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  • Title: The use of levonorgestrel implants (Norplant) for contraception in adolescent mothers.
    Author: Polaneczky M, Slap G, Forke C, Rappaport A, Sondheimer S.
    Journal: N Engl J Med; 1994 Nov 03; 331(18):1201-6. PubMed ID: 7935659.
    Abstract:
    BACKGROUND: Although levonorgestrel implants (Norplant) would appear to be a good contraceptive option for adolescent mothers, there is little information about the use of Norplant in this population. METHODS: We studied 100 postpartum adolescents who chose a contraceptive method at an urban teaching hospital between September 1991 and July 1992. Structured interviews were conducted and medical records were reviewed soon after delivery and at a mean (+/- SD) of 15.5 +/- 2.9 months post partum. RESULTS: Forty-eight of the adolescent mothers chose Norplant, 50 chose oral contraceptives, and 2 (not further studied) chose barrier methods of contraception. The factors significantly associated with the choice of Norplant were older age (16.7 years among those who chose Norplant, vs. 16.2 years among those who chose oral contraceptives), multiparity (24 subjects vs. 6 subjects), and previous use of oral contraceptives (34 subjects vs. 21 subjects). During follow-up, there were no differences between the Norplant group and the oral-contraceptive group in the frequency of clinic visits (an average of 2.3 visits per subject in each group), failure to return after the postpartum visit (9 subjects vs. 11 subjects), or the incidence of sexually transmitted diseases (42 percent vs. 36 percent). At follow-up, 95 percent of the subjects in the Norplant group and 33 percent of those in the oral-contraceptive group were still using the method they had chosen (P < 0.001). During the first postpartum year 1 subject in the Norplant group and 19 in the oral-contraceptive group became pregnant (P < 0.001). Norplant users did not differ from all other adolescents studied with regard to sexual activity or condom use. CONCLUSIONS: The selection of Norplant by adolescent mothers as a method of contraception is associated with higher rates of continued use and lower rates of new pregnancy than the selection of oral contraceptives and does not affect the use of health care services, sexual activity, condom use, or the rate of sexually transmitted diseases. Norplant would seem like a good contraceptive option for adolescent mothers, but little data exists about the use of this particular contraceptive method in that population. The authors publish findings from a prospective study to determine the factors associated with the choice of Norplant compared with other contraceptive methods and to assess the effect of Norplant on the use of health care services, sexual activity, additional pregnancy, and condom use. 100 postpartum adolescents who chose a contraceptive method at an urban teaching hospital over the period September 1991 - July 1992 were studied through structured interviews and the review of medical records soon after delivery and at a mean 15.5 months post partum. 48 of the adolescent mothers chose Norplant, 50 chose oral contraceptives, and two chose barrier methods of contraception. Norplant acceptors were of mean age 16.7 years, while oral contraceptive acceptors were of mean age 16.2 years. 24 Norplant acceptors and six oral contraceptive acceptors were multiparous, and 34 Norplant acceptors and 21 oral contraceptive users had previous experience with oral contraceptives. No differences were observed between groups during follow-up in the frequency of clinic visits, failure to return after the postpartum visit, sexual activity, condom use, or the incidence of sexually transmitted diseases. At follow-up, 95% of the subjects in the Norplant group compared to 33% of those in the oral contraceptive group were still using the method they had chosen. During the first postpartum year, one subject in the Norplant group and 19 in the oral contraceptive group became pregnant.
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