Factors influencing uptake of intrauterine devices among postpartum adolescents: a qualitative study.

OBJECTIVE: We assessed barriers and facilitators to uptake of the intrauterine device (IUD) among primiparous African American adolescent mothers. STUDY DESIGN: Twenty participants who expressed IUD desire completed 4-5 qualitative interviews during the first postpartum year as part of a larger longitudinal study. Transcripts were analyzed for salient themes using a grounded theory approach to content analysis. RESULTS: Twelve participants did not obtain IUDs and instead used condoms, used no method, or intermittently used hormonal methods, resulting in 3 repeat pregnancies. Outdated IUD eligibility requirements, long wait times, lack of insurance coverage, and fear of IUD-related side effects precluded or delayed uptake. Facilitators to IUD uptake included strong recommendations from providers or family members, planning for IUD during pregnancy, and perceived reproductive autonomy. CONCLUSION: Postpartum adolescents may reduce their risk of rapid repeat pregnancy by using IUDs. Providers and members of adolescents' support networks can be instrumental in method adoption.

Daily context matters: predictors of missed oral contraceptive pills among college and graduate students.

OBJECTIVE: The purpose of this study was to understand the relationship between daily contextual factors and oral contraceptive (OC) adherence among students who attend college or graduate school. STUDY DESIGN: Data on OC adherence, demographics, contextual factors, and side-effects were collected as part of the acceptability of the NuvaRing (Merck & Co, Whitehouse Station, NJ) vs OC study, in which students were assigned randomly to the contraceptive vaginal ring or to a low-dose OC. We performed bivariate and multivariable analyses to create an explanatory model for nonperfect OC adherence (missed at least 1 pill during 3 months of use). RESULTS: In a multivariable predictive model, missing a pill was associated positively with high perceived stress (odds ratio [OR], 3.16; P = .007), having ≥10 hours per week of paid employment (OR, 2.13; P = .075), and living with a partner (OR, 9.92; P = .040). CONCLUSION: Stressful and hectic lives contribute to poor OC adherence. When counseling women about contraception, clinicians should consider the influence of daily life on contraceptive adherence.

Contraceptive attitudes among inner-city African American female adolescents: Barriers to effective hormonal contraceptive use.

STUDY OBJECTIVE: To better understand the contraceptive attitudes of low-income, inner-city African American female adolescents. DESIGN: We conducted four focus group sessions with African American female adolescents. SETTING: An urban, community health clinic serving low-income patients on Chicago's south side. PARTICIPANTS: African American female adolescents (n = 15) between 14 and 19 years of age. INTERVENTIONS: Focus group sessions lasting approximately 90 minutes in length were conducted using a pre-determined script with set probes and open-ended questions. MAIN OUTCOME MEASURES: Qualitative analysis was conducted to identify major themes related to adolescents' contraceptive attitudes. RESULTS: Six themes related to the contraceptive attitudes of these adolescents emerged: Concerns About Hormones, Concerns About Privacy, Concerns About Compliance, Limited Awareness of New Methods of Hormonal Contraception (HC), Preference for Condoms, and Acceptability of Emergency Contraception (EC). Overall, adolescents in these sessions expressed skepticism and unwillingness to use continuous methods of HC. For some adolescents, concerns about hormones, privacy, and compliance outweighed their concerns about pregnancy. CONCLUSION: Concerns about perceived side effects and long-term health risks associated HC and privacy in obtaining contraception and reproductive health care, as well as concerns about ability to comply with daily and weekly HC regimens are common among African American female adolescents and may deter consistent HC use. Although condoms and EC appear to be highly acceptable among this group, adolescents also report a number of barriers to their consistent use. Efforts to reduce early, unintended pregnancy among African American youth should focus on addressing adolescents' HC-related concerns, improving access to EC, and helping female adolescents effectively negotiate condom use.