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Original Investigation
May 20, 2019

Condom Use With Long-Acting Reversible Contraception vs Non–Long-Acting Reversible Contraception Hormonal Methods Among Postpartum Adolescents

Author Affiliations
  • 1Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
  • 2Research Participation Program at the Centers for Disease Control and Prevention administered by the Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
  • 3Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
JAMA Pediatr. 2019;173(7):663-670. doi:10.1001/jamapediatrics.2019.1136
Key Points

Question  Among sexually active postpartum adolescents, are long-acting reversible contraceptive (LARC) users as likely to use condoms than users of non-LARC hormonal methods?

Findings  In this cross-sectional analysis of 5480 teenage mothers using LARC or non-LARC hormonal methods, overall, 29% also used condoms; however, condom use was half as common in LARC vs non-LARC hormonal method users. Condom use was lowest among intrauterine device users and highest among pill users compared with users of other hormonal contraceptive methods examined.

Meaning  Evidence-based interventions emphasizing the importance of postpartum condom use for prevention of sexually transmitted infections, particularly among teenage mothers using LARC, may help reduce risk of sexually transmitted infections.

Abstract

Importance  Increased use of long-acting reversible contraception (LARC; intrauterine devices [IUDs] and implants) has likely contributed to declining US teenage pregnancy and birth rates, yet sexually transmitted infection (STI) rates among teenagers remain high. While LARC methods are highly effective for pregnancy prevention, they, as with all nonbarrier methods, do not protect against STIs, including HIV. Studies of the general adolescent population suggest condom use is lower among LARC vs non-LARC hormonal methods users (birth control pill, contraceptive patch, vaginal ring, or injection). Despite the high use of LARC among postpartum teenagers, no studies have examined whether condom use differs by contraceptive method in this population.

Objective  To compare condom use among sexually active postpartum teenagers using LARC vs those using non-LARC hormonal methods.

Design, Setting, and Participants  Cross-sectional analysis using 2012 to 2015 data from the Pregnancy Risk Assessment Monitoring System (PRAMS), a multisite and population-based surveillance system that collects data on maternal attitudes, behaviors, and experiences before, during, and shortly after pregnancy. We used data from 37 sites. Using multivariable survey-weighted logistic regression, we assessed the association of condom use by contraceptive methods. Participants were teenage mothers (≤19 years) with a recent live birth reporting LARC or non-LARC hormonal method use. Data were analyzed between March 2018 and April 2018.

Main Outcomes and Measures  Condom use with LARC vs condom use with non-LARC hormonal methods.

Results  Among the 5480 (weighted N = 245 847) postpartum teenage mothers in our sample, most were aged 18 to 19 years, unmarried, had current Medicaid coverage, were first-time mothers, had reported their pregnancy was unintended, and almost half were non-Hispanic white. Overall, condom use was reported by 28.8% of these teenagers. Users of LARC compared with non-LARC hormonal methods were half as likely to use condoms (17.8% vs 35.6%; adjusted prevalence ratio [aPR], 0.50; 95% CI, 0.41-0.60). Users of IUDs (15.1%) were less likely to report condom use than those using an implant (21.5%; aPR, 0.70; 95% CI, 0.51-0.98), patch, ring, or injection users (24.9%; aPR, 0.61; 95% CI, 0.47-0.79), and pill users (47.2%; aPR, 0.32; 95% CI, 0.25-0.40).

Conclusions and Relevance  Self-reported condom use was low overall among postpartum teenage mothers and lower among users of LARC vs non-LARC hormonal methods. Given the high rates of STIs among teenage mothers combined with higher use of LARC among postpartum teenaged mothers, interventions to promote condom use for STI/HIV prevention during the postpartum period are critically important.

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