SAN DIEGO – Long-acting reversible contraceptives reduced teen pregnancy by 56%, compared with national statistics for teens overall, preliminary results from an ongoing analysis demonstrated.
At the annual meeting of the North American Society for Pediatric and Adolescent Gynecology, Dr. Tessa Madden shared updated findings from the Contraceptive CHOICE Project, an effort to promote LARC use in the St. Louis region and to measure acceptability, satisfaction, side effects, and the rates of continuation across a variety of contraceptive methods, including LARCs. The goals were to increase IUD use in the St. Louis region from 1%-2% to 6% or greater, to improve the rates of postabortion IUD use from less than 1% to 10% or greater, and to increase the use of contraceptive implants to 3% or greater.
Dr. Tessa Madden
The investigators also hypothesized that teen pregnancy rates would decline by 10%. "It turns out that we were overly conservative in our estimates for what we could do," said Dr. Madden of Washington University in St. Louis. "We also hypothesized that women who got a LARC method would have higher rates of continuation and higher rates of satisfaction, compared with women who were using shorter-acting reversible methods."
Study participants included 9,256 women who lived in either the city of St. Louis or St. Louis County. The women were 14-45 years of age, were either currently sexually active or planning on becoming sexually active, did not want to become pregnant in the next 12 months, and were willing to start a new contraceptive method. Two-thirds of the participants enrolled at the Washington University School of Medicine, while the remainder enrolled at one of 13 partner community clinics.
Participants who enrolled in the clinical university site underwent formal standardized counseling. "Trained contraceptive counselors read a script to participants before they enrolled in the project, and they had models to demonstrate the different kinds of contraceptive methods," Dr. Madden explained. Study participants "heard about contraceptive methods in a tier-based approach, so they heard about the most effective methods first." Those who enrolled at the community clinic underwent "usual" counseling.
In a study from the first 5,087 enrolled in the Contraceptive CHOICE Project, Dr. Madden and her associates reported that at 12 months, 86% of patients who chose a LARC were still using it, compared with only 55% of those who chose a non-LARC method (Obstet. Gynecol. 2011;117:1105-13). This closely mirrored the percentage of patients who reported overall satisfaction with their chosen birth control method (84% in the LARC group vs. 53% in the non-LARC group). Comparing LARC and non-LARC methods, we see that 84% of participants were satisfied with their LARC method at 12-months, compared with 53% of participants using non-LARC methods.
At the meeting, Dr. Madden discussed preliminary findings from the overall study population, as well as from a cohort of 1,404 adolescents in CHOICE, who were aged 14-19 at the time of enrollment. Of the adolescents, 63% were black, 30% were white, and the rest were from other racial groups. Half of the teens had a prior pregnancy.
A full 75% of women in the overall population chose an IUD or an implant, compared with 72% of the adolescents, "which is still pretty high," Dr. Madden said. Implant use in the overall population was 17%, compared with 34% among adolescents. "Implants were more acceptable to the younger teens, and IUDs become more acceptable to the older teens," she noted.
Only 7% of those under age 20 years discontinued any LARC by 6 months, compared with 8% of those aged 20 years and older, a difference that was not statistically significant (P = .17). "I’m hoping this can help put to bed the notion that teens get these [LARC] methods and then decide 6 weeks later that they want the [device] out," Dr. Madden said. "This does not happen in most cases."
The annual pregnancy rate among adolescents in CHOICE who chose a LARC was 29.9/1,000, compared with the 2008 U.S. teen pregnancy rate of 67.8/1,000, a reduction of 56%.
The findings matter, she added, "because LARCs really are better at preventing unintended pregnancy compared with non-LARC methods. Our follow-up rates at 1 year are greater than 90%. We found that women who were using contraceptive pills, patches, or rings had a 20-fold increased risk of unintended pregnancy, compared with women using a LARC method. We also found that LARCs were just as effective in young women compared with older women."
Dr. Madden predicted that consumer interest in LARCs will continue to grow because "more women and adolescents are asking for these methods. They’re reading about them online and people are blogging about them, so they’re more empowered to ask for them."