Rapid Repeat Pregnancy Risk Persists As Teens Fail to Use Prescribed ECPs


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 and understood the necessity of using abstinence or effective contraceptives to do so.

Additionally, each participant received either a prescription for or a packet of ECPs, with no limit on refills, Ms. Sheeder said.

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.

The outcome measures for the study were episodes of unprotected intercourse, ECP use, a composite index for group pregnancy risk computed by summing the products of the method-specific failure rates and the proportion of sexually active teenagers using each method, and unwanted conception, she reported.

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 ECP in relation to unprotected intercourse, whereby a 1:1 ratio was considered appropriate ECP use. A ratio of less than 1:1 was deemed underuse and a ratio greater than 1:1 was considered augmented use, she said.

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.

The prevalence of unprotected intercourse and ECP use did not vary significantly in relation to age, race/ethnicity, education level and participation, reason for not using contraception before conception, future family plans, or postpartum month, Ms. Sheeder reported.

The group pregnancy risk did not change during the study period, 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, said Ms. Sheeder. The remaining 10 pregnancies were not attributable to unrecognized contraceptive or ECP failure, she said.

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