JAMA Study Reveals High Need for Contraception Services in EDs Among Sexually Active Adolescents

In a cross-sectional study involving 1,063 individuals treated at six pediatric EDs, nearly 29% of sexually active female adolescents reported not using contraception. This places them at a calculated pregnancy risk index of 7.89 expected pregnancies per 100 adolescents annually. Additionally, although 10.2% of participants were eligible for emergency contraception (EC), only 5.6% of those eligible received it.

Adolescents in the US are at significant risk of unintended pregnancy, encountering numerous obstacles when seeking access to effective and dependable contraception. Considering this, Hannah Canter, Department of Pediatrics, Oregon Health and Science University, Portland, and colleagues aimed to measure and describe the use of contraception, EC prescriptions, and pregnancy risk index (PRI) among female adolescents accessing the emergency department for care.

This cross-sectional study is a secondary analysis of data collected during a multicenter trial conducted from April 2021 to April 2022. The study utilized a tablet-based, content-validated, confidential sexual health survey at six urban, pediatric tertiary care emergency departments affiliated with the Pediatric Emergency Care Applied Research Network.

Participants consisted of individuals aged 15 to 21 years who presented to the emergency department, completed a confidential sexual health survey, and reported being female at birth and having previous penile-vaginal sexual intercourse.

The main outcome included analyzing the types and prevalence of contraception used, calculating the Pregnancy Risk Index (PRI), and evaluating the provision of emergency contraception. Separate multivariable logistic regression models were employed to identify sociodemographic factors influencing these outcomes.

The following were the key findings of the study:

• The analysis included 1063 participants (median age, 17.5 years). In total, 71.1% reported contraception use during their last sexual encounter.
• Long-acting reversible contraception use (LARC) was the least used (15.4% of participants), and 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 eight pregnancies per 100 female individuals per year.
• Although 10.2% of participants were eligible for EC, EC was ordered for only 5.6% of those eligible.

In conclusion, the study showed that most participants disclosed using at least one form of contraception in the cross-sectional study of sexually active adolescents presenting to the ED. However, long-acting reversible contraceptives were notably underutilized, and nearly 29% of participants reported not using any contraception at all.

The study revealed an unintended pregnancy risk of nearly 8% among the study population, with only a small percentage of eligible patients receiving emergency contraception.

"These findings suggest a high need and potential opportunity for the provision of contraception services in the ED setting," the researchers wrote.

Reference:

Canter H, Reed J, Palmer C, et al. Contraception Use and Pregnancy Risk Among Adolescents in Pediatric Emergency Departments. JAMA Netw Open. 2024;7(6):e2418213. doi:10.1001/jamanetworkopen.2024.18213