The Use of Levonorgestrel Implants (Norplant) for Contraception in Adolescent Mothers

Polaneczky, Margaret; Slap, Gail B.; Forke, Christine M.; Rappaport, Aviva I; Sondheimer, Steven J.

doi:10.1056/nejm199411033311806

Cited by 147 publications

(43 citation statements)

References 19 publications

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“…23,24 Norplant insertion clearly has the potential to reduce the pace of subsequent adolescent childbearing. 31,32 However, the results of this and other studies suggest that if Norplant insertions and Depo-Provera injections are not accompanied by substantive changes in the daily living environment, (eg, those changes that are likely to make childbearing a less attractive life course option), early discontinuation and repeat pregnancies are likely to occur. 4,10 -16,23-25 Other investigators have also found that young mothers who report that they wanted their first baby are more likely to experience a closely spaced second birth.…”

Section: Discussionmentioning

confidence: 42%

Reasons For First Teen Pregnancies Predict the Rate of Subsequent Teen Conceptions

et al. 1998

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ABSTRACT. Objective. To identify reasons for inconsistent contraceptive use that antedate conception and continue to predispose participants in adolescent-oriented maternity programs to unsafe sexual practices after delivery. We hypothesized that teens who attributed their failure to use contraceptives before their first conception exclusively to concerns about their side effects and/or their own lack of motivation to prevent conception would report less consistent contraceptive use and more repeat conceptions than would teens who attributed their previous failure to use contraceptives to their lack of capacity to do so.Method. We conducted a 2-year, prospective, longitudinal study of contraceptive use and repeat conceptions in a racially/ethnically diverse population of poor 13-to 18-year-olds. The 198 study participants were enrolled consecutively during their first pregnancies from an adolescent-oriented maternity program.Results. The majority (84%) of the teens attributed their failure to use contraceptives before their first pregnancy partially to a lack of capacity to do so. As hypothesized, these teen mothers were significantly more likely to use hormonal contraceptives (85% vs 62%), (particularly Norplant, 47% vs 19%) and less likely to conceive again (13% vs 41%). Most teens attributed their inconsistent contraceptive use during the postpartum study period to three factors: side effects, plans to abstain from sexual intercourse, and their lack of motivation to postpone additional childbearing.Conclusions. The reasons teen mothers give for not using contraceptives consistently before their first pregnancies predict the occurrence of subsequent conceptions during adolescence. Those who attribute their previous failure to use contraceptives consistently to side-effect concerns and their own lack of motivation to postpone childbearing are least likely to use hormonal contraceptives after delivery and most likely to conceive again. Our findings suggest that future research should focus on the development of more effective interventions for preventing repeat conceptions among adolescent mothers who had the capacity to prevent their first pregnancies. Pediatrics 1998;101(1). URL: http://www.pediatrics. org/cgi/content/full/101/1/e8; adolescent pregnancy, repeat adolescent pregnancy, contraception.

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Section: Discussionmentioning

confidence: 42%

Reasons For First Teen Pregnancies Predict the Rate of Subsequent Teen Conceptions

et al. 1998

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“…Among adolescents attending a clinic in Baltimore in 1992-1993, 29% chose implants (36). High use prevalence has also been reported among postpartum teens: 50% chose injectables in one study (37) and 48% chose implants in another (38). Another study of postpartum adolescents reported that 43% of African-American, 33% of MexicanAmerican, and 24% of Caucasian women chose DMPA (39).…”

Section: Discussionmentioning

confidence: 92%

Effects of Injectable or Implantable Progestin-Only Contraceptives on Insulin-Glucose Metabolism and Diabetes Risk

2003

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Progestin-only contraceptives administered by injection (Depo-Provera) or subcutaneous implant (Norplant) have been available to U.S. women for about a decade. Two epidemiological studies found their use associated with increased incidence of type 2 diabetes. In reviewing publications relating progestin injections and implants to glucose metabolism, 25 studies of various study designs and laboratory methods were identified that reported at least one insulin value in nondiabetic women. Research subjects were usually nonobese and often from developing countries. Of eight studies that performed sequential oral glucose tolerance tests (OGTTs) after at least 6 months of Depo-Provera or Norplant use, seven found significant elevations (approximate doubling) of insulin at 2 or 3 h after glucose challenge; the effects on fasting, half-hour, or 1-h postchallenge insulin values were less consistent. The three studies that performed sequential intravenous glucose tolerance tests (IVGTTs) on injection users all found an increased early-phase insulin response. One study used sequential hyperglycemichyperinsulinemic clamps to demonstrate reduced total-body glucose uptake per unit of insulin after 8 weeks of Norplant use. The metabolic studies generally did not show a reduction in the glucose tolerance of their nondiabetic subjects. However, compared with the lean and low-risk women who were usually selected for metabolic research, many U.S. women receiving these injections or implants may start out with increased insulin resistance due to greater weight, sedentary lifestyle, and family or childbearing histories. Additional research could help clarify whether exposure to injectable or implantable contraceptives leads to increased risk of type 2 diabetes and gestational diabetes in women with predisposing factors. Diabetes Care 26:216 -225, 2003I n the early 1990s two new modes of progestin-only hormonal contraception became available to women living in the U.S. The following decade has been notable for the emergence of type 2 diabetes among adolescent girls (more than boys) (1) and a rising prevalence of gestational diabetes (2). The temporal overlap of a diabetes increase among young women and availability of new contraceptive methods has stimulated us to review the published literature on insulinglucose metabolism in the presence of these hormonal agents.One new contraceptive mode was a depot injection containing 150 mg medroxyprogesterone acetate (DMPA, "Depo-Provera"). Administered by the intramuscular route, it delivers medroxyprogesterone at a plasma concentration of ϳ1 ng/ml (3). The DMPA injection must be repeated every 3 months for continuing contraceptive benefit. The other new mode was a system of six Silastic capsules, each containing 36 mg of the progestin levonorgestrel (LNG), designed for longterm subcutaneous insertion in the upper arm (LNG implant, "Norplant"). This implant system delivers LNG initially at ϳ85 g/day, declining gradually to ϳ30 g/ day (4). Serum concentrations of LNG decrease from ϳ0.35 ng/ml a...

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“…Of course, one can reverse the argument and postulate that the pill's additional pregnancy prevention effect is also very small if the male consistently uses the condom, so the adoption of the pill by the Japanese may be much less than in countries with less massive use of the condom. Even in the US, there is scant and mixed evidence on whether using hormonal contraception for pregnancy prevention reduces condom use for disease prevention [3][4][5][6]. Anecdotal evidence from Africa shows that women on subcutaneously placed hormonal implants may be less likely than women on injectables to have male partners who use condoms, because the implants are palpable and the male partners rationally reduce their use of the condom because their fear of impregnating the women is reduced (Rohler C, pers.…”

Section: Introductionmentioning

confidence: 96%

A comparison of consensus and nonconsensus approaches to modeling contraceptive choice behavior

Chao

2002

Health Economics

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This paper develops a more general model of contraceptive choice, taking into account a fundamental difference between the condom and the contraceptive pill, the two most commonly used reversible contraceptives in the US. The pill produces a single output of pregnancy prevention, but the condom is an input into a joint production for both pregnancy prevention and disease protection. Since the condom is ultimately used by the male, and the pill by the female, noncooperative game theory is used to model the separate male and female utility functions. Using both Stackelberg and Nash as solution concepts, econometric specifications are derived and the models are compared with the specifications derived from a consensus model of the household. Simultaneous-move Nash best describes the behavior of unmarried and noncohabiting sexual partners, and female-leader Stackelberg outperforms the other models for married or cohabiting couples.

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The Use of Levonorgestrel Implants (Norplant) for Contraception in Adolescent Mothers

Cited by 147 publications

References 19 publications

Reasons For First Teen Pregnancies Predict the Rate of Subsequent Teen Conceptions

Reasons For First Teen Pregnancies Predict the Rate of Subsequent Teen Conceptions

Effects of Injectable or Implantable Progestin-Only Contraceptives on Insulin-Glucose Metabolism and Diabetes Risk

A comparison of consensus and nonconsensus approaches to modeling contraceptive choice behavior

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