Condom use in adolescents and young women following initiation of long- or short-acting contraceptive methods

Abstract

Objective: The objective was to determine if young women initiating long-acting reversible contraceptives (LARCs) who report new sexual partner(s) would be less likely to report use of a condom than women using short-acting reversible contraceptive (SARC) methods.

Study design: We enrolled a prospective cohort of 13-24-year-old women attending an adolescent-specific contraception clinic. Participants completed questionnaires at the contraceptive initiation visit and 6 months later. At follow-up, we asked if they had sexual intercourse with a new partner, if they had used condoms, if their condom use patterns had changed and why. We analyzed factors associated with condom use.

Results: We enrolled 1048 women; 771 (73.6%) initiated LARC and 384 (36.6%) initiated SARC. At 6 months, 508 participants (48.5%) completed the follow-up survey: 380 LARC initiators and 128 SARC initiators. Approximately 23% of LARC initiators and 27% of SARC initiators reported a new partner. SARC initiators who had a new partner were more likely to report condom use at least one time than LARC initiators reporting a new partner [82.4% vs. 59.6%; odds ratio (OR): 3.17, 95% confidence interval (CI): 1.19-8.43]. Such condom use was 42% higher among LARC initiators who reported a new sexual partner than those without and 38% higher for SARC initiators. In multivariable logistic regression, new sexual partner [adjusted OR (aOR) 3.29, 95% CI 2.10-5.16], SARC initiation (aOR 2.08, 95% CI 1.35-3.22) and age <20 (aOR 1.68, 95% CI 1.14-2.49) were independent predictors of condom use.

Conclusion: While young women are less likely to report condom use in the 6 months after initiating a LARC than after initiating a short-acting method, both groups increase their condom use similarly if they report a new sexual partner.

Implications: The differential in condom use between LARC initiators and SARC initiators is likely related to their perceived need for pregnancy prevention, as both groups increase their condom use similarly if they had new sexual partners.

Keywords: Adolescents; Condoms; Dual-method contraception; Pregnancy prevention; Sexually transmitted infection prevention.