Improved continuation rate of depo-provera in teen mothers

BACKGROUND: Poor compliance and high discontinuation rates of Depo-Provera (DP) and other contraceptive methods are major factors in the continuing problem of teen pregnancy. In this study we attempted to determine if providing comprehensive health care for teen mothers and their babies would improve continuation rates of DP. METHODS: Review of clinical data in a Teen-Tot program in regards to DP. Patients who started DP between 1/1/96 and 1/1/99 were included. Teen mothers and their babies receive all their health care in this clinic, supported by State funding. Key elements regarding DP in this clinic are: continuity of care, phone or mail reminders of appointments, free DP for patients without insurance, counseling at each visit and available evening clinic. RESULTS: In the period above a total of 299 (age 13-22) patients were started on DP. 51% were white, 47% black and 2% others. 63% were single, 20% married, 3% cohabitating and 14% undetermined (missing data). 78% had one baby and 22% more than one. A total of 189 patients (63.2%) continued to be compliant after one year of use. 84 patients (28% of total) continued beyond the second year, but the actual percentage of continuation will be higher when patients who are now on DP more than 1 but less than 2 years are included. The most common side effect reported was bleeding/spotting (32%). However only 7 patients (2.3%) discontinued use because of it. CONCLUSION: Continuity of care (same staff and providers on each visit), regular counseling, flexible hours (evening appointments), financial ease (free DP and no visit charge for those without insurance), combined Teen-Tot health visits and regular reminders of appointments help improve compliance and continuation rates in teen mothers leading to better success in prevention of repeat teen pregnancy.