Pill, Patch, Ring, DMPA – Regardless of the Method - Low One-year Continuation Among Young Method Starters

Objective: To examine contraceptive continuation among young women who initiated a hormonal method for the first time.

Setting: Family planning clinics located in low-income communities of the San Francisco Bay Area.

Participants: 1,387 non-married, sexually-active, females, aged 15-24 years, English or Spanish-speaking, not desiring pregnancy in the next year, who initiated the pill, patch, Nuvaring or Depo-Provera (DMPA).

Main Outcome Measures: Participants completed a baseline survey and follow-up surveys at 3-, 6-, and 12 months eliciting contraceptive use.

Results: At 3 months, 36.6% of combined hormonal starters discontinued and 61.7% of DMPA starters were late for a re-injection or did not intend to obtain one. At 12 months, 68.9% of combined hormonal and 74.9% of DMPA starters had discontinued their method. Pill and ring starters were more likely to continue than either patch or DMPA starters. Factors associated with continuation included baseline method chosen and intent to use method for a year. When controlling for age, women who did not want children for at least four years were significantly more likely to continue their contraception. Prior abortions or enrollment from an abortion clinic was independently associated with method discontinuation. Continuation rates did not differ by age, race, relationship status or duration.

Conclusions: Regardless of the method, young women who start hormonal contraceptives that require user maintenance over time will have low continuation and are at high risk for unintended pregnancy. Long Acting Reversible Methods may be more appropriate for young women who do not desire pregnancy in the immediate future.