Long-acting reversible contraceptive methods: knowledge and accessibility among adolescents

Abstract

The rate of unintended pregnancy among adolescents in Brazil is high and represents both a social and an individual problem because it causes several physical and emotional harms. Strategies to reduce this rate are needed, and long-acting reversible contraceptives (LARCs) are effective options, although they remain underused. To investigate knowledge and use of these methods, a cross-sectional observational study was conducted using a questionnaire sent to 360 young people in Projeto Aprendiz ABC. The questionnaire was completed by 204 participants aged 15 to 19 years (mean, 16 ± 1.03 years), 56.8% of whom were female. Regarding knowledge of LARCs, 53 (25.9%) did not know any of the methods listed, 46 (31.1%) knew all methods, 101 (68.2%) knew only the intrauterine device (IUD), and one (0.7%) knew only the subdermal implant. Knowledge of LARCs did not differ by age (p=0.27) or educational level (p=0.11), but it was greater among female participants (p=0.00), those who had access to sexuality education (p=0.01), and those who had already initiated sexual activity (p=0.00). Only 47 participants knew about the implant. Age, educational level, access to sexuality education, and initiation of sexual activity were not associated with knowledge of this method; however, women were more likely to know about the implant (p=0.01). Regarding use, only two young people used a LARC, both a copper IUD. In terms of interest, 75.9% stated that they would like to use these methods. Regarding cost, 68.4% reported being unable to afford them. The findings show that the IUD was the third best-known contraceptive method among the participants, whereas the implant was the least known, revealing a discrepancy in knowledge even between LARC methods. Although the IUD was relatively well known, it was still rarely used, indicating that factors other than knowledge prevent young people from using the method. Most participants could not afford a hormonal IUD or implant, making cost one of the main barriers to access, although many would like to use the method if it were free. In summary, knowledge is greater for the IUD than for the implant, and cost is a decisive factor in adolescents’ access to LARCs.