Postpartum Contraceptive Use Among Adolescent Mothers in Thailand
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In Thailand, an average of 355 women under the age of 20 give birth every day, 10 of whom are less than 15 years old (Public Health Statistics, 2012; Bureau of Reproductive Health, Department of Health, 2013). In 2012, 11.7% of mothers aged 15-19, or 6.4 per 1,000, gave birth more than once or were pregnant for a second time before they reached the age of 20. According to the Ministry of Public Health, over the nine-year period between 2004 and 2012, repeat birth rates among 15-19 year olds increased from 4.9 per 1,000 adolescents, peaked at 6.4, then subsequently decreased to 6.2 in 2012-2013. Repeated pregnancy in postpartum adolescents is a crisis that affects their physical and psychosocial well-being. The consequences of repeat pregnancy are significant for adolescents and society. Repeat adolescent pregnancy implies a failure in reproductive health services, especially in terms of advising adolescent mothers to start using birth control immediately after giving birth. Previous studies have found several factors associated with repeat pregnancy among adolescents. These include inconsistent contraceptive use, lower educational achievement, and an unsupportive family member. Use of highly effective contraception in the postpartum period can reduce the risk of rapid repeat pregnancy among sexually active mothers. Research on adolescents’ postpartum contraceptive use has been limited to adolescents living in Northern Thailand. Little is known about the use of contraceptives, knowledge and attitudes toward contraceptive methods and the factors that influence contraceptive use among Thai adolescent mothers.
The purpose of this exploratory study was to use qualitative methods to better understand contraceptive use among Thai adolescent mothers. In-depth interviews were used to understand the factors influencing adolescent mothers’ postpartum contraceptive use. Qualitative research is well-suited to explore complex phenomenon like contraceptive use because it provides rich contextualized data and can capture important variations among individuals. In-depth individual interviews in particular can illuminate participants’ perspectives and experiences as well as the social context that shapes them. Because adolescents’ contraceptive use before pregnancy is strongly associated with their use afterward, this study focuses on learning more about contraceptive use before pregnancy.
The participants were 26 adolescent mothers in intermediate postpartum hospitalization. Data were collected at four hospitals in Northern Thailand, during June to November 2015. The sample size was determined by data saturation as is appropriate for qualitative research. All participants and their parents provided written informed consent. This study was approved by the Chiang Mai University Faculty of Nursing Research Ethics Committee.
The research instruments included a semi-structured interview guide, which explored a broad range of contraceptive use before pregnancy and after birth, including contraceptive use, knowledge about contraceptive, attitudes and intentions toward contraceptive use after birth. Interviews were conducted privately in a separate room, and participants were encouraged to speak freely about their opinions. Interviews lasted approximately 30 to 45 minutes.
Interviews were recorded using a digital audio recorder and the co-facilitator took notes. Audio files were transcribed verbatim by the investigative team immediately after interview completion. Data were categorized using content analysis. Emergent themes were identified. Descriptive statistics were used to characterize the participants.
The median age of particpants was 17 (range 15-19); the mean age was 17.27. All (100%) participants were primigravid. Twenty-four participants (92.31%) used contraception at the time of conception, whereas, two participants (7.69%) did not use any contraception. Twenty participants (76.92%) reported that the pregnancy was unplanned.
The five contraceptive methods used included condoms, birth control pills, contraceptive injections, external ejaculation, and emergency contraceptive pills. The majority of participants reported that a lack of knowledge and misinformation about sex, reproductive health, and contraceptive methods contributed to adolescent pregnancy. Some participants did not know how to take birth control pills and inconsistently used other forms of contraception. Reasons given included forgetting to use contraception or that condoms reduce pleasure for the male. Some participants believed that external ejaculation prevented pregnancy. Participants noted that they often lacked adult supervision because of their parents’ work situations, leaving them on their own without productive activities. Other factors such as the media, alcohol, and stigma of abortion were contributing factors to adolescent pregnancy. Participants reported that convenience, perceived effectiveness, familiarity, and side effects were the primary reasons for selecting or changing a method of contraception postpartum and recommended several methods of promoting contraceptive use among adolescents.
The findings from this study indicate that patterns of contraceptive use among adolescent mothers place them at high risk of rapid repeat pregnancy. Understanding adolescent mothers’ contraceptive use and the influencing factors is important for developing effective program for interventions.