and its predictors in Ethiopia.MethodsAbout 4,563 women were drawn randomly by Central Statistics Agency from its master sampling frame. The survey was conducted from January, 2014 to March, 2016 within six months'' interval for the study period. The study was conducted using secondary data collected by PMA2020/Ethiopia project. Negative Binomial regression model was employed for data analysis. The model was selected using information criterion.ResultsPredictors like easy access of health service, residence area, level of health institutions, regions, availability of community health volunteers, experience sharing, support from husbands, level of education and employment status of women as well as residence area significantly affected the performance of contraceptive use in Ethiopia. From the interaction effects of health centers with region and health post with number of opening days per a week were significant predictors of the contraceptive use.ConclusionThe performance of contraceptive use was different from one individual to another because of their experience sharing, support from their husbands, employment status and education level. A woman who got encouragement to use birth control from her husband had good performance to be effective for her contraceptive use. There should be an experience sharing/orientation, about use of birth control to protect women from unwanted pregnancy. Hence, rural women should get experience from urban women.     

Evaluating teen options for preventing pregnancy: Impacts and mechanisms

This paper presents findings from an experimental evaluation of the Teen Options to Prevent Pregnancy (TOPP) program, an 18-month intervention that consists of a unique combination of personalized contraceptive counseling, facilitated access to contraceptive services, and referrals to social services. We find that TOPP led to large and statistically significant increases in the use of long-acting reversible contraceptives (LARCs), accompanied by substantial reductions in repeat and unintended pregnancy among adolescent mothers. We provide an exploratory analysis of the channels through which TOPP achieved its impacts on contraceptive behavior and pregnancy outcomes. A back-of-the-envelope decomposition implies that the increase in LARC use can explain at most one-third of the reduction in repeat pregnancy. We provide suggestive evidence that direct access to contraceptive services was important for increasing LARC use and reducing repeat pregnancy. We did not find any spillover effects on non-targeted outcomes, such as educational attainment and benefit receipt.     

Contextual Variation in Early Adolescent Childbearing: A Multilevel Study From 33,822 Communities in 44 Low- and Middle-Income Countries

PurposeExisting literature calls for a deeper examination into how local context influences adolescent sexual and reproductive health outcomes. We seek to describe individual and contextual variation in early adolescent childbearing (younger than 16 years) in 44 low- and middle-income countries by (1) examining the role of individual-level social disadvantage, (2) exploring the ecological influence of context at the country and community level, and (3) assessing whether ecological effects vary according to a woman's wealth.MethodsWe used nationally representative data from 33,822 communities in 44 low- and middle-income countries. We employed multilevel modeling to examine the variation in early adolescent childbearing apportioned to the individual, community, and country levels.ResultsGlobally, poverty and low educational attainment are associated with early adolescent childbearing. After accounting for individual-level characteristics, significant residual variance remains at both the community and country levels. Routine, individual-level covariates explain 46.4% of the total variance at the community level and 21.3% of the total variance at the country level in relation to the baseline, age-adjusted model. The variance apportioned to the community level is estimated to equal 43.5% (95% confidence interval: .40, .49) of the total variance among the poorest women compared with 32.6% (95% confidence interval: .25, .39) among the richest women. Across countries, we find substantial heterogeneity in the variance observed at the community level.ConclusionsOur results point to the need for a continued focus on multilevel interventions that include approaches to target both the individual and population levels. More research is needed to identify the mechanisms through which local context influences adolescent sexual and reproductive health outcomes.     

Adolescent Neurological Development and its Implications for Adolescent Substance Use Prevention

Recent technological advancements have facilitated the study of adolescent neurological development and its implications for adolescent decision-making and behavior. This article reviews findings from the adolescent neurodevelopment and substance use prevention literatures. It also discusses how findings from these two distinct areas of adolescent development can complement each other and be used to build more developmentally appropriate interventions for preventing adolescent substance use. Specifically, a combination of child-centered and family-based strategies is advocated based on extant neurological and prevention literature. Editors’ strategic implications: Researchers are encouraged to take up the authors’ challenge and study the links between adolescent neurological development/decision making ability and the long term efficacy of comprehensive interventions for preventing adolescent substance use.     

Adolescent Cannabis Use During a Period of Rapid Policy Change: Evidence From the PATH Study

PurposeTo determine whether shifts in various state-level cannabis policies are associated with individual-level changes in adolescent cannabis use following implementation.MethodsWe use the restricted-access youth cohort of the PATH Study, a recent, longitudinal, and nationally representative dataset, to assess whether changes in cannabis policy affect youth cannabis use. Data include respondents aged 12 to 17 years across up to six repeated observations (N = 26,673). Hybrid (between-person and within-person) panel models are used to examine adolescent past-month cannabis use.ResultsWithin-person effects showed that the odds of past-month cannabis use are lower (odds ratio [OR] = 0.632; p < .05) in years when a respondent's state allowed only cannabidiol (CBD) compared to years when the state had legalized medical cannabis. The odds of past-month cannabis use are lower during years when a respondent's state had decriminalized (OR = 0.617; p < .01) or criminalized (OR = 0.648; p < .05) adult recreational cannabis possession compared to years when it was legalized. These effects were robust to numerous controls, including time and state fixed effects. By contrast, significant between-person effects became nonsignificant with state fixed effects included, implying that state-level average use distinguishes average differences between states rather than policy.DiscussionLiberalized cannabis policy is significantly associated with recent adolescent cannabis use. The most consequential policy shift associated with adolescent use is from either criminalization or decriminalization of cannabis possession to legalization, such that states making these changes should consider additional prevention efforts.     

Inspiring Healthy Adolescent Choices: A Rationale for and Guide to Strength Promotion in Primary Care

The social, emotional, and biological health of adolescents requires their development as autonomous beings who make responsible decisions about their own health. Clinicians can assist in this development by adopting a strength-based approach to adolescent health care, which applies concepts from positive youth development to the medical office setting.     

Computer-assisted motivational interviewing for contraceptive use in women leaving prison: A randomized controlled trial

ObjectivesRates of unintended pregnancies in women with a history of incarceration are high and access to contraception before and after arrest can be limited. Individualized counseling can better prepare women for healthy pregnancy or provide an opportunity for contraceptive education and access within correctional facilities. In this study, we assessed the efficacy of motivational interviewing as an individualized intervention to increase the initiation of contraceptive methods while incarcerated and continuation after release in female inmates who wanted to avoid pregnancy for at least one year after release.Study designWe performed an RCT in a population of incarcerated women who wanted to avoid pregnancy. Women were randomized to either a computer-assisted motivational interviewing intervention group (n = 119) or an educational video with counseling control group. (n = 113). The primary outcome was initiation of a method of birth control prior to release from the correctional facility.ResultsInitiation of contraception was higher in the intervention group (56% vs. 42%, p = 0.03), but this difference was not significant after controlling for number of male partners within the year prior to incarceration. There was no difference between the groups in the rates of pregnancies or STIs or continuation of contraception after release, which was generally low (21%).ConclusionComputer-assisted motivational interviewing did not improve uptake or continuation of contraception in this study.ImplicationsPeriods of incarceration provide an opportunity to offer contraceptive services to women who want to avoid a pregnancy. Motivational interviewing may not be an effective method to affect contraceptive behaviors in this population. Future research should explore the family planning values and preferences of women who become involved with the correctional system.