The evidence behind preventing unintended pregnancies in adolescents

Valentine’s Day is around the corner, and love is in the air! In spirit of this holiday, as well as Sexual and Reproductive Health Day on the 14th, our topic this week is about approaches to preventing unintended pregnancy in adolescents.

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Source: Wikimedia Commons

Unintended teenage pregnancy is a common public health concern worldwide (Oringanje, Meremikwu, Eko, Esu, Meremikwu, & Ehiri, 2010). Children born to teenage mothers are more likely to have low birth weight and to be neglected and abused (Elfebein, 2003). Teenagers who have an unintended pregnancy face a number of potential challenges, including increased risk of adverse obstetric outcomes (i.e. preterm birth and low birth weight), greater likelihood of single parenthood, and difficulty completing their education. These factors can disadvantage the teen’s future social and economic opportunities, which, in turn, exert considerable cost on society in terms of lost employment opportunities and use of social assistance programs (Oringanje, Meremikwu, Eko, Esu, Meremikwu, & Ehiri, 2010).

Many preventative programs have been implemented to attempt to reduce the rate of teen pregnancy. These can include any activity targeting increasing adolescents’ knowledge and attitudes related to risk of unintended pregnancies. Interventions often promote delay in initiation of sexual intercourse and encourage consistent use of birth control methods to reduce unintended pregnancies. Preventative approaches can include:

  • Health education or counseling only
  • Health education plus skills-building
  • Health education plus contraception education
  • Contraception education and distribution
  • Faith-based group or individual counseling

To evaluate the effectiveness of these programs, a Cochrane systematic review assessed 41 randomized controlled trials including 95,662 teens for the impact of primary preventative interventions on unintended pregnancies in adolescents. The strategies reviewed included are:

Educational interventions: health education, HIV/STI education, community services, counseling only, health education plus skills-building, faith-based group or individual counseling.

Contraception promotion: contraception education with or without distribution.

Multiple interventions: combination of educational and contraception interventions.

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Source: Wikimedia Commons

What were the key findings?

  • Concurrently applying multiple interventions, like skill building, education, and contraception promotion, was the most effective means of lowering the rate of unintended pregnancy among adolescents.
  • Promoting the use of contraceptive measures alone does not seem to reduce unintended pregnancy.
  • Results for behavioral outcomes (initiation of sexual intercourse and use of birth
    control methods) were inconsistent across trials.

While the review reported that the best way to prevent unintended pregnancies in teens is to take a combined approach and apply multiple interventions focusing on both education and contraception promotion, the authors caution that the evidence base is limited due to variation in outcome reporting (and potential inaccuracies with participant self-reporting), and these results are not strong enough to guide practice. They also highlight:

“Application of the findings of this review should be approached with caution given the methodological deficiencies of included trials, the substantial heterogeneity across trials in the ways programs were delivered and the frequent omission of methodological details and implementation information from primary trial reports.”

More Information:

http://sexualityandu.ca

http://teachingsexualhealth.ca

https://sexetc.org

References:

Elfebein DS, Felice ME. Adolescent pregnancy. Pediatr Clin North Am 2003;50(4):781–800.

Oringanje, C., Meremikwu, M. M., Eko, H., Esu, E., Meremikwu, A., & Ehiri, J. E. (2009). Interventions for preventing unintended pregnancies among adolescents. Cochrane Database Syst Rev, 4(4).

Cochrane summary