Long-Acting Reversible Contraception Counseling and Use for Older Adolescents and Nulliparous Women.
PURPOSE
The majority of pregnancies during adolescence are unintended, and few adolescents use long-acting reversible contraception (LARC) due in part to health care providers' misconceptions about nulliparous women's eligibility for the intrauterine device. We examined differences in LARC counseling, selection, and initiation by age and parity in a study with a provider's LARC training intervention.


METHODS
Sexually active women aged 18-25 years receiving contraceptive counseling (n = 1,500) were enrolled at 20 interventions and 20 control clinics and followed for 12 months. We assessed LARC counseling and selection, by age and parity, with generalized estimated equations with robust standard errors. We assessed LARC use over 1 year with Cox proportional hazards models with shared frailty for clustering.


RESULTS
Women in the intervention had increased LARC counseling, selection, and initiation, with similar effects among older adolescent and nulliparous women, and among young adult and parous women. Across study arms, older adolescents were as likely as young adults to receive LARC counseling (adjusted odds ratio [aOR] = .85; 95% confidence interval [CI]: .63-1.15), select LARC (aOR = .86; 95% CI: .64-1.17), and use LARC methods (adjusted hazard ratio [aHR] = .94; 95% CI: .69-1.27). Nulliparous women were less likely to receive counseling (aOR = .57; 95% CI: .42-.79) and to select LARC (aOR = .53; 95% CI: .37-.75) than parous women, and they initiated LARC methods at lower rates (aHR = .65; 95% CI: .48-.90). Nulliparous women had similar rates of implant initiation but lower rates of intrauterine device initiation (aHR = .59; 95% CI: .41-.85).


CONCLUSIONS
Continued efforts should be made to improve counseling and access to LARC methods for nulliparous women of all ages.
['Gibbs|Susannah E|SE|', 'Rocca|Corinne H|CH|', 'Bednarek|Paula|P|', 'Thompson|Kirsten M J|KMJ|', 'Darney|Philip D|PD|', 'Harper|Cynthia C|CC|']
D000293:Adolescent D000328:Adult D000367:Age Factors D037001:Directive Counseling D005193:Family Planning Services D005260:Female D007722:Health Knowledge, Attitudes, Practice D006801:Humans D057194:Intention to Treat Analysis D000075523:Long-Acting Reversible Contraception D010298:Parity D011247:Pregnancy D011253:Pregnancy in Adolescence D016016:Proportional Hazards Models D014481:United States D055815:Young Adult
Long-acting reversible contraception Adolescent Nulliparous