Teen Pregnancies Plummet With Free Contraception, Education

Beth Skwarecki

October 02, 2014

Teenagers who were educated about contraceptive options and offered free birth control frequently choose long-acting reversible contraceptives (LARCs) and rarely got pregnant, according to a prospective cohort study published in the October 2 issue of in the New England Journal of Medicine.

The popular choices in this study, dubbed the Contraceptive CHOICE Project, were the same methods the American Academy of Pediatrics recently announced should be first-line choices for young women.

"By providing all these methods free of charge and promoting the use of the most effective methods, we found that most women chose the most effective methods, the [intrauterine device [IUD]) and the implant," Jeffrey Peipert, MD, PhD, from the Division of Clinical Research, Department of Obstetrics and Gynecology at Washington University School of Medicine in St. Louis, Missouri, said in a press statement. "Seventy-two percent of teenagers in the CHOICE project chose the long-acting methods. This is in contrast to the national rate of approximately 4 to 5%."

Gina M. Secura, PhD, MPH, also from the Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, and colleagues write that lack of information, limited access, and cost have been cited as the major factors preventing teenagers from using LARCs. This study was designed to remove those barriers.

The young women in the study were between 14 and 19 years of age at enrollment. Of the 1404 participating minors, all but four enrolled with their parents' written consent. Participants were sexually active (97%) or planning to be sexually active within the next 6 months, had no desire for pregnancy in the next 12 months, and were not using contraception or were willing to switch the type of contraception they used. Half had previously been pregnant, and 18% had had abortions.

At an enrollment session, a counselor presented participants with information about contraceptive options in order from most to least effective, reviewing the benefits of each. Participants received the method of their choice the same day, where possible, according to evidence-based guidelines, and were screened for sexually transmitted infections. The investigators contacted the women for follow-up telephone interviews after 3 months, and then every 6 months for 2 to 3 years.

The younger women, age 14 to 17 years, were more likely than the older teenagers to choose long-acting reversible methods. Of those choosing LARCs, younger teenagers were more likely to choose implants, and older teenagers were more likely to choose IUDs.

Follow-up rates at 1, 2, and 3 years were 92%, 82%, and 75%, respectively. The rate of pregnancy was 34.0 per 1000 women in the cohort (95% confidence interval, 25.7 - 44.1) compared with 158.5 per 1000 for sexually active teenagers and 57.4 for all teenagers nationwide. Birth rates were also significantly lower, at 19.4 births per 1000 (95% confidence interval, 13.3 - 27.4) compared with 94.0 for sexually active US teenagers and 34.4 among all US teenagers. Abortion rates were 9.7 per 1000 in the study (95% confidence interval, 5.6 - 15.8) compared with 41.5 for sexually active US teenagers and 14.7 for all US teenagers.

Among women who got pregnant, the methods they were using at the time of conception were the levonorgestrel IUD (two participants), depot medroxyprogesterone acetate injection (one participant), oral contraceptive pills (13 participants), the ring (four participants), the patch (two participants), condoms (nine participants), and no method (25 participants).

The authors note several caveats in generalizing the results of the study, including self-report of pregnancies and comparison with national statistics, using a variety of methods. In addition, the follow-up interviews may have encouraged the teenagers to keep using their chosen method. One difficulty in comparing the study results between 2008 and 2013 with national data from 2010 is that teenage pregnancy rates declined nationally by 15% between 2008 and 2010, which is the last year for which pregnancy rates were available. The investigators write that, "Even with this continued decline, the reductions observed in [the study] are substantial and of public health importance."

The study was supported by grants from the Susan Thompson Buffett Foundation, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Center for Advancing Translational Sciences, National Institutes of Health. Dr Peipert has reported receiving fees for serving on advisory boards from Bayer, Teva, MicroCHIPS, and Watson/Activis and receiving grant support from Bayer, Teva, and Merck. One coauthor has reported receiving fees for serving on advisory boards from Bayer. The other authors have disclosed no relevant financial relationships.

N Engl J Med. 2014;371:1316-1323. Full text

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