Date of Award

January 2014

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Sheryl Ryan

Subject Area(s)

Medicine

Abstract

Adolescents have alarmingly high rates of unintended pregnancies in the United States, and more commonly rely on user-dependent and therefore less effective forms of birth control including oral contraceptive pills, the contraceptive patch, and contraceptive ring. Long-acting reversible contraceptive (LARC) methods, which include both intrauterine devices and the subdermal etonogestrel implant, are now considered by most professional and governmental organizations as an acceptable first-line contraceptive method in adolescents. Yet access to LARC methods in an appropriate clinical setting and in a timely manner remains a barrier to uptake. Although adolescent medicine providers specialize in providing reproductive services to adolescents, few have been trained to insert the contraceptive implant or report doing so in their practice. No studies to date have assessed whether provision of the contraceptive implant at an Adolescent Medicine clinic improves uptake or decreases time to initiation.

The primary aim of this study is to assess whether provision of subdermal contraceptive implants by adolescent medicine providers increases interest in and uptake of this form of contraception. We conducted a retrospective chart review of two cohorts of female patients aged 14-21 seen during two 5-month periods at an adolescent medicine clinic at a single academic medical center. The first cohort required an additional appointment at the affiliated Women's Center family planning clinic in order to obtain the implant; the second cohort was able to obtain the implant on-site within the adolescent medicine clinic. We measured intention to obtain the implant at the end of the index visit, and actual initiation of the implant within 2 months.

We found that, among women who were initiating a new contraceptive method or re-starting a prior method, intention to obtain subdermal implants increased from 4.8% to 15.6% when implants were made available on-site ( P = 0.039). The absolute number of patients who successfully obtained an implant also increased between the two cohorts (from n = 1/3 in Cohort 1 to n = 7/12 in Cohort 2), however this was not statistically significant, most likely because of the low sample size (p = 0.57). Our results suggest that training adolescent health care providers to insert subdermal implants, and access to this method on-site in primary care settings, can increase interest in and uptake of this highly effective form of contraception in adolescents.

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