Hospital General de los SSH, Pachuca, Hidalgo, Mexico
Adolescents generally have little information on the correct use of contraception and fertility, increasing the risk of pregnancy. The aim of this study was to determine why adolescents do not accept contraception during the immediate postpartum period. Adolescent patients included presented 12 to 19 years old, who signed the letter of informed consent, they were in immediate postpartum, post-abortion (implemented curettage, manual vacuum aspiration) or pot-cesarean section and who did not accept the use of a contraceptive method. A total of 148 patients with a mean ± SEM age of 17.3 ± 1.3 years were included. Only 107 (90.7%) of the patients had prenatal care, and only 77 (72%) of the patients were guided about the contraceptive methods that could be used in the immediate postpartum period. The 3 main reasons to reject contraception were: ignorance about contraception that she can use (n = 26; 22%), the couple will use birth control (n = 16; 13.6%) and she has no partner (n = 12; 10.2%). In conclusion, we observed that most teens do not use contraception, mainly due to lack of information or by leaving the responsibility to their partner.
Keywords: Rejection of Contraceptive Method; Adolescents; Immediate postpartum period; Pregnancy
In Mexico, as well as worldwide, pregnancies in the adolescent population have increased, which is alarming because it involves different social and health problems in this age group. It has been documented that 40% of women who become pregnant in adolescence, it was not planned or wanted at that time.1 The most common morbidity during the first half of pregnancy in adolescents are abortion, anemia, urinary tract infections and asymptomatic bacteriuria; whereas in the second half of the pregnancy these include hypertensive disorders, bleeding associated with placental conditions, poor weight gain associated with maternal malnutrition, symptoms of preterm labor and premature rupture of membranes.2
It has been recommended to include teen pregnancy as a priority program of reproductive health, and thus to prevent pregnancies sequences.3 Consultation counseling or information is an ideal place to counter the lack of information associated with contraception. The trend speaks that adolescents generally have little information on the correct use of contraception and fertility, increasing the risk of pregnancy. It has been observed that much of the information is provided by their parents.4 The mass media influence sex in adolescents; on one hand, they transmit sexual education, but also convey messages about sex without being married. These messages are received and observed by children and can influence the onset of sexual life at an earlier age.5
The most important achievement in the field of adolescent sexual and reproductive health in Mexico, was probably the inclusion of contents of sex education in the curriculum at primary and secondary levels. But to consolidate this progress is essential to overcome the limitations of teachers to teach these subjects; to do this, we must increase both their knowledge about sexuality as their level of acceptance and naturalness to address the issue.6 Therefore, the general objective of the study was to determine why adolescents do not accept contraception during the immediate postpartum period.
The study protocol was approved by the Ethics Committees and Research SSH Pachuca General Hospital. The study was conducted according to the Declaration of Helsinki. An observational, prospective, descriptive and analytical study was carried out.
The study was performed in the General Hospital of Pachuca, from April to August in 2014. Adolescents include patients, with 12 to 19 years old, who signed the letter of informed consent, they were in immediate puerperium due to delivery, abortion or cesarean section and who did not accept the use of a contraceptive method. A survey was administered to all patients before they leave the hospital.
The data analysis was descriptive. From the data, measures of central tendency and dispersion were obtained. The data are presented in figures and tables. For data analysis Microsoft Excel 2007 software was used.
At the end, 118 patients were included, 33 (27.9%) patients were 17 years of age, 29 patients (24.6%) were 19 years old, 26 (22.0%) of them were 18 years old, 21 (17.8%) patients were 16 years old, only 5 (4.2% ) were 15 years, 3 (2.5%) patients were 14 years old and 1 (0.8%) patient was 13 years old. The mean ± SEM age was 17.3 ± 1.3 years, with a minimum age of 13 years and a maximum age of 19 years.
According to the schooling of participants, 7 (3.4%) patients had only kindergarten degree, 23 (18.6%) patients had primary degree, 56 (57.6%) had secondary degree and 34 (20.3%) patients had high-school degree or they had started bachelor degree.
The occupation in 110 (93.2%) of the patients was housewife, while 7 (5.9%) patients were engaged in study and only one (0.8%) patient was employed.
In relation to the number of pregnancies of patients, in 91 (77.1%), it was their first pregnancy, in 23 (19.5%) patients, it was their second pregnancy, and in 4 (3.4%) patients, it was their third pregnancy. In Figure 1, the percentages of the age of first pregnancy in female patients are shown. It is observed that the highest percentage of patients that had their first pregnancy was at age 16.
Regarding marital status, 72 (61.0%) patients cohabiting, 27 (22.9%) were single and 19 (16.1%) were married.
Figure 1. Percentage of patients according to the age in years in which they had their first pregnancy.
In this category, 70 (59.3%) of the patients denied having used any contraceptive method, and only 48 (40.7%) of them had used contraceptives. Figure 2 shows the most widely used contraceptive methods.
Patients who used contraception before (n = 48; 40.7%) were oriented primarily by health personnel and school (Figure 3).
With regard to prenatal care during the last pregnancy, only 11 (9.3%) of them did not attend this control and 107 (90.7%) of patients were to follow up visit.
Figure 2 Contraceptive methods used by patients represented in absolute frequencies of the 48 patients.
Figure 3. Source of guidance on contraception receiving patients. The data are presented as absolute frequencies
Of the patients who received prenatal care (n = 107), only 77 (72%) of patients were guided about contraceptive methods that could be used in the immediate postpartum period.
Of the 118 patients, only 45 (38.1%) patients reported having knowledge of contraceptive methods they could use in immediate postpartum and their effects, whereas 73 (61.9%) patients said that they do not have any knowledge.
Among the reasons reported for not accepting a contraceptive method, the three most common were: unaware of the contraception method can be used, they argued that their partner would use some method, and thirdly, that at that time they are without partners (see table 1).
Table 1. Causes why patients agreed not to use contraception in the immediate postpartum period.
| n | % | |
| Ignorance about the contraceptive methods she may use | 26 16 12 11 11 10 6 5 5 4 2 2 2 2 4 |
22.0 13.6 10.2 9.3 9.3 8.5 5.1 4.2 4.2 3.4 1.7 1.7 1.7 1.7 3.415.3 |
| Your partner will use contraception | 16 | 13.6 |
| No partner | 12 | 10.2 |
| Do not plan to have sex soon | 11 | 9.3 |
| She does not want the adverse effects of the methods | 11 | 9.3 |
| She will wish use hormone after | 10 | 8.5 |
| She wants to talk about the methods with your partner | 6 | 5.1 |
| She thinks the IUD is not effective | 5 | 4.2 |
| She prefers to go to another health center | 5 | 4.2 |
| She has afraid of losing her fertility | 4 | 3.4 |
| Her partner is opposed | 2 | 1.7 |
| They are not 100% effective | 2 | 1.7 |
| She does not want foreign substances or objects in her body | 2 | 1.7 |
| She does not wants to present more pain at this time | 2 | 1.7 |
| Other | 4 | 3.4 |
For all that implies a pregnancy in adolescents, the American Academy of Pediatrics in 2005 focused the prevention of teen pregnancy in promoting abstinence, sex education, contraceptive use and the culmination of their education.7
In a study to assess the quality of prenatal care among adolescents, the participants rated the information received about contraceptive as regular or unclear up to 29.3% of the participants.8
In another study with 100 Uruguayan woman adolescents, it was found that 97% of participants had knowledge of the various contraceptive methods, but 68% did not use them or they used them incorrectly. Of the patients surveyed, 78% had been informed about the contraceptive methods, with the 3 mainstream media: School (40%), family (37.5%) and health workers (22.5%).9 A recent study found that of 120 adolescents surveyed, 117 (97.5%) had received information on how to use contraceptives, the most frequent sources of information were the school (37.5%), followed by health personnel (31.7%) and parents (21.7%). 10 Our results agree with the results of the previous studies, as our 3 main sources of information on contraception were: school, health personnel, and parents.
Cruz et al. 11 mentioned that the main reasons why teens reject or are not using contraception include the lack of adequate information, purchasing shame, lack of health services and counseling to ensure the privacy and confidentiality they deserved. In our study, we found that the 3 main causes were: ignorance about birth control methods they can use (n = 26; 22%), their partner will use birth control (n = 16; 13.6%) and they have no partner ( n = 12; 10.2%).
Regarding school, in a study by Lira Plascencia12 it mentions that 83.4% of pregnant teenagers occupied home and left the possibility to prepare academically and they have better economic capacity in the future.
Teen pregnancy is considered a condition of high risk, it should be treated with antenatal care in hospitals, and they should have a specialized area for comprehensive care in order to monitor the pregnancy, provide counseling and accurate and early guidance on contraception.
Although currently there are different ways to get information and free access to contraceptive methods, most teenagers do not use these before or after pregnancy, which tells us that they are exercising their sexuality in a way irresponsible, due to the immaturity of their age and lack of information.
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[a] Author for corresponding:
María Guadalupe Torres Paredes
E-mail:torrespmagpe@hotmail.com