Postpartum contraceptive use among adolescent mothers

Background: Adolescent mothers are at high risk for rapid repeat pregnancy; they need to increase use of effective contraception postpartum. Most studies addressing this issue are limited by small samples and lack data on contraceptive counseling during and after pregnancy. Methods: We use PRAMS data for 27 states to describe contraceptive method use and choice among mothers ages 15–19 with a live birth during 2004 to 2006. Most teens (89%) were 3-6 months postpartum. Not all states included questions in their surveys about method choice or postpartum checks. Therefore, we estimated two logistic regression models of any method use: one using data from all 27 states (n=8,922) that excluded postpartum checks, and one using data from 12 states (n=4,084) that included postpartum checks. A multinomial logistic regression model of method choice that included postpartum checks is limited to 6 states (n=2,326). Results: Some 84% of teen mothers used contraception postpartum. Among users, 79% used a highly effective method (primarily pill, injectable, or patch). Both prenatal contraceptive counseling and having a postpartum checkup were associated with increased use of any contraception, while having a postpartum check was associated with increased use of highly effective methods. Use of any method decreased with time. Conclusions: A substantial proportion of new adolescent mothers are not using effective contraception, and use declines over time. Contraceptive counseling during pregnancy and postpartum checks offer critical opportunities for providers to help adolescent mothers understand their risk of repeat pregnancy and the importance of using highly effective methods.