Comparison of Long-Acting, Reversible Contraceptive Use for Low-Income Adolescent Mothers in Two Intensive Case Management Programs

Purpose.Adolescent parenting puts families at risk for poor health and socioeconomic outcomes. Annual costs to our nation are estimated at $9.4 billion. Previous research indicates that between 25-40% of adolescent mothers will experience a rapid subsequent pregnancy. Those who have additional children are at greater risk for school difficulties, drug use, delinquency, and long-term poverty. Previous studies have shown long-acting reversible contraception (LARC) to be effective, safe birth control methods (BCM) for adolescents. Although CDC data shows that LARC usage among adolescents is increasing, less than 5% use LARCs (IUDs and arm implants). The purpose of this project was to compare LARC use among low-income parenting adolescents in two intensive case management (ICM) programs with similar services and goals: one based in a medical clinic and the other in a community-based, social service agency. This study examined 1) whether LARC use was different for clients in these ICM programs, and 2) whether adolescents using LARCs had fewer subsequent births within 36 months of the previous birth.

Methods. This research project analyzed existing data from an evaluation project. Fifty-five adolescent mothers were tracked through clinic-based ICM (mean age=15.1 yrs, sd=1.2), and fifty-five were provided ICM through a community-based social service organization (mean age=16.5 yrs, sd=1.6). Clients served by the social service agency were significantly older. 83% of total sample were Latina. Most common BCM at intake for both groups was condoms (32%). Only adolescents that completed at least two quarterly outcome tracking forms (OTFs) were included in the study. The average number of completed OTFs for each group was 5.6 (sd=2.9) and 4.9 (sd=2.5), respectively. Births were confirmed through administrative records. Chi-square analyses were used for comparisons.

Results. Eighteen percent of participants used LARC at some point with a significantly higher percentage from the medical setting versus the social service agency, χ²= 3.91, p<.05.  Specifically, 26% of participants receiving ICM through a medical setting selected a LARC, and 100% of participants stayed on this LARC once selected, while 11% of participants in ICM at the community-based agency selected LARC at some point and 50% retained usage. Overall 15% experienced a subsequent birth within three years. None who had used a LARC had a subsequent birth compared to 17% who did not report using a LARC, χ²= 3.19, p<.08. 

Implications. As expected, LARC use was associated with fewer subsequent births, and thus when appropriate it is recommended that case managers explore this BCM with clients. It appears too that LARC use may be more common in clinic based programs. It is speculated that this difference is a result of easier access to LARCs in this setting. Thus, for programs not based in a medical setting, case managers should explore methods for facilitating application of LARCs such as providing transportation and/or strengthening collaboration with an adolescent health clinic.  Further exploration of the relatively high rate of discontinuing LARCs by clients at the social service agency is needed to gain insight into LARC use patterns for this population.