CC BY 4.0 · Rev Bras Ginecol Obstet 2019; 41(10): 607-612
DOI: 10.1055/s-0039-1697985
Original Article
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Empowering Adolescent Mothers in the Choice of Contraceptive Methods at the Postpartum Period: Avoiding a Subsequent Pregnancy

Empoderando mães adolescentes na escolha do método contraceptivo no pós-parto: Evitando-se a gravidez subsequente
Anderson Borovac-Pinheiro
1   Department of Tocogynecology, Medical Sciences School, Universidade Estadual de Campinas, Campinas, SP, Brazil
,
Erica Almeida Ramos Jesus
1   Department of Tocogynecology, Medical Sciences School, Universidade Estadual de Campinas, Campinas, SP, Brazil
,
1   Department of Tocogynecology, Medical Sciences School, Universidade Estadual de Campinas, Campinas, SP, Brazil
› Author Affiliations
Further Information

Publication History

25 March 2019

12 August 2019

Publication Date:
28 October 2019 (online)

Abstract

Objective Almost 80% of adolescent pregnancies are unplanned, and between 28 and 63% of adolescent mothers had a repeated pregnancy within 18 months. Among girls with repeated pregnancies, two-thirds reported that the pregnancy was unplanned. We aim to assess contraceptive use by adolescent mothers with increasing choice for long-acting reversible contraception (LARC) methods in postpartum consultation after a semistructured group intervention involving adolescent mothers.

Methods Retrospective observational study conducted at the Universidade Estadual de Campinas, Campinas, state of São Paulo, Brazil, involving new antenatal and postpartum education groups for adolescents. At postpartum consultations, the adolescents chose their contraceptive. The data was compared with previous series followed in a period before the implementation of the education group – a historical control group.

Results We included 129 adolescent after childbirth from January 1st, 2015 through July 31st, 2017. Out of this total, 63% had ever used contraceptive methods before pregnancy, and the most frequent method was combined oral contraceptives (33%) followed by condoms (21%). At the first postpartum consultation, the most common contraceptive chosen was intrauterine contraception (IUC) (37.2%) and depot-medroxyprogesterone acetate (DMPA) (34.1%). When comparing the rates before and after the education interventions, there was a 3-fold increase in the use of IUCs.

Conclusion Antenatal and postpartum education have shown a significant increase in the choice for LARC methods among adolescent mothers, with very high acceptability after a period using the method. The educational groups performed during the antenatal care and beyond the gestational period are easy to be applied worldwide with low dependence on funding.

Resumo

Objetivo Cerca de 80% das gestações na adolescência não são planejadas, e entre 28 e 63% das mães adolescentes apresentam repetição da gravidez em 18 meses. Entre as meninas com gravidez repetida, dois terços relataram que a gravidez não foi planejada. Nosso objetivo é avaliar o uso de anticoncepcionais por mães adolescentes com crescente escolha para métodos de contracepção reversível de longa ação (LARCs, na sigla em inglês) na consulta pós-parto após uma intervenção em grupo semiestruturada envolvendo mães adolescentes.

Métodos Estudo observacional retrospectivo realizado na Universidade Estadual de Campinas, São Paulo, SP, Brasil, envolvendo novos grupos de educação pré-natal e pós-parto para adolescentes. Nas consultas pós-parto, os adolescentes optaram pela contracepção. Os dados foram comparados com uma série de casos seguida em um período anterior à implementação do grupo de educação pré-natal - um grupo de controle histórico.

Resultados Foram incluídas 129 adolescentes no período pós-parto de 1° de janeiro de 2015 a 31 de julho de 2017. Destas, 63% já tinham usado métodos contraceptivos antes da gravidez, e o método prévio mais frequente foi contraceptivo oral combinado (33%) seguido por preservativo (21%). Na primeira consulta pós-parto, o anticoncepcional mais comumente escolhido foi o dispositivo intrauterino (DIU) (37,2%) e o acetato de medroxiprogesterona de depósito (DMPA) (34,1%). Ao comparar as taxas antes e depois das intervenções de educação pré-natal, houve um aumento de três vezes no uso de DIUs.

Conclusão Educação pré-natal e pós-parto mostraram um aumento significativo na escolha de métodos contraceptivos reversíveis de longa duração entre mães adolescentes. Grupos educativos realizados durante o pré-natal e além do período gestacional são ferramentas para promoção da saúde e são de fácil aplicação mundial, com baixa dependência de financiamento.

Contributions

Borovac-Pinheiro A. and Surita F. G. conceived and designed the study. Borovac-Pinheiro A. and Jesus E. A. R. collected the data. All of the authors were involved in the data analysis and interpretation. Borovac-Pinheiro A.and Surita F. G. were involved in writing. All of the authors approved the final version of the manuscript.


 
  • References

  • 1 United Nations Sustainable Development Summit 2015 https://sustainabledevelopment.un.org/post2015/summit . Accessed March 1, 2017.
  • 2 United Nations Population Fund. Girlhood, not Motherhood: Preventing Adolescent Pregnancy. New York, NY: UNFPA; 2015 https://www.unfpa.org/sites/default/files/pub-pdf/Girlhood_not_motherhood_final_web.pdf . Accessed April 24, 2018.
  • 3 Galvão RBF, Figueira CO, Borovac-Pinheiro A, Paulino DSM, Faria-Schützer DB, Surita FG. Hazards of repeat pregnancy during adolescence: a case-control study. Rev Bras Ginecol Obstet 2018; 40 (08) 437-443 . Doi: 10.1055/s-0038-1666811
  • 4 World Health Organization. World Health Statistics 2018: Monitoring Health for the SDGs, Sustained Development Goals. Geneva: WHO; 2018 https://apps.who.int/iris/bitstream/handle/10665/272596/9789241565585-eng.pdf?ua=1 . Accessed April 29, 2018.
  • 5 Chiarotti S. . coord. Niñas Madres. Embarazo y Maternidad Infantil Forzada en América Latina y el Caribe. Buenos Aires: CLADEM; 2016 http://clademargentina.com.ar/wp-content/uploads/2017/03/Ni%C3%B1as-Madres-Balance-Regional.pdf . Accessed May 22, 2018.
  • 6 Leftwich HK, Alves MVO. Adolescent Pregnancy. Pediatr Clin North Am 2017; 64 (02) 381-388 . Doi: 10.1016/j.pcl.2016.11.007
  • 7 Meade CS, Ickovics JR. Systematic review of sexual risk among pregnant and mothering teens in the USA: pregnancy as an opportunity for integrated prevention of STD and repeat pregnancy. Soc Sci Med 2005; 60 (04) 661-678 . Doi: 10.1016/j.socscimed.2004.06.015
  • 8 Ott MA, Sucato GS. ; Committee on Adolescence. Contraception for adolescents. Pediatrics 2014; 134 (04) e1257-e1281 . Doi: 10.1542/peds.2014-2300
  • 9 Brunson MR, Klein DA, Olsen CH, Weir LF, Roberts TA. Postpartum contraception: initiation and effectiveness in a large universal healthcare system. Am J Obstet Gynecol 2017; 217 (01) 55.e1-55.e9 . Doi: 10.1016/j.ajog.2017.02.036
  • 10 Borovac-Pinheiro A, Surita FG, D'Annibale A, Pacagnella RC, Pinto E Silva JL. Adolescent contraception before and after pregnancy—choices and challenges for the future. Rev Bras Ginecol Obstet 2016; 38 (11) 545-551 . Doi: 10.1055/s-0036-1593971
  • 11 Stevens J, Lutz R, Osuagwu N, Rotz D, Goesling B. A randomized trial of motivational interviewing and facilitated contraceptive access to prevent rapid repeat pregnancy among adolescent mothers. Am J Obstet Gynecol 2017; 217 (04) 423.e1-423.e9 . Doi: 10.1016/j.ajog.2017.06.010
  • 12 Blumenthal PD, Voedisch A, Gemzell-Danielsson K. Strategies to prevent unintended pregnancy: increasing use of long-acting reversible contraception. Hum Reprod Update 2011; 17 (01) 121-137 . Doi: 10.1093/humupd/dmq026
  • 13 Trussell J, Wynn LL. Reducing unintended pregnancy in the United States. Contraception 2008; 77 (01) 1-5 . Doi: 10.1016/j.contraception.2007.09.001
  • 14 Correia L, Martins I, Oliveira N, Antunes I, Palma F, Alves MJ. Contraceptive choices pre and post pregnancy in adolescence. J Pediatr Adolesc Gynecol 2015; 28 (01) 24-28 . Doi: 10.1016/j.jpag.2014.02.004
  • 15 Faisal-Cury A, Tabb KM, Niciunovas G, Cunningham C, Menezes PR, Huang H. Lower education among low-income Brazilian adolescent females is associated with planned pregnancies. Int J Womens Health 2017; 9: 43-48 . Doi: 10.2147/IJWH.S118911
  • 16 Wilkie GL, Leung K, Kumaraswami T, Barlow E, Moore Simas TA. Effects of obstetric complications on adolescent postpartum contraception and rapid repeat pregnancy. J Pediatr Adolesc Gynecol 2016; 29 (06) 612-616 . Doi: 10.1016/j.jpag.2016.05.002
  • 17 Secura GM, Madden T, McNicholas C. , et al. Provision of no-cost, long-acting contraception and teenage pregnancy. N Engl J Med 2014; 371 (14) 1316-1323 . Doi: 10.1056/NEJMoa1400506
  • 18 Kaewkiattikun K. Effects of immediate postpartum contraceptive counseling on long-acting reversible contraceptive use in adolescents. Adolesc Health Med Ther 2017; 8: 115-123 . Doi: 10.2147/AHMT.S148434
  • 19 Fortier E, Foster AM. Exploring young mothers' experiences with postpartum contraception in Ottawa: results from a multimethods qualitative study. Contraception 2018; 97 (05) 434-438 . Doi: 10.1016/j.contraception.2017.12.017
  • 20 Mestad R, Secura G, Allsworth JE, Madden T, Zhao Q, Peipert JF. Acceptance of long-acting reversible contraceptive methods by adolescent participants in the Contraceptive CHOICE Project. Contraception 2011; 84 (05) 493-498 . Doi: 10.1016/j.contraception.2011.03.001
  • 21 Ponce de Leon RG, Ewerling F, Serruya SJ. , et al. Contraceptive use in Latin America and the Caribbean with a focus on long-acting reversible contraceptives: prevalence and inequalities in 23 countries. Lancet Glob Health 2019; 7 (02) e227-e235 . Doi: 10.1016/S2214-109X(18)30481-9