Meta-Analysis of the Safety and Efficacy of Long-Acting Reversible Contraceptive Methods (LARC) Methods in Young Women and Adolescents: Health Policy Implications

No evidence in the literature searched comparing LARC and non-LARC methods in young women and adolescent girls, as well as comparison between available LARC methods, related to efficacy and safety are yet described. Therefore, we sought to identify which method of contraception is the best choice to advice young girls in order to prevent unwanted pregnancy. Systematic searches of PUBMED, EMBASE, Lilacs and Cochrane databases from inception until May 2017 identify 20 observational studies, which seven of them are comparison of LARC versus non-LARC, and 13 studies comparing LARC versus LARC. All of the studies presented high quality according to Newcastle Ottawa Scale (NOS), GRADE rated as low or very low for the majority of outcomes. Our findings showed a better adherence favoring LARC at 12 months [RR 1*70 (95% CI 1*20 - 2*41) I2=91%; 1,461 young women], which implicates a better outcome for adolescents to prevent unwanted pregnancy. It also shows a better efficacy for LNG-IUS when compared to Copper IUD [RR 0*55 (95% CI 0*43 - 0*72) I2=0%; 12,129 young women]. Therefore, LARC has potential benefits on preventing unplanned pregnancy among young women and adolescents, However, researchers still have a lot of work to do in order to improve the quality and certainty of the evidences, and their usability for health policy making. Funding Statement: This work received an educational grant from Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES). Declaration of Interests: Dr. Farah received an educational grant from CAPES, during the conduct of the study. Dr. Moraes has nothing to disclose. Dr. Ilona Katalin de Jarmy Di Bella has nothing to disclose. Dr. Girao has nothing to disclose. Dr. Fonseca has nothing to disclose. Ethics Approval Statement: This study was approved by ethical committee (UNIFESP-EPM: 58281316.4.0000.5505). This meta-analysis was conducted following MOOSE Guidelines for Meta-Analyses and Systematic Reviews of Observational Studies, and the final protocol was registered in PROSPERO (CRD42017055452).