Maslyanskaya et al identified risk factors for discontinuing effective contraception by a teenage female at high risk for pregnancy. These can help to identify a patient at risk for unintended pregnancy. The authors are from Albert Einstein College of Medicine, Children's Hospital of Montefiore, and Brown University.
Patient selection: teenage female at high risk for pregnancy placed on contraception, age 13 to 20
Outcome: early discontinuation of the contraceptive method (over 6 months)
Risk factors for early discontinuation:
(1) school dropout (hazard ratio 8.2)
(2) history of hormonal contraception in past (hazard ratio 1.9)
(3) method of contraception
(3a) intrauterine device (IUD, hazard ratio 1.0 = reference method)
(3b) combined oral contraceptive (hazard ratio 6.6)
(3c) depot medroxyprogesterone acetate (hazard ratio 5.6)
(3d) patch or intravaginal ring (hazard ratio 12)
The risk of early discontinuation increases with the number of risk factors present.
Reasons for not initiating or discontinuing a contraceptive method included:
(1) lack of insurance coverage
(2) reports of negative side effects
(3) adverse side effects
(4) expulsion without replacement (for IUD)
(5) unable to remember to take (for oral conctraceptives)
(6) unable to get refill (for oral contraceptives)
(7) changed mind (no longer wanted contraception)
