From the Journals

Teen mothers using long-acting reversible contraception are least likely to use condoms



Postpartum teenage mothers who use long-acting reversible contraceptives (LARC) reported using condoms half as often as their peers using non-LARC methods such as the birth control pill, vaginal ring, contraceptive patch, or injection, according to research in JAMA Pediatrics.

This highlights a need for education to lower the risk of sexually transmitted infections in this population.

A condom packet ©Florea Marius Catalin/

“Our finding that less than 30% of sexually active teenage mothers using LARC or non-LARC hormonal methods also reported using condoms suggests the need for enhanced efforts to increase condom use among teenage mothers,” wrote Katherine Kortsmit, PhD, MPH, of the National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention, Atlanta, and colleagues.

The researchers performed a cross-sectional analysis of contraceptive use among 5,480 new teenage mothers between 2012 and 2015 who were aged 19 years or younger in the Pregnancy Risk Assessment Monitoring System (PRAMS). Participants were mainly first-time teenage mothers between ages 18 and 19 years (46% non-Hispanic white), current Medicaid users, and reported an unintended pregnancy. Dr. Kortsmit and colleagues monitored use of LARC and non-LARC hormonal methods, including condom use, among participants in PRAMS from 37 different sites.

Among teenage mothers in PRAM, 29% reported using condoms; 18% of mothers using LARC said they also used condoms, compared with 36% of mothers who used non-LARC hormonal methods (adjusted prevalence ratio, 0.50; 95% confidence interval, 0.41-0.60). Participants with IUDs were least likely to report using condoms (15%), compared with participants using implants (22%; aPR, 0.70; 95% CI, 0.51-0.98), participants using the patch, ring, or injection (25%; aPR, 0.61; 95% CI, 0.47-0.79), or the pill (47%; aPR, 0.32; 95% CI, 0.25-0.40).

“These findings can be used to inform clinician counseling that sexually active teenage mothers have low uptake of condom use combined with more effective contraceptive methods and may need additional counseling on the importance of consistent and correct condom use for the prevention of STIs,” Dr. Kortsmit and associates wrote.

Limitations included the self-reported nature of the study, and lack of information on baseline condom use prior to pregnancy, relationship characteristics, and sexual partners during the postpartum period.

Education on contraceptive methods by clinicians is an important part of an adolescent’s contextualization of the benefits and risks of those methods, especially for women of color and marginalized groups, Andrea J. Hoopes, MD, MPH; and Gina S. Sucato, MD, MPH, wrote in an editorial related to the study by Kortsmit and colleagues.

In particular, these groups have higher rates of unplanned pregnancy, may have a history of being coerced to use contraception, and may be reluctant to discuss their sexual history or contraception use. “Many young women, including teenage mothers, remain at risk for coercion from partners, family members, and health care clinicians, so adopting a stance that ensures autonomy while eliciting unique developmental perspectives is paramount,” they said.

It is critically important to give women access to LARCs that are effective and easily used, and patients have a right to choose the contraception method that best fits their situation. It is through integrated programs, made available by Title X funding, that clinicians may be able to monitor their patients’ sexual, reproductive, and psychological health needs, and have conversations about the importance of contraception and prevention of sexually transmitted infections.

“Future studies should examine specific interventions aimed at promoting all adolescents’ motivations to remain safe and healthy by using condoms consistently and by seeking comprehensive sexual health care services, regardless of contraceptive method,” concluded Dr. Hoopes and Dr. Sucato, of the Adolescent Center at Kaiser Permanente Washington in Seattle. “In addition to receiving counseling about, and access to, condoms, adolescents need to develop the skills to negotiate condom use with partners.”

Dr. Kortsmit received support in the form of an appointment to the Research Participation Program at Centers for Disease Control and Prevention through an interagency agreement. The other authors reported no conflicts of interest.

Dr. Hoopes reported previous grant support from Bayer and the North American Society for Pediatric and Adolescent Gynecology. Dr. Sucato reported previous grant and other research support from Teva.

SOURCE: Kortsmit K et al. JAMA Pediatr. 2019. doi: 10.1001/jamapediatrics.2019.1136; Hoopes AJ et al. JAMA Pediatr. 2019. doi: 10.1001/jamapediatrics.2019.1133.

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