Long-acting reversible contraceptive use in postpartum and postabortion adolescents: initiation, predictors, and continuation outcomes

Adolescent pregnancy remains a significant global public health issue. Thailand enacted the Act on Prevention and Solution to the Adolescent Pregnancy Problem and implemented a public health policy that provides free long-acting reversible contraceptives (LARCs) access to adolescents. At our institution, a structured, adolescent-focused protocol was developed to improve contraceptive counselling and access for postpartum and postabortion adolescents. This study aimed to determine the LARC initiation rate following implementation of this practice. Continuation rates and factors associated with LARC initiation and early discontinuation were also analyzed.

This retrospective study was conducted at a tertiary referral university hospital. Thai adolescents aged under 20 years at the time of delivery or abortion at our hospital were included. Demographic and clinical data were collected, including selected contraceptive method, LARC insertion and removal dates, and follow-up data for up to 36 months. Independent sample t-tests, Mann-Whitney U tests and chi-square tests were used as appropriated. The primary outcome was reported as frequency and percentages. Kaplan-Meier survival analysis assessed continuation rates, while logistic regression and Cox proportional hazards models identified factors associated with initiation and early discontinuation (defined as LARC removal before 3 years), respectively.

Of 1,081 postpartum and post-abortion adolescents, 839 (77.6%) participants initiated LARC. Of these, 91.7% initiated LARC before hospital discharge. The most commonly chosen methods were the 2-rod levonorgestrel implant (44.2%) and the 1-rod etonogestrel implant (32.9%), while 0.6% chose the copper intrauterine device. Significant factors of LARC initiation included younger maternal age (adjusted odds ratio [aOR] 0.598; 95% CI: 0.518-0.691; p < 0.001), being employed (aOR 2.233; 95% CI: 1.050-4.751; p = 0.037), and younger partner age (aOR 0.966; 95% CI: 0.935-0.998; p = 0.035). The cumulative LARC continuation rates were 98.1% at 1 year, 93.0% at 2 years, and 79.7% at 3 years. The most commonly reasons for early removal were bleeding disturbances (40.7%), weight changes (18.5%) and desire for pregnancy (13.0%).

Thailand's health policy of free LARC access, combined with a tailored structured adolescent protocol, resulted in high LARC initiation and continuation rates, demonstrating the effectiveness of integrated clinical and policy interventions in reducing adolescent pregnancy.