JAMA study shows high need for contraceptives in emergency rooms among sexually active adolescents

In a cross-sectional study of 1,063 individuals treated in six pediatric emergency departments, nearly 29% of sexually active female adolescents reported no contraceptive use, yielding a calculated pregnancy risk index of 7.89 expected pregnancies per 100 adolescents per year. In addition, although 10.2% of participants were eligible for emergency contraception (EC), only 5.6% of those eligible received it.

Adolescents in the United States face significant risk of unintended pregnancy and face numerous barriers when seeking access to effective and reliable contraception. With this in mind, Hannah Canter of the Department of Pediatrics at Oregon Health and Science University in Portland and colleagues sought to measure and describe contraceptive use, EC prescriptions, and the Pregnancy Risk Index (PRI) among female adolescents who visit the emergency department for care.

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

Participants were individuals aged 15 to 21 years who presented to the emergency department, completed a confidential sexual health questionnaire, and reported being female at birth and having previously had penile-vaginal intercourse.

The main outcome measures included analysis of the type and prevalence of contraceptives used, calculation of the pregnancy risk index (PRI), and assessment of emergency contraception provision. Separate multivariable logistic regression models were used to identify sociodemographic factors influencing these outcomes.

The main findings of the study were:

• The analysis included 1063 participants (mean age 17.5 years). Overall, 71.1% reported using contraception during their last sexual intercourse.
• The least frequently used contraceptive method was long-acting reversible contraceptives (LARCs) (15.4% of participants) and 28.9% reported not using any contraceptives at all.
• Sociodemographic factors associated with contraceptive use overall and LARC use in particular include insurance and race and ethnicity.
• The overall PRI was 7.89, which corresponds to an expected number of eight pregnancies per 100 women per year.
• Although 10.2% of participants were eligible for EC, EC was only ordered for 5.6% of those eligible.

In summary, the study showed that most participants in the cross-sectional study of sexually active adolescents presenting to the emergency department reported using at least one form of contraception. However, long-acting reversible contraceptives were significantly underused, and nearly 29% of participants reported using no contraception at all.

The study found a risk of unwanted pregnancy of almost 8% in the patient studied, with only a small percentage of eligible patients receiving emergency contraception.

“These findings indicate a high need and potential opportunities for providing contraception in the emergency department,” the researchers write.

Reference:

Canter H, Reed J, Palmer C, et al. Contraceptive use and pregnancy risk among adolescents in pediatric emergency departments. JAMA Netw Open. 2024;7(6):e2418213. doi:10.1001/jamanetworkopen.2024.18213