Factors associated with young women discontinuing use of long-acting reversible contraceptives
(LARCs) before 30 months included lower motivation to prevent pregnancy, being married,
giving birth before LARC use and non-white race, a recent study showed.
Intrauterine devices (IUDs) and implants are among the most effective methods to prevent
pregnancy, but studies have shown discontinuation rates are higher among teens and
young adults than in women over 25.
Researchers sought to determine why younger women stop using LARCs, which might improve
counseling of those seeking birth control.
Study participants included patients ages 13-24 who visited a Colorado family planning
clinic from August 2011 to February 2013 to obtain contraceptives. They completed
a survey before their appointment that asked about relationships, past pregnancies,
attitudes toward pregnancy and preference for a certain type of contraceptive.
Researchers followed up with or obtained data from electronic health records for 385
participants who used IUDs and 390 who chose implants to find out if they were still
using the contraceptive six, 12, 24 and 30 months later. If they were not, they were
asked why they stopped using the LARC.
Follow-up data showed that IUD users were less likely to discontinue use by 30 months
than implant users (36.3% vs. 45.4%). IUD use was stopped most often due to pain,
bleeding or malposition/expulsion, while implants were discontinued most often because
of bleeding, weight change or mood change.
Multivariate analysis showed that women who said at baseline that avoiding pregnancy
was very important were half as likely to stop using their contraceptive before 12,
24 or 30 months, while non-white race and being married or living with a partner independently
predicted discontinuation by 24 or 30 months.
“We encourage providers to support young patients in choosing LARC if they are medically
appropriate candidates for these methods, as recommended by the American Academy of
Pediatrics and the American College of Obstetricians and Gynecologists,” the authors
concluded. “We also urge providers to be cognizant of patient autonomy and choice,
especially in historically vulnerable populations.”