ATLANTA — Advanced provision of emergency contraceptive pills did not significantly decrease the rapid repeat pregnancy rate in a racially and ethnically diverse group of adolescents enrolled in a Colorado study “because many of the young women failed to use them,” Jeanelle Sheeder reported at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.
To better understand why emergency contraceptive pills (ECPs) have not had the anticipated impact on teen pregnancy, Ms. Sheeder and colleagues in the department of pediatrics at the University of Colorado Health Sciences Center in Denver assessed the sexual and contraceptive behavior of 382 predominantly primiparous 14- to 21-year-old women in that institution's adolescent maternity program. At the time of enrollment, all of the young women expressed a desire not to get pregnant again for at least 2 years. Each participant received either a prescription for or a packet of ECPs, with no limit on refills.
At each clinic visit, conducted at 6- to 8-week intervals through the sixth postpartum month, the study participants completed a questionnaire that asked about their interval sexual and contraceptive behavior, Ms. Sheeder said.
Controlling for age, race/ethnicity, education level, reason for not using contraception before conception, future family plans, and postpartum month, the investigators also analyzed the use of ECPs in relation to unprotected intercourse.
During the course of the study, 44% of the young mothers had episodes of unprotected intercourse, said Ms. Sheeder, noting that “of these women, 15% reported one episode of unprotected intercourse, 24% had two to four episodes, and 5% had more than four episodes.”
While more than half (54%) of the women reporting unprotected intercourse used ECPs, only 28% used them appropriately, Ms. Sheeder noted. “They were underutilized by 65% of the women and 7% engaged in augmented use,” she said.
A total of 19 pregnancies occurred during the study period. “Teens who experienced unwanted pregnancies did not engage in more unprotected intercourse or ECP underuse than those who did not,” Ms. Sheeder noted.
Of the 19 pregnancies, 9 were in young women who reported using some contraceptive method during the study period but their contraceptive use was inconsistent or incorrect. The remaining 10 pregnancies were not attributable to unrecognized contraceptive or ECP failure.
The findings suggest a high prevalence of unprotected intercourse during the first 6 postpartum months among teen mothers who say they don't want a rapid repeat pregnancy, said Ms. Sheeder. “Additionally, it appears that the reason ECPs have not significantly decreased the repeat teen pregnancy rate is because most teen mothers underutilize ECPs even when they have them on hand,” she said.