J Pediatr Adolesc Gynecol. 2016 Aug 22.

Etonogestrel-releasing contraceptive implant for postpartum adolescents: a randomized controlled trial

, Bauer AE, Stuart GS, Levi EE, Zerden ML, Danvers A and Garrett JM

Abstract

Study design: To compare immediate postpartum insertion of the contraceptive implant to placement at the 6-week postpartum visit among adolescent and young women.

Objective: Cross-sectional estimates of contraceptive use do not provide understanding of time to postpartum uptake. This paper uses a range of Malawian data sources: a prospective study to explore time to uptake of contraception and a cross-sectional survey to assess whether sexually active postpartum women whose fecundity has returned use contraception, and whether abstaining/amenorrheic women report using contraception.

Design: Non-blinded, randomized controlled trial.

Setting and participants: Postpartum adolescents and young women ages 14-24 years delivering at an academic tertiary care hospital serving both rural and urban populations in North Carolina.

Interventions: Placement of an etonogestrel-releasing contraceptive implant prior to leaving the hospital postpartum, or at the 4-6 week postpartum visit.

Main outcome measure: Contraceptive implant use at 12 months postpartum.

Results: Ninety-six participants were randomized into the trial. Data regarding use at 12 months were available for 64 participants, 37 in the immediate group and 27 in the 6-week group. There was no difference in use at 12 months between the immediate group and the 6-week group (81% vs. 78%; p=0.75). At 3 months, the immediate group was more likely to have the implant in place (92% vs. 70%; p=0.02).

Conclusions: Placing the contraceptive implant in the immediate postpartum period results in higher use at 3 months postpartum and appears to have similar use rates at 12 months compared to 6-week postpartum placement. Providing contraceptive implants to adolescents prior to hospital discharge takes advantage of access to care, increases the likelihood of effective contraception in the early postpartum period, appears to have no adverse effects on breastfeeding, and may lead to increased utilization at one year postpartum.

Comment: Earlier we stated pleas for safe and effective contraception immediately postpartum. This is the first time that a pediatric journal mentions it. Especially for adolescent mothers and their babies a longer interval between children is crucial for their health, and a contraceptive implant right after delivery of the placenta will have a huge benefit. (HMV)