Effectiveness of Reversible Contraceptive Promotion for Repeated Pregnancy Reduction among adolescents at Pakkred Hospital, Nonthaburi in Fiscal Year 2019-2023

Abstract

This research and development study was conducted at Pakkred Hospital between 2019 to 2023. There were two main objectives. Part 1 aimed to explore the scale of adolescent pregnancy problem, the distribution of adolescent repeat pregnancies, and the factors significantly associated to adolescent repeat pregnancies. Part 2 aimed to evaluate the effectiveness of a reversible contraceptive promotion service system among adolescents, which included semi-permanent and temporary contraceptive methods. Both main objectives were performed by collecting secondary data from 414 medical records of pregnant adolescents who had received antenatal care, delivery, or abortion services at the hospital during that period. If an adolescent had multiple pregnancies, the data which collected from last pregnancy were considered an observed pregnancy. The prevalence of rapid repeated pregnancies and the coverage of reversible contraceptive promotion services were assessed as percentages. Factors associated with repeated pregnancies in observed adolescents were analyzed using the Chi-square test, Fisher exact test, correlation analysis, and logistic regression. The first part of the study found that 2.2% (9/414) of adolescents had repeat pregnancies after observation, with 0.96% (4/414) being early repeat pregnancies. 12.1% (50/414) of adolescent observation pregnancies were second or subsequent pregnancies. A significant factor contributing to repeat pregnancies after observation was the use of contraceptive implants. Adolescents who received post-observation contraceptive implants had a 97.9% lower rate of repeat pregnancies than those who did not (OR=0.021, 95%CI: 0.001-0.404, p=0.05). The second part of the study revealed that the reversible contraceptive promotion service system reached 64.7% of pregnant adolescents receiving the service. Pregnant adolescents who received full counseling through the reversible contraceptive promotion service system were 2.4 times more likely to decide to have a post-observation contraceptive implant compared to other contraceptive methods (OR=2.44, 95%CI: 1.04-5.70, p<0.05), and 3.2 times more likely to start contraception immediately before leaving the hospital compared to postponing contraception (OR=3.20, 95%CI: 1.66-6.15, p=0.05). This study leads to the idea of developing a reversible contraceptive promotion service system for pregnant adolescents to include more family members who play a role in the adolescents’ decision-making, in order to fill the gap in preventing repeat pregnancies among adolescents.