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

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 1^st, 2015 through July 31^st, 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.

Keywords

contraception - long-acting reversible contraception - adolescent - postpartum period - antenatal education

Palavras-chave

contracepção - anticoncepcional reversível de longa duração - adolescente - pós-parto - educação pré-natal

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.

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