The risk of pregnancy is high among adolescents seeking emergency department (ED) care, indicating an opportunity to expand pregnancy prevention services in this setting, according to a recent study published in JAMA Network Open.1
Takeaways
Adolescents seeking emergency department (ED) care have a significant risk of unintended pregnancy, underscoring the need for targeted prevention efforts.
With 70.8% of pregnancies among adolescents being unintended, there is a clear need for increased access to contraceptive services.
Many adolescents use the ED as their primary healthcare source, highlighting the importance of providing comprehensive sexual health services in this setting.
A substantial majority (85.1%) of adolescents believe that pregnancy prevention and contraception information should be offered in EDs, and 66.8% would use these services.
The study identified disparities in contraception use based on race and insurance status, and found that the provision of emergency contraception in EDs could reduce unintended pregnancies.
Thousands of US adolescents are impacted by unintended pregnancy annually, with a rate of 29.4 pregnancies per 1000 individuals aged 15 to 19 years reported in 2019 and 70.8% being unintended. These rates indicate a significant need for contraceptives among adolescents.
Many adolescents lack a primary care home and use the ED as their primary source of health care. However, data has indicated low contraception use in adolescent populations.
One study found that 85.1% of adolescents aged 14 to 21 years believed pregnancy prevention and contraception information should be provided at the ED.2 Additionally, 64.9% believed pregnancy prevention services should be offered at all ED visits, and 66.8% expressed they or a friend would be likely to use contraceptive care from an ED.
To evaluate contraception use and pregnancy risk among adolescents receiving care at the ED, investigators conducted a cross-sectional study.1 Data was collected between April 1, 2021, and April 30, 2022, at 6 urban, pediatric tertiary care EDs.
Participants were aged 15 to 21 years without developmental or cognitive delay, altered mental status, or critical illness impacting computerized sexual health survey (cSHS) completion. Electronic medical records were consulted for race and ethnicity data, while sexual health was determined using the cSHS.1
The use and type of contraceptive during the last sexual encounter was reported as the primary outcome of the analysis, used to calculate the pregnancy risk index (PRI). Emergency contraception (EC) prescription during the ED visit was reported as the secondary outcome among eligible participants.
There were 1063 female adolescents engaging in penile-vaginal sexual intercourse who completed survey items about contraception use included in the analysis. Participants were aged a median 17.5 years, and 20.8% were Hispanic, 44.1% non-Hispanic Black, 29.3% non-Hispanic White, and 5.8% other races and ethnicities.1
Government insurance was reported in 65.2% of participants at the time of visit, and some form of contraception use in their most recent sexual encounter by 71.1%. The use of multiple contraceptives was reported by 24.9% and no contraception by 28.9%.
The most common contraception method was short-acting hormonal method, reported in 29.4% of adolescents. This was followed by male condoms in 24.5%, long-active reversible contraception in 15.4%, withdrawal in 7.7%, and EC in 4.7%.1
Contraception use was significantly more common in non-Hispanic White, Hispanic, and other and race and ethnicity patients vs non-Hispanic Black patients. Patients with commercial insurance and those with 5 days to 1 year since their last sexual intercourse encounter were also more likely to report contraception use.
The overall study population reported a PRI of 7.39, indicating an expected 8 pregnancies per 100 female adolescents annually. EC eligibility based on sexual intercourse less than 5 days ago was reported in 10.2% of participants, with 5.6% receiving EC.
These results indicated a potential for reduced risk of unintended pregnancies in adolescents from expansion of contraception services in pediatric EDs. Investigators recommended future studies to determine optimal strategies for improving EC administration in the ED.1
References
- Canter H, Reed J, Palmer C, et al. Contraception use and pregnancy risk among adolescents in pediatric emergency departments. JAMA Netw Open. 2024;7(6):e2418213. doi:10.1001/jamanetworkopen.2024.18213
- Solomon M, Badolato GM, Chernick LS, Trent ME, Chamberlain JM, Goyal MK. Examining the role of the pediatric emergency department in reducing unintended adolescent pregnancy. The Journal of Pediatrics. 2017;189:196-200. doi:10.1016/j.jpeds.2017.06.053
