Evaluation of a program for preventing adolescent pregnancy

Pooled incidence of continuation and pregnancy rates of four contraceptive methods in young women: a meta-analysis

BACKGROUND

Continuation rates of contraceptive methods in young women vary among studies, and there is scarce data regarding the pregnancy rate in this population.

METHODS

Four independently systematic searches were performed in PUBMED, EMBASE, LILACS, and Cochrane databases from inception until January 2021 for oral contraceptive pill (OCP), copper IUD, levonorgestrel intrauterine system (LNG-IUS), and subdermal implant. Inclusion criteria were observational or RCT studies that reported continuation for at least 12 months and/or pregnancy rate of these contraceptives methods in girls aged 22 years old or younger. Two authors extracted data from the study design and the outcomes. Pooled proportions of each method were applied using the inverse variance in all calculations with LOGIT transformation, using the random-effects model. Cochrane collaboration tool and New Castle-Ottawa were used to assess the quality and bias of all included studies. GRADE criteria evaluated the quality of evidence.

RESULTS

Continuation rate for OCP was 51% (95%CI 34%-68%), while for cooper IUD was 77% (95%CI 74%-80%), LNG-IUS 84% (95%CI 80%-87%), and implant 85% (95%CI 81%-88%). The pooled estimated pregnancy rate for OCP was 11% (95%CI 6%-20%), while for cooper IUD was 5% (95%CI 3%-7%), LNG-IUS 1.6% (95%CI 1.2%-2.3%), and implant 1.8% (95%CI 0.4%-8.4%).

CONCLUSION

Long-acting contraceptive methods presented higher continuation rates and lower pregnancy rates when compared to OCPs.

The Health Belief Model as a Conceptual Framework for Explaining Contraceptive Compliance

The problem of compliance in family planning is discussed in relation to the lack of theoretical and conceptual clarity in research, which has produced contradictory, and often inconsistent findings. Current research has contributed little to explaining the phenomenon of compliance and to directing further research. The Health Belief Model, which has been demonstrated to have application in the areas of preventive health behavior and compliance with medical regimens, is offered as a potentially useful conceptual framework for family planning research. The generalization of the Health Belief Model to family planning behavior is seen as an out-growth of the theoretical strength of the Model and the similarities between family planning and other health behavior.

The effectiveness of contraceptive programs for teenagers

This paper critically reviews the effectiveness of adolescent family planning programs in the United States. Various models for evaluating family planning programs and the findings from empirical studies of adolescent programs are reviewed. During the past decade there have been major increases in the availability and utilization of contraceptive services by adolescents. Most of those who are sexually active are now aware that these services exist. Program continuation rates among adolescents are not high, in part, because of the sporadic nature of adolescent sexual activity. Data on contraceptive continuation and pregnancy rates in these programs are limited, since few studies follow up clinic noncontinuers. Among clinic continuers pregnancy rates are relatively low, suggesting that at least some programs are effective in reducing pregnancy and/or fertility rates (number of children born) in their target populations. Ecological analyses seem to indicate that programs have had an impact on adolescent marital fertility.

Identifying adolescents at risk for noncompliance with contraceptive therapy

The sociomedical characteristics of 96 sexually active adolescent females have been studied in order to understand noncompliance with the contraceptive prescription, an important antecendent of adolescent pregnancy. Compliance was found to correlate positively with postmenarchal age, frequency of intercourse, autonomy in making and paying for a clinic appointment specifically for the purpose of obtaining contraception, and acceptance of a method at the time of the initial clinic visit. These findings serve to alert the pediatrician to the adolescent at risk for noncompliance before the experience of failure, and in so doing to identify those in need of special assistance to ensure the success of contraceptive measures.

Adolescent sexual activity: contraception and abortion

One hundred twenty-five pregnant adolescents 16 years of age or younger and their parents were studied prior to abortion and were compared with 72 nulligravid control subjects. The control group reported less incidence of sexual intercourse and more causal heterosexual relationships of shorter durations. A significantly larger percentage of the abortion group approved of premarital sexual intercourse "when the couple is going steady." Sixty-eight per cent of the adolescents who were seeking abortions had never used a contraceptive. Abortion "on demand" was favored by the majority of the abortion group, whereas the control group favored "abortion under special circumstances." Neither were the pregnant teenagers' parents aware of nor had they discussed their daughter's sexual activities, much less contraception. Prevention of unwanted pregnancies in early adolescence should encompass an educational effort on the part of the health professions, involving both the adolescents and their parents.

Contraception in adolescence--a review of the literature

During the last 10 years an increasing number of pregnancies have been noted in adolescents. The children of these pregnancies are often at risk. The problem was discussed in a meeting on Pregnancy and Abortion in Adolescence in 1974, held at WHO headquarters, Geneva. An annotated bibliography was prepared for that meeting, from which this review originated. The literature covered a wide range of subjects, but an attempt has been made in this review to discuss the problem in six main sections: social aspects; sexual attitudes and behaviour; sex education and information; contraceptive services for adolescents; medical and clinical aspects and legislation. Quite a number of teenagers are sexually active even in their early teens but often keep to one partner. Their use of contraception is poor, partly because of a lack of education and information. Young people are demanding better information and services, which would probably best be provided through special teenage clinics. So far, there have been very few investigative studies dealing exclusively with adolescent use of different contraceptive methods. Methods of contraception available at present are often unsuitable for use by adolescents, and further research on the problem is needed.

Problems with contraception in adolescents. The successful use of an intrauterine device

Contraceptive methods of all types have their highest failure rates in young or nulliparous females. This paper describes ex periences with intrauterine contraceptive devices in adolescents.