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

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 PARTICIPANTSCross-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 (Յ19 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.

Long-Acting Reversible Contraceptive Methods Need a Barrier to Prevent Sexually Transmitted Infections in Adolescents

“…Skepticism about LARC use in adolescents based on the authors’ primary findings should be tempered by the limitations noted previously as well the cross-sectional nature of the study. In a prospective study cited by Kortsmit et al in their article’s Discussion section, LARC users’ rates of condom use were already lower at baseline. This study of women age 14 to 45 years who had initiated either shorter-acting contraception or LARC methods and desired to prevent pregnancy for at least 1 year found no difference in reported condom use over time, but it nonetheless did identify slightly higher rates of STIs in LARC users.…”

“…In this issue of JAMA Pediatrics , Kortsmit and colleagues examined dual use in a postpartum adolescent population. The authors performed a cross-sectional analysis of population-based data collected from 37 sites from 2012 to 2015 as part of the Pregnancy Risk Assessment Monitoring System.…”

“…Thus, young women who choose LARCs may have distinct relationship characteristics and STI risk perceptions that are also associated with condom use and yet are challenging to accurately measure and account for in studies like those of Kortsmit et al At the same time, the high effectiveness of LARCs makes condoms less necessary for backup pregnancy prevention. In light of these findings, how as clinicians do we engage in a balanced discussion about comprehensive sexual health care with adolescent patients, particularly those at risk for a second pregnancy?…”

Identifying gaps in dual protection from sexually transmissible infections and unintended pregnancies among Australian women: an observational study

“…Studies from a range of settings cross-sectionally link long-acting reversible contraceptives (LARCs) with lower condom use. [14][15][16][17][18] However, longitudinal studies assessing LARC initiation have suggested that the differing condom uptake reflects background levels of condom use before starting LARCs rather than risk com pensation among women who choose these methods. 19 At a population level, the ongoing debate about risk compensation and LARCs obscures any comprehensive view of dual protec tion practice gaps because condoms and oral contraceptives remain the most prevalent contraceptive methods in Australia.…”

Chlamydia Infection Among Adolescent Long-Acting Reversible Contraceptive and Shorter-Acting Hormonal Contraceptive Users Receiving Services at New York City School-Based Health Centers

“…8,10e14 A recent large cross-sectional study among postpartum adolescents reported condom use was half as common in LARC users compared with non-LARC users. 9 This has raised the concern among some that LARC use might lead to increased STIs in the female adolescent population. 6,7,13 Chlamydia is the most common STI among adolescents in the United States.…”