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Factors Associated With Contraceptive Method Choice and Initiation in Adolescents and Young Women

  • Rebecca Cohen
    Correspondence
    Address correspondence to: Rebecca Cohen, M.D., M.P.H., University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue B198-2, Aurora, CO 80045.
    Affiliations
    Division of Family Planning, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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  • Jeanelle Sheeder
    Affiliations
    Division of Family Planning, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado

    Section of Adolescent Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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  • Author Footnotes
    1 Robert Wood Johnson University Hospital Somerset, 110 Rehill Avenue, Somerville, NJ 08876, USA.
    Meghan Kane
    Footnotes
    1 Robert Wood Johnson University Hospital Somerset, 110 Rehill Avenue, Somerville, NJ 08876, USA.
    Affiliations
    Division of Family Planning, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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  • Stephanie B. Teal
    Affiliations
    Division of Family Planning, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado

    Section of Adolescent Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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  • Author Footnotes
    1 Robert Wood Johnson University Hospital Somerset, 110 Rehill Avenue, Somerville, NJ 08876, USA.

      Abstract

      Purpose

      The purpose of the study was to identify factors associated with uptake of contraceptive implants or intrauterine devices (IUDs) by adolescents and young women.

      Methods

      For this prospective cohort study, we recruited English-speaking female contraceptive initiators aged 14–24 years attending a Title X-supported, youth-focused clinic. Immediately prior to their visits, participants completed surveys assessing demographic and reproductive characteristics and awareness of, interest in, and intent to initiate specific contraceptive methods. Participants also answered questions about their social contacts' contraceptive experiences. Following the visit, participants reported the method initiated and the perceived importance of provider counseling. We used a multivariable regression model to ascertain factors associated with initiation of an IUD, an implant, or a short-acting reversible method.

      Results

      We enrolled 1,048 contraceptive initiators: 277 initiated short-acting methods, 384 IUDs, and 387 implants. High previsit personal acceptability of the method was associated with choosing that method for both implants and IUDs. Knowing someone who uses a specific method and likes it was predictive of personal acceptability of that method (IUD adjusted odds ratio: 10.9, 95% confidence interval: 3.8–31.1; implant adjusted odds ratio: 7.0, 95% confidence interval: 2.3–21.0). However, 10.4% of those initiating IUDs and 14.2% of those initiating implants had never heard of the method before their appointment. Even women with previsit intent to initiate a specific method found importance in contraceptive counseling.

      Conclusions

      Previsit personal acceptability, which was associated with social contacts' experiences, was the strongest predictor of specific method uptake in our study. However, counseling informed the decisions of those with low previsit awareness and supported patients with formed intent.

      Keywords

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