Motivational Interviewing to Promote Long-Acting Reversible Contraception in Postpartum Teenagers

• Published in: Journal of pediatric & adolescent gynecology 2017-06, Vol.30 (3), p.383-388
• Main Authors: Tomlin, Kristl, MD, Bambulas, Tammalynn, MSN, CNM, Sutton, Maureen, MPH, Pazdernik, Vanessa, MS, Coonrod, Dean V., MD, MPH
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescent-focused prenatal care; Cohort Studies; Contraception - methods; Contraception - statistics & numerical data; Contraception Behavior - statistics & numerical data; Female; Humans; Long-acting reversible contraceptives; Motivational interviewing; Motivational Interviewing - methods; Obstetrics and Gynecology; Pediatrics; Postpartum Period; Pregnancy; Pregnancy in Adolescence - statistics & numerical data; Prenatal Care - statistics & numerical data; Rapid repeat pregnancy; Retrospective Studies; Teenage pregnancy
• ISSN: 1083-3188; 1873-4332
• DOI: 10.1016/j.jpag.2016.11.001

Abstract Study Objective To determine if teenage patients receiving prenatal care in an adolescent-focused clinic, emphasizing long-acting reversible contraception (LARC) using motivational interviewing techniques, had higher rates of uptake of postpartum LARC than a control group. Design and Setting Retrospective cohort study comparing young women who received prenatal care in an adolescent-focused setting with those enrolled in standard prenatal care. Participants Adolescents between the ages of 13 and 17 years receiving prenatal care within the Maricopa Integrated Health safety-net system between 2007 and 2014. Interventions Motivational interviewing within the context of adolescent-focused prenatal care. Main Outcome Measures Rates of uptake of LARC within 13 postpartum weeks. Results The adjusted rate of LARC for adolescent-focused prenatal care participants by 13 weeks postpartum was 38% (95% confidence interval [CI], 29%-47%) compared with 18% (95% CI, 11%-28%) for standard care participants, with an adjusted odds ratio of LARC use of 2.8 (95% CI, 1.5-5.2). Among patients who received adolescent-focused prenatal care, most (27% vs 12.7%) were using an intrauterine device as opposed to an implantable contraceptive device. Conclusion Participation in an adolescent-focused antepartum setting using motivational interviewing to emphasize postpartum LARC resulted in nearly 3 times higher rates of uptake compared with standard prenatal care.