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WHICH TEEN MOTHERS REQUEST EARLY NORPLANT REMOVAL? † 37

Repeat teen pregnancies occur commonly even when adolescents have access to contraceptives. While Norplant is attractive because it remains effective for 5 yrs, since even teen pregnancies are rarely entirely unwanted we hypothesized that teen mothers requesting early Norplant removal are at highest demographic risk for repeat conception. At the time of insertion we prospectively assessed the prevalence of risk factors for repeat pregnancy in a group of 210, ≤18 yr old, postpartum Norplant recipients. We followed 180(86%) of them for 2 yrs; 65 (36%) had their Norplants removed. Bivariate analyses revealed no differences between those who did and didn't have their Norplants out regarding: age (mean±sd: 17±1 yrs), birth-insertion interval (mean±sd: 11±10 wks), gravidity/parity(79% primiparous), or medicaid use (96%). Teens who had their Norplants removed had more risk factors for repeat pregnancy (p=.02). They were more apt to be Black (39% vs 16%; p=.001), to want another baby in 2 yrs (32% vs 12%;p=.003), to feel their boyfriend wanted another baby (18% vs 5%; p=.01), to be depressed while pregnant (22% vs 9%; p=.03), and to have ≥3 sibs (52% vs 36% p=.05). Everyone reported side-effects; moodiness was the most common(65%), followed by bleeding & headache. While multivariate analyses revealed that side-effects were the most important determinants of Norplant removal, the study hypothesis was also supported. The prevalence of repeat pregnancy risk factors remained a significant, independent predictor of Norplant removal. Post-Norplant contraceptives use was poor and conception occurred rapidly (mean±sd:7±7 mos). Coupled with our finding that at insertion, Norplant users who subsequently request early removal are at higher demographic risk for repeat conception these data suggest that lack of motivation to delay conception colors the decisions antedating Norplant removal more than previously thought. This change in our understanding of the relation between Norplant side-effects and removal implies that supporting teens' negative childbearing attitudes could be an important aspect of treating the side-effects which typically prompt early Norplant removal and lead to repeat teen pregnancies.