Original Study| Volume 30, ISSUE 3, P383-388, June 2017

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Motivational Interviewing to Promote Long-Acting Reversible Contraception in Postpartum Teenagers

Published:November 18, 2016DOI:


      Study Objective

      To determine if teenage patients receiving prenatal care in an adolescent-focused clinic, emphasizing long-acting reversible contraception (LARC) using motivational interviewing techniques, had higher rates of uptake of postpartum LARC than a control group.

      Design and Setting

      Retrospective cohort study comparing young women who received prenatal care in an adolescent-focused setting with those enrolled in standard prenatal care.


      Adolescents between the ages of 13 and 17 years receiving prenatal care within the Maricopa Integrated Health safety-net system between 2007 and 2014.


      Motivational interviewing within the context of adolescent-focused prenatal care.

      Main Outcome Measures

      Rates of uptake of LARC within 13 postpartum weeks.


      The adjusted rate of LARC for adolescent-focused prenatal care participants by 13 weeks postpartum was 38% (95% confidence interval [CI], 29%-47%) compared with 18% (95% CI, 11%-28%) for standard care participants, with an adjusted odds ratio of LARC use of 2.8 (95% CI, 1.5-5.2). Among patients who received adolescent-focused prenatal care, most (27% vs 12.7%) were using an intrauterine device as opposed to an implantable contraceptive device.


      Participation in an adolescent-focused antepartum setting using motivational interviewing to emphasize postpartum LARC resulted in nearly 3 times higher rates of uptake compared with standard prenatal care.

      Key Words

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        • Darroch J.E.
        • Singh S.
        • Frost J.J.
        Differences in teenage pregnancy rates among five developed countries: the roles of sexual activity and contraceptive use.
        Fam Plann Perspect. 2001; 33: 244
        • Kost K.
        • Henshaw S.
        US Teenage Pregnancies, Births and Abortions, 2010: National and State Trends by Age, Race and Ethnicity.
        2014 (Guttmacher Institute, Washington, DC)
        • Committee on Adolescent Health Care Long-Acting Reversible Contraception Working Group
        The American College of Obstetricians and Gynecologists: Committee opinion no. 539: adolescents and long-acting reversible contraception: implants and intrauterine devices.
        Obstet Gynecol. 2012; 120: 983
        • Gavin L.
        • Warner L.
        • O'Neil M.
        Vital signs: repeat births among teens-United States, 2007-2010.
        MMWR Morb Mortal Wkly Rep. 2013; 62: 249
        • Bouris A.
        • Guilamo-Ramos V.
        • Cherry K.
        • et al.
        Preventing rapid repeat births among Latina adolescents: the role of parents.
        Am J Public Health. 1842; 2012: 102
        • Wilson E.K.
        • Fowler C.I.
        • Koo H.P.
        Postpartum contraceptive use among adolescent mothers in seven states.
        J Adolesc Health. 2013; 52: 278
        • Stevens-Simon C.
        • Kelly L.
        • Kulick R.
        A village would be nice but…it takes a long-acting contraceptive to prevent repeat adolescent pregnancies.
        Am J Prev Med. 2001; 21: 60
        • Damle L.F.
        • Gohari A.C.
        • McEvoy A.K.
        • et al.
        Early initiation of postpartum contraception: does it decrease rapid repeat pregnancy in adolescents?.
        J Pediatr Adolesc Gynecol. 2015; 28: 57
        • Baldwin M.K.
        • Edelman A.B.
        The effect of long-acting reversible contraception on rapid repeat pregnancy in adolescents: a review.
        J Adolesc Health. 2013; 52: S47
        • Tocce K.M.
        • Sheeder J.L.
        • Teal S.B.
        Rapid repeat pregnancy in adolescents: do immediate postpartum contraceptive implants make a difference?.
        Am J Obstet Gynecol. 2012; 206: 481
        • Winner B.
        • Peipert J.F.
        • Zhao Q.
        • et al.
        Effectiveness of long-acting reversible contraception.
        N Engl J Med. 1998; 2012: 366
        • Cohen R.
        • Sheeder J.
        • Arango N.
        • et al.
        Twelve-month contraceptive continuation and repeat pregnancy among young mothers choosing postdelivery contraceptive implants or postplacental intrauterine devices.
        Contraception. 2016; 93: 178
        • Committee on Adolescence
        Contraception for adolescents.
        Pediatrics. 2014; 134: e1244
        • Finer L.B.
        • Jerman J.
        • Kavanaugh M.L.
        Changes in use of long-acting contraceptive methods in the United States, 2007-2009.
        Fertil Steril. 2012; 98: 893
        • ACOG Committee Opinion No. 423
        Motivational interviewing: a tool for behavioral change.
        Obstet Gynecol. 2009; 113: 243
        • Connery H.S.
        • Albright B.B.
        • Rodolico J.M.
        Adolescent substance use and unplanned pregnancy: strategies for risk reduction.
        Obstet Gynecol Clin North Am. 2014; 41: 191
        • Gold M.A.
        • Tzilos G.K.
        • Stein L.A.
        • et al.
        A randomized controlled trial to compare computer-assisted motivational intervention with didactic educational counseling to reduce unprotected sex in female adolescents.
        J Pediatr Adolesc Gynecol. 2016; 29: 26
        • Fleming K.L.
        • Sokoloff A.
        • Raine T.R.
        Attitudes and beliefs about the intrauterine device among teenagers and young women.
        Contraception. 2010; 82: 178
        • Greenberg K.B.
        • Makino K.K.
        • Coles M.S.
        Factors associated with provision of long-acting reversible contraception among adolescent health care providers.
        J Adolesc Health. 2013; 52: 372
        • Barnet B.
        • Liu J.
        • DeVoe M.
        • et al.
        Motivational intervention to reduce rapid subsequent births to adolescent mothers: a community-based randomized trial.
        Ann Fam Med. 2009; 7: 436
        • Petersen R.
        • Albright J.
        • Garrett J.M.
        • et al.
        Pregnancy and STD prevention counseling using an adaptation of motivational interviewing: a randomized controlled trial.
        Perspect Sex Reprod Health. 2007; 39: 21
        • Wilson A.
        • Nirantharakumar K.
        • Truchanowicz E.G.
        • et al.
        Motivational interviews to improve contraceptive use in populations at high risk of unintended pregnancy: a systematic review and meta-analysis.
        Eur J Obstet Gynecol Reprod Biol. 2015; 191: 72
        • Kavanaugh M.L.
        • Jerman J.
        • Ethier K.
        • et al.
        Meeting the contraceptive needs of teens and young adults: youth-friendly and long-acting reversible contraceptive services in U.S. family planning facilities.
        J Adolesc Health. 2013; 52: 284
        • Patel P.R.
        • Lamarre R.
        • Baxley S.
        • et al.
        Prenatal discussion of contraceptive options in teenage pregnancies.
        J Womens Health. 2015; 25: 449