Justification for the project
Long-acting reversible contraceptive (LARC) methods such as etonogestrel contraceptive implants and intrauterine devices (IUDs) have low failure rates and are effective at preventing teen pregnancy. High upfront cost limits use of these methods, but acceptability and initiation are high among adolescents when these methods are offered for free. While continuation rates of LARC methods are higher than those of short-acting reversible methods such as oral contraceptive pills, in one large cohort the 2-year discontinuation rate among adolescents using any LARC method was 33.5%. Identifying predictors of discontinuation is the first step in developing interventions to improve method satisfaction and continuation.
Between 9/2011 and 4/2013, 1067 women ages 14-24 attending BC4U (an adolescent-focused Title X clinic) for a contraceptive initiation visit enrolled in a prospective cohort examining factors associated with choice of contraceptive method. Of this cohort, 389 young women initiated use of etonogestrel implants and 387 initiated use of IUDs. They provided baseline demographic, reproductive, knowledge and attitudinal measures and consent for future contact and record review. We will examine method continuation and reasons for discontinuation over the intervening 30-46 months. This is a unique opportunity to examine baseline factors and experience of side-effects associated with contraceptive discontinuation and method switching. Our goal is to identify the extent to which time to discontinuation of LARC among adolescents is associated with baseline characteristics, method choice, initial confidence in method choice, and experience of side-effects.