When N.S. last came to clinic, she was planning her future after high school. Like many 18-year-olds in our care, she was thoughtful and hopeful. She was sexually active and wanted to avoid pregnancy for many years. She relied on condoms for contraception and used emergency contraception once. She knew she would struggle to take daily pills or change a patch weekly or a ring monthly so wanted a longer-acting method. A previous trial of depo medroxyprogesterone acetate (DMPA)* had been frustrating because of persistent unscheduled bleeding. She was interested in the subdermal contraceptive implant. However, when informed that her bleeding pattern could change and she may have unscheduled bleeding, she became concerned.

Since N.S. shared menstrual materials with her mother, her mother could track her menstruation. Given the cost of menstrual supplies, her mother vigilantly monitored their stockpile. Her mother disapproved of her boyfriend, so N.S. hid her...

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