National Health and Medical Research Council SPHERE Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care, Monash University, Notting Hill, Victoria, Australia.
Department of General Practice, Monash University, Notting Hill, Victoria, Australia.
Acta Obstet Gynecol Scand. 2021 Apr;100(4):629-640. doi: 10.1111/aogs.14129. Epub 2021 Mar 9.
Long-acting reversible contraception (LARC) methods are safe for adolescents and provide the greatest assurance against rapid repeated pregnancy when inserted during the immediate postpartum (IPP) and immediate post-abortion (IPA) period. Despite increasing enthusiasm for IPP/IPA LARC insertion, adolescents' preferences and experiences have seldom been examined. The objective of this review was to examine the attitudes of adolescents (aged 10-19 years) towards IPP/IPA LARC, their experiences and perceptions around having an LARC device fitted IPP/IPA and the factors involved in decision-making to use, not use or discontinue IPP/IPA LARC.
In January 2021, we searched seven bibliographic databases for original research articles published in English, from the year 2000. Studies of any design focused on IPP/IPA LARC were eligible for inclusion. Three of the authors assessed articles for eligibility and extracted data relevant to the outcomes of the review. Joanna Briggs Institute Critical Appraisal Tools were used to assess methodological quality. Key themes emerging from the data were synthesized and reported narratively.
We identified 10 relevant articles, four of which were entirely adolescent-focused. Only three addressed IPA LARC. IPP availability was important for ensuring access to LARC postpartum. Attitudes towards LARC IPP were associated with adolescents' sociodemographic characteristics and positive perceptions related to the long duration of action. Determinants of discontinuation and nonuse included poor-quality contraceptive counseling, intolerable side effects and subsequent distress, misconceptions about LARC safety IPP and the influence of partners and community on autonomy. No factors involved in IPA LARC decision-making were available. Limited evidence demonstrated that adolescents may favor contraceptive implants over intrauterine devices, and in certain contexts may face greater barriers to IPA LARC access than adult women do.
Immediate insertion of LARC postpartum appears acceptable to adolescents who do not experience side effects and those with the opportunity to make autonomous contraception decisions. This important topic has been addressed in few studies involving an entirely adolescent population. Very limited evidence is available on IPA LARC. Further research on adolescents' lived experiences of IPP/IPA LARC access and use is necessary to inform the provision of person-centered care when assisting adolescents' contraceptive choice following pregnancy.
长效可逆避孕方法（LARC）对青少年是安全的，当在产后即刻（IPP）和流产后即刻（IPA）期间插入时，能最大程度地确保迅速重复妊娠。尽管对 IPP/IPA LARC 插入的热情不断增加，但对青少年的偏好和经验却很少进行检查。本综述的目的是检查青少年（10-19 岁）对 IPP/IPA LARC 的态度、他们在 IPP/IPA 时使用 LARC 装置的经历和看法，以及参与决定使用、不使用或停止使用 IPP/IPA LARC 的因素。
2021 年 1 月，我们在七个文献数据库中搜索了自 2000 年以来以英文发表的原始研究文章。任何设计的研究只要关注 IPP/IPA LARC 就符合纳入条件。三位作者评估了文章的合格性，并提取了与综述结果相关的数据。使用 Joanna Briggs 研究所批判性评价工具评估方法学质量。从数据中综合并以叙述的方式报告出现的主要主题。
我们确定了 10 篇相关文章，其中 4 篇完全以青少年为重点。只有 3 篇文章涉及 IPA LARC。IPP 的可及性对于确保产后获得 LARC 至关重要。青少年对 IPP LARC 的态度与他们的社会人口特征有关，与 LARC 作用时间长有关的积极看法有关。停止和不使用的决定因素包括避孕咨询质量差、无法忍受的副作用和随后的痛苦、对 LARC IPP 安全性的误解以及伴侣和社区对自主权的影响。IPA LARC 决策中没有涉及任何因素。有限的证据表明，青少年可能更喜欢避孕植入物而不是宫内节育器，并且在某些情况下，她们获得 IPA LARC 的障碍可能比成年女性更大。
没有经历副作用的青少年和有机会做出自主避孕决定的青少年似乎可以接受产后立即插入 LARC。涉及完全由青少年组成的人群的少数研究涉及了这个重要的主题。IPA LARC 的证据非常有限。需要进一步研究青少年在产后即刻和流产后即刻获得和使用 LARC 的经验，以便在协助青少年在怀孕后选择避孕方法时提供以患者为中心的护理。
