Postpartum Teenagers' Views on Providing Contraception in School-Based Health Clinics

Background: To determine characteristics of teen pregnancies in southeast Texas and the opinions of postpartum teenagers with regard to having contraceptive services available in high school clinics. Methods: A cross-sectional study of postpartum teenagers interviewed during their hospital stay. Results: Of 404 postpartum teenagers interviewed, 86% had unplanned pregnancies. Approximately 53% of respondents first had intercourse at less than 16 years of age. Of the 130 teenagers who had used contraception prior to pregnancy, 85% became pregnant because they were unable to visit the clinic to obtain a contraceptive refill or replacement. In multivariate modeling, factors associated with using contraceptives prior to pregnancy included black race (p <.001) and more than 1 previous pregnancy (p <.001). Variables associated with having an unplanned pregnancy included having discussed contraceptives at home or school (p = 0.049). Of the 404 postpartum teenagers surveyed, 223 (82%) were in favor of having contraceptive services offered in high school clinics. Conclusions: Contraceptive education is not sufficient to prevent teenage pregnancy. Increase in access is critical as teenagers with previous pregnancies were more likely to use contraception, likely due to their interaction with the medical community during the antecedent pregnancy. One possible solution is to bring contraceptive services to the teenagers, by offering them at school based health systems. A majority of teenagers surveyed in this study supported this proposal.