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abortion, Contraception

Long acting contraceptive implant dramatically reduces repeat teen pregnancies

Teen pregnancies cost the taxpayer $11 billion a year.

When a teen has a baby she has up a 12% to 49% chance of having another baby within the same year. Having two teenage births dramatically increases the risk of a premature delivery and a stillbirth with the second baby as well as further decreases the likelihood that the teen will finish high school and increases her likelihood of relying on public assistance. Abortion rates are also very high among teen pregnancies.

GIven these health and socioeconomic issues, preventing a second teen pregnancy should be one of our highest priorities. This should be a no brainer that both democrats and republicans can actively embrace (I mean decrease welfare, decrease abortion, decrease teen pregnancy, decrease premature delivery and stillbirth? Talk about a great unifying set of causes).

study from the University of Colorado’s CAMP (Colorado Adolescent Maternity Program) tells us how we can achieve this goal of reducing a 2nd teen pregnancy: the etonogestrel contraceptive implant (Implanon).

In this observational study adolescents who had just delivered were offered immediate rod insertion (the manufacturer recommends waiting for 4 weeks, but there is not biological reason to delay a progestin post partum) or usual contraceptive counseling (as an aside all the teens were informed that inserting the rod early was not supported by the package insert). 171 teen moms opted for the implant and 225 decided on other contraceptive measures.

The results: at 6 months post delivery NONE of the implant group were pregnant as compared with 9.9% (21) of the other contraceptive methods group. By one year 2.6% of the implant group were pregnant and 18.6% of controls. It is important to note that of the 4 teens who were pregnant in the Implanon group at one year, three had elected to have the implant removed and were using another method when they became pregnant. So there was only one rod failure out of the 132 teens who were still using that method at one year – a failure rate of < 1%.

So if a teen mom who has just delivered keeps the Implanon she has a < 1% chance of being pregnant within the year (and 86% still had the implant by a year). For the pro-life people, that also means a < 1% risk of abortion. If she goes with any other contraceptive option her risk of another pregnancy with 1 year is close to 20%. Keep in mind the CAMP program probably has a better overall repeat teen pregnancy rate than average as it is a dedicated teen health program with a significant emphasis on post natal and infant care that includes education and employment planning as well as parenting skills.

Teen pregnancy remains a huge issue in the United States: there were 367,752 infants birth to mothers aged 15-19 in 2010. Half of teen moms don’t graduate high school. While teen pregnancy rates are slowly decreasing, given the significant health and socioeconomic ramifications with a repeat teen pregnancy and the success of using the Implanon post partum, every State should include (and emphasize) immediate Implanon insertion for teens post delivery as part of their maternal medical program.

Offering publicly funded Implanon to teens post partum is not the sign of a nanny state, it’s cost-effective high quality evidence based medicine that reduces both abortion and premature delivery. I call on every politician to get behind this effort now.

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Discussion

5 thoughts on “Long acting contraceptive implant dramatically reduces repeat teen pregnancies

  1. Huge difference in pregnancy rates for different ethnic groups! Great information, Dr Jenn! I can see the GOP response saying why insurance should pay for this contraception again when the teen fails to learn their lesson after one time.

    Posted by Rich Hartmann | May 22, 2012, 7:57 am
  2. Teens simply are pharmacologically non-compliant by nature. Couple this with the overwhelming needs of a normal infant in a good circumstance and apply this to a likely single teen mother in a difficult circumstance and it is not hard to imagine the teen missing a few days of OCP or “forgetting” some barrier method. Which is likely very common with predictable results. Provided this agent is safe over the long term, this is a good solution to a complex problem.

    Posted by danielfkane | May 22, 2012, 8:08 am
  3. The study is confounded because it failed to randomly assign participants to the experimental and control groups, according to your summary. Instead, according to your summary, the participants parents were given the choice of whether to use the rod or the pill. Because of this social and environmental differences between the groups may be masquerading as medical difference.

    Example: Those parents who gave their consent to have their daughters implanted with the rod may be more concerned about a future pregnancy and thus may be more likely to employ other methods to help make sure their daughter does not become pregnant. Teens who give their assent to rod use may be more concerned about becoming pregnant in the future and may therefore be more likely to use other means of contraception on top of the rod (e.g. condoms or spermacide).

    There are only four reasons why an experimental methodology would not include random assignment: ethical reasons, unresolvable methodological incompatibilities, incompetence, and chicanery. It is the responsibility of the researcher to demonstrate the former lest we be forced to assume the latter!

    Please correct me if I’m wrong. The paper is behind a paywall so I haven’t had a chance to actually read the full text.

    Posted by Samantha | May 22, 2012, 10:43 am
    • You should read the article before commenting on it. Especially before commenting on the methodology!
      A teen mom does not need parental consent for contraception, so knowing that fact might also be helpful when opining on the subject.
      Finally, a prospective observational study is none of the 4 things you assert it to be. While the teen’s choice of method clearly plays a role, that is also a reflection of real life. We don’t force teens to have a method, we let them choose. While randomized, double blinded trials are the gold standard, blinded trials with an implant are not possible. Would randomization have given more info? Possibly. Does the lack of randomization negate the fact that teens who are offered and chose Inplanon have a less than 1% pregnancy rate within the year? No.

      The study is high quality and an excellent addition to the contraception literature. Inplanon should be offered to all teen moms before they leave the hospital.

      Posted by Dr. Jen Gunter | May 22, 2012, 11:00 am
      • Well, this is embarrassing. I missed the sentence where you identified the methodology to be observational, read the rest of what you wrote, read the abstract (which makes it sound experimental), and hit a paywall.

        Anyway, you’re right and now I feel stupid.

        As an aside: there is no reason why you can’t have a double-blinded, randomized trial with an implant. You just need the control group to have a placebo implant and real pills and for the experimental group to have a real implant and placebo pills. Of course, you can only do that when there’s sufficient clinical equipoise which now, it would seem, does not exist.

        Posted by Samantha | May 22, 2012, 11:49 am

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