Skip Navigation LinksHome > November 2013 - Volume 122 - Issue 5 > Twenty-Four–Month Continuation of Reversible Contraception
Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e3182a91f45
Original Research

Twenty-Four–Month Continuation of Reversible Contraception

O'Neil-Callahan, Micaela MD; Peipert, Jeffrey F. MD, PhD; Zhao, Qiuhong MS; Madden, Tessa MD, MPH; Secura, Gina PhD, MPH

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Abstract

OBJECTIVE: To estimate 24-month continuation rates of all reversible contraceptive methods for women enrolled in the Contraceptive CHOICE Project.

METHODS: We analyzed 24-month data from the 9,256 participants enrolled in the Contraceptive CHOICE Project, a prospective observational cohort study that provides no-cost contraception to women in the St. Louis region. The project promoted the use of long-acting reversible contraception (LARC) (intrauterine devices [IUDs] and implants) in an effort to reduce the rates of unintended pregnancy. This analysis includes participants who received their baseline contraceptive method within 3 months of enrollment and who completed a 24-month follow-up survey (N=6,153).

RESULTS: Twenty-four month continuation rates for long-acting reversible contraception and non-LARC methods were 77% and 41%, respectively. Continuation rates for the levonorgestrel and the copper IUDs were similar (79% compared with 77%), whereas the implant continuation rate was significantly lower (69%, P<.001) compared with IUDs at 24 months. There was no statistically significant difference in 24-month continuation rates among the four non-LARC methods (oral contraceptive pill [OCP] 43%, patch 40%, ring 41%, depot medroxyprogesterone acetate [DMPA] 38%; P=.72). Participants who chose a LARC method at enrollment were at significantly lower risk of contraceptive method discontinuation (adjusted hazard ratio 0.29, 95% confidence interval 0.26–0.32) compared with women who selected a non-LARC method.

CONCLUSION: Intrauterine devices and the implant have the highest rates of continuation at 24 months. Given their effectiveness and high continuation rates, IUDs and implants should be first-line contraceptive options and shorter-acting methods such as OCPs, patch, ring, and DMPA should be second tier.

LEVEL OF EVIDENCE: II

© 2013 by The American College of Obstetricians and Gynecologists.

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