Long-acting reversible contraceptive use in postpartum and postabortion adolescents: initiation, predictors, and continuation outcomes.
- 1Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Family Planning and Reproductive Health Unit, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
- 2Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Family Planning and Reproductive Health Unit, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand. [email protected].
- 3Research Development Division, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Abstract
Background
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.Methods
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.Results
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%).Conclusion
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.
Related
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- Prenatal and postpartum tobacco use in adolescents and young adults: a qualitative study
- Factors associated with the use of Long Acting Reversible Contraceptives among adolescents at first level hospitals in Lusaka, Zambia.
- Contraceptive knowledge and interpregnancy interval among women attending a tertiary care hospital in Malaysia
BibTeX
@article{sangvornrungsie2026longacting,
title = {{Long-acting reversible contraceptive use in postpartum and postabortion adolescents: initiation, predictors, and continuation outcomes.}},
author = {Paparnin Sangvornrungsie and Nalinee Panichyawat and Thanyarat Wongwananuruk and Nichamon Parkpinyo and Julaporn Pooliam and Marisa Vongsiri and Jaratporn Inthawong},
journal = {Reproductive health},
year = {2026},
month = aug,
doi = {10.1186/s12978-026-02428-4},
url = {https://europepmc.org/article/MED/42963789},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Long-acting reversible contraceptive use in postpartum and postabortion adolescents: initiation, predictors, and continuation outcomes.
AU - Paparnin Sangvornrungsie
AU - Nalinee Panichyawat
AU - Thanyarat Wongwananuruk
AU - Nichamon Parkpinyo
AU - Julaporn Pooliam
AU - Marisa Vongsiri
AU - Jaratporn Inthawong
PY - 2026
DA - 2026/08/04
JO - Reproductive health
DO - 10.1186/s12978-026-02428-4
UR - https://europepmc.org/article/MED/42963789
AB - Background 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.Methods 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.Results 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%).Conclusion 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.
SN - 1742-4755
ER -