Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2024 Jun 3;7(6):e2418213.
doi: 10.1001/jamanetworkopen.2024.18213.

Contraception Use and Pregnancy Risk Among Adolescents in Pediatric Emergency Departments

Hannah Canter  1 , Jennifer Reed  2 , Chella Palmer  3 , T Charles Casper  3 , Kristin Stukus  4 , Sarah Schmidt  5 , Michelle Pickett  6 , Cynthia Mollen  7 , Cara Elsholz  3 , Andrea T Cruz  8 , Erin Augustine  9 , Monika K Goyal  10
Affiliations
Multicenter Study

Contraception Use and Pregnancy Risk Among Adolescents in Pediatric Emergency Departments

Hannah Canter et al. JAMA Netw Open. .

Abstract

Importance: Unintended pregnancy is a major health risk for adolescents in the US, and adolescents face many barriers to obtaining effective and reliable contraception.

Objective: To measure and describe the use of contraception, pregnancy risk index (PRI), and emergency contraception (EC) prescriptions among female adolescents accessing the emergency department (ED) for care.

Design, setting, and participants: This cross-sectional study is a planned secondary analysis of a multicenter trial from April 2021 through April 2022 that used a tablet-based, content-validated, confidential sexual health survey at 6 urban, pediatric tertiary care EDs affiliated with the Pediatric Emergency Care Applied Research Network. Participants were individuals aged 15 to 21 years presenting to the ED who completed the confidential sexual health survey and indicated female sex assigned at birth and prior penile-vaginal sexual intercourse. Data analysis was performed from January 2023 to February 2024.

Main outcomes and measures: The primary outcomes were the type and proportion of contraception use, the PRI, and provision of EC. Separate multivariable logistic regression models were performed to identify sociodemographic factors associated with these outcomes.

Results: A total of 1063 participants (median [IQR] age, 17.5 [16.5-18.3] years) were included in this analysis; 219 (20.8%) identified as Hispanic, 464 (44.1%) identified as non-Hispanic Black, 308 (29.3%) identified as non-Hispanic White, and 61 (5.8%) identified as other races and ethnicities. In total, 756 participants (71.1%) reported contraception use during their last sexual encounter. Long-acting reversible contraception use (LARC) was the least used (164 participants [15.4%]), and 307 (28.9%) reported no contraception use. Sociodemographic factors associated with overall contraception use, and LARC use specifically, included insurance and race and ethnicity. The overall PRI was 7.89, or an expected 8 pregnancies per 100 female individuals per year. Although 108 participants (10.2%) were eligible for EC, EC was ordered for only 6 (5.6%) of those eligible.

Conclusions and relevance: In this cross-sectional study of sexually active adolescents presenting to the ED, the majority of participants reported using at least 1 form of contraception; however, LARCs were the least used option, and 28.9% of participants reported no contraceptive use. The unintended pregnancy risk was almost 8% in the study population. Few patients eligible for EC received it. These data suggest a high need and potential opportunity for provision of contraception services in the ED setting.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Reed reported owning stock in Thermo Fisher Scientific, Danaher Corporation, Intuitive Surgical, Stryker, United Health Group, Becton Dickinson Stock, and CVS Caremark outside the submitted work. Dr Casper reported receiving grants from the National Institutes of Health (NIH), National Institute of Child Health and Human Development (NICHD), and the Health Resources and Services Administration (HRSA) during the conduct of the study. Dr Stukus reported receiving grants from the NIH during the conduct of the study. Dr Cruz reported receiving royalties from UpToDate outside the submitted work. No other disclosures were reported.

Comment in

References

    1. Finer LB, Zolna MR. Declines in unintended pregnancy in the United States, 2008-2011. N Engl J Med. 2016;374(9):843-852. doi:10.1056/NEJMsa1506575 - DOI - PMC - PubMed
    1. National Center for Health Statistics. Rossen LM, Hamilton BE, Abma JC, et al. . Updated methodology to estimate overall and unintended pregnancy rates in the United States: data evaluation and methods research. Vital and Health Statistics, series 2, number 201. April 2023. Accessed May 16, 2024. https://www.cdc.gov/nchs/data/series/sr_02/sr02-201.pdf
    1. Solomon M, Badolato GM, Chernick LS, Trent ME, Chamberlain JM, Goyal MK. Examining the role of the pediatric emergency department in reducing unintended adolescent pregnancy. J Pediatr. 2017;189:196-200. doi:10.1016/j.jpeds.2017.06.053 - DOI - PMC - PubMed
    1. Sharko M, Jameson R, Ancker JS, Krams L, Webber EC, Rosenbloom ST. State-by-state variability in adolescent privacy laws. Pediatrics. 2022;149(6):e2021053458. doi:10.1542/peds.2021-053458 - DOI - PubMed
    1. [No authors listed.] Committee opinion no. 615: access to contraception. Obstet Gynecol. 2015;125(1):250-255. doi:10.1097/01.AOG.0000459866.14114.33 - DOI - PubMed

Publication types

MeSH terms