Teens educated about long-acting birth control use it when cost no issue

A large, prospective study shows that teens ages 15 to 19 will choose and use long-acting reversible contraceptives (LARCs) when they are educated about those methods and given them at no cost. Doing so could significantly reduce rates of pregnancy, birth, and abortion in this population, according to the report published in The New England Journal of Medicine.

Of the 1404 teens in the Contraceptive CHOICE Project, 72% chose an intrauterine device (IUD) or implant, whereas the remainder (28%) chose another form of contraception. During the 2008 to 2013 study period, the CHOICE participants had mean annual rates of pregnancy, birth, and abortion of 34.0, 19.4, and 9.7 per 1000, compared with rates of 158.5, 94.0, and 41.5 per 1000, respectively, for sexually experienced US teens in 2008.

Performed by researchers from the Washington University School of Medicine in St. Louis, the CHOICE project enrolled English- or Spanish-speaking girls who were already sexually active or planning to have sex in the next 6 months. Of them, almost half had a previous unintended pregnancy and 18% had a history of abortion. The participants received counseling about LARCs-from most to least effective-on potential side effects, risks, and benefits. The teens then made their own choice of method and were provided with it and followed for a period of 2 to 3 years, using phone interviews done at 3 and 6 months and every 6 months thereafter. After every completed interview, a teen received a $10 gift card.

Rates of pregnancy, live birth, and induced abortion were the primary study outcomes. The researchers also examined the impact of age and race on those rates as secondary outcomes. Among the CHOICE study participants, rates of pregnancy were 26.9 and 31.8 for white and black teens, compared with the rates of 137 and 253, respectively, reflected in data from the Guttmacher Institute for similar groups in the United States in 2008. Contraceptives available to the teens in the study were IUDs, implants, pills, the ring, and the patch. Most chose LARCs, with the implant the preference of those ages 14 to 17 and the IUD most popular among older teens. Teens who chose a LARC device but had a medical contraindication to same-day insertion were given a shorter-acting method until their chosen method could be started.

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The study results, the authors said, “suggests that it is possible to achieve a much greater rate of use [of LARCs in teens]. Furthermore, teens in our cohort continued to use LARC methods longer than shorter-acting methods such as the oral contraceptive pill and DMPA injection.”

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