Adolescent mothers who receive prenatal contraceptive counseling or have a postnatal checkup are less likely than other teenage mothers to forgo contraceptives in the months after delivery, according to an analysis of surveillance data from seven states.[1] After adjustment for other characteristics, the predicted probability that a mother aged 15–19 would have unprotected sex was reduced if she had had prenatal contraceptive counseling (9% vs. 17%) or a postpartum checkup (9% vs. 19%). Moreover, adolescent mothers who had received prenatal contraceptive counseling were more likely than others to use the pill after delivery, and those who had had a postpartum checkup had an elevated probability of using the injectable, ring or patch and a reduced probability of relying on condoms or other methods with high failure rates.
At least one in 10 adolescent mothers become pregnant within a year of their first delivery. To assess the relationships of prenatal and postnatal care with postpartum use of contraceptives, researchers analyzed data from the Pregnancy Risk Assessment and Monitoring System, an ongoing state-level surveillance project that sends self-administered surveys to a stratified random sample of women 2–4 months after they have had a live birth. The current analysis was restricted to 3,207 participants aged 15–19 who were not pregnant, provided information on all study variables and lived in one of the seven states whose surveys in 2006–2008 sometimes or always asked about postpartum checkups (Arkansas, Missouri, New York, Rhode Island, South Carolina, Tennessee and West Virginia). Respondents provided information on their social and demographic characteristics and contraceptive practices; they also reported whether they had received contraceptive counseling during prenatal care and had had a postpartum checkup. Respondents were categorized as either using no contraceptive method but abstaining from sex; using no method but being sexually active; using a long-acting method (IUD, implant or sterilization); using a medium-acting method (injectable, ring or patch); using the pill; or using condoms or another method. The researchers used multinomial logistic regression to identify the associations of prenatal contraceptive counseling and postpartum checkups with contraceptive use after delivery, and reported their findings as predicted probabilities for ease of interpretation.
Two-thirds of the young women were aged 18–19, half were white and one in seven were married. Eighteen percent had had a previous live birth, and 36% had been using a contraceptive method when they became pregnant. Four-fifths had had prenatal contraceptive counseling, and a similar proportion had had a postnatal checkup. Seventy-eight percent completed the survey 3–5 months after delivery, but 13% completed it within three months of giving birth. Most participants were from New York (38%), Arkansas (18%), South Carolina or Tennessee (12% each).
At the time of the survey, 19% of young women were not using contraceptives; slightly more than half of nonusers were sexually active. The most commonly used contraceptives were the pill (30%) and medium-acting methods (24%); other respondents relied on an IUD, an implant or sterilization (12%) or on condoms, withdrawal or another method (15%).
In the multinomial regression analysis, receipt of prenatal contraceptive counseling was associated with an elevated predicted probability of pill use (32% vs. 22%) and a reduced probability of not using a method despite being sexually active (9% vs. 17%). The probability of use of other methods, including long- and medium-acting contraceptives, did not differ by prenatal counseling status.
Women who had had a postpartum checkup, on the other hand, had an elevated predicted probability of using a medium-acting method (26% vs. 12%), and reduced probabilities of using a condom or other failure-prone method (13% vs. 24%) and of having unprotected sex (9% vs. 19%). The probabilities of pill use and use of a long-acting method did not differ by postpartum checkup status.
In addition, compared with older adolescents, youth aged 15–17 were less likely to use condoms (11% vs. 16%) and more likely to use medium-acting methods (30% vs. 21%). Time since delivery was inversely related to the probability that a respondent was using a medium-acting contraceptive. Compared with blacks, whites were more likely to use the pill (35% vs. 23%) and less likely to use a medium-acting method (20% vs. 32%); Hispanics were more likely than whites and blacks to be abstaining (17% vs. 7% each). Finally, women who had been using contraceptives at the time of conception had a lower probability of engaging in unprotected postpartum sex than did women who had not been using a method (2% vs. 15%).
Limitations of the study, according to the authors, include that the sample was not nationally representative, women's responses were subject to recall bias, no information was available about the content of services provided at postnatal checkups and women who had had such checkups may have differed in important ways from those who had not. Nonetheless, the findings suggest that many adolescent mothers are at high risk for having a rapid repeat pregnancy because they are not practicing contraception or are using a method with a high failure rate, the investigators conclude. Moreover, the association of prenatal counseling with postnatal contraceptive use underscores the potential value of "enhancing the scope and quality of prenatal contraceptive counseling."—P. Doskoch
Reference
1. Wilson EK, Fowler CI and Koo HP, Postpartum contraceptive use among adolescent mothers in seven states, Journal of Adolescent Health, 2013, 52(3):278–283.