Association between long-acting reversible contraceptive use, teenage pregnancy, and abortion rates in England

Connolly, Anne; Pietri, G.; Yu, Jingbo; Humphreys, S.C.

doi:10.2147/ijwh.s64431

Cited by 11 publications

(6 citation statements)

References 5 publications

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“…Prior counselling on future fertility was also associated with being on LTPM. This finding was in agreement with the South African study, 10 which showed higher chances of being on LTPM for mothers who had prior counselling on future fertility. Consequently, there is a need for broader counselling in post-partum mothers to include their future fertility intentions and all contraceptives available to reduce unintended pregnancy rates.…”

Section: Discussionsupporting

confidence: 92%

“… 5 A study in England showed a decrease in unintended pregnancies between 1998 and 2011, and a statistically significant association between the decrease and the use of LTPM was found. 10 In 2012, the American College of Obstetricians and Gynaecologists recommended the use of LTPM for all women. 11 These methods are safe, non-user-dependent and have the highest continuation rates compared with other methods.…”

Section: Introductionmentioning

confidence: 99%

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Does counselling improve uptake of long-term and permanent contraceptive methods in a high HIV-prevalence setting?

Siveregi¹,

Dudley

Makumucha

et al. 2015

Afr. j. prim. health care fam. med.

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BackgroundStudies have shown a reduced uptake of contraceptive methods in HIV-positive women of childbearing age, mainly because of unmet needs that may be a result of poor promotion of available methods of contraception, especially long-term and permanent methods (LTPM).AimTo compare the uptake of contraceptive methods, and particularly LTPM, by HIV-positive and HIV-negative post-partum mothers, and to assess the effects of counselling on contraceptive choices.SettingThree government district hospitals in Swaziland.MethodsInterviews were conducted using a structured questionnaire, before and after counselling HIV-negative and HIV-positive post-partum women in LTPM use, unintended pregnancy rates, future fertility and reasons for contraceptive choices.ResultsA total of 711 women, of whom half were HIV-positive, participated in the study. Most (72.3% HIV-negative and 84% HIV-positive) were on modern methods of contraception, with the majority using 2-monthly and 3-monthly injectables. Intended use of any contraceptive increased to 99% after counselling. LTPM use was 7.0% in HIV-negative mothers and 15.3% in HIV-positive mothers before counselling, compared with 41.3% and 42.4% in HIV-negative and HIV-positive mothers, respectively, after counselling. Pregnancy intentions and counselling on future fertility were significantly associated with current use of contraception, whilst current LTPM use and level of education were significantly associated with LTPM post-counselling.ConclusionCounselling on all methods including LTPM reduced unmet needs in contraception in HIV-positive and HIV-negative mothers and could improve contraceptive uptake and reduce unintended pregnancies. Health workers do not always remember to include LTPM when they counsel clients, which could result in a low uptake of these methods. Further experimental studies should be conducted to validate these results.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Does counselling improve uptake of long-term and permanent contraceptive methods in a high HIV-prevalence setting?

Siveregi¹,

Dudley

Makumucha

et al. 2015

Afr. j. prim. health care fam. med.

View full text Add to dashboard Cite

show abstract

“…Researchers finding a strong association between falling teenage pregnancy rates and increasing use of long-acting reversible contraception in England since the late 1990s have underlined the contribution of increased access to reliable contraception to the decline. 17 Observers in the USA have reached similar conclusions 18 supported by intervention studies examining the effect of providing highly effective contraception free of charge. 19 By contrast, researchers using ecological analyses of routinely collected area-level data in England to examine the association between educational attainment, contraceptive use, and trends in conception in women younger than 18 years concluded that the larger association with education indicates that this is the key driver.…”

Section: Discussionmentioning

confidence: 80%

“…The strong and sustained association between conception in women younger than 18 years and earlier sexual activity suggests that sizeable additional gains might also be made by helping young women to become sexually active at a time that is right for them. 27 A third of all young women, and 60% of those for whom first sex occurs before age 16 years, subsequently consider that to have been too early for them. Bringing actual timing of first sexual encounter in line with preference for timing of first sexual encounter could cut teenage pregnancy rates further, and an intensified policy focus aimed at achieving this might be warranted.…”

Section: Discussionmentioning

confidence: 99%

Changes in conceptions in women younger than 18 years and the circumstances of young mothers in England in 2000–12: an observational study

et al. 2016

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SummaryBackgroundIn 2000, a 10-year Teenage Pregnancy Strategy was launched in England to reduce conceptions in women younger than 18 years and social exclusion in young parents. We used routinely collected data and data from Britain's National Surveys of Sexual Attitudes and Lifestyles (Natsal) to examine progress towards these goals.MethodsIn this observational study, we used random-effects meta-regression to analyse the change in conception rates from 1994–98 to 2009–13 by top-tier local authorities in England, in relation to Teenage Pregnancy Strategy-related expenditure per head, socioeconomic deprivation, and region. Data from similar probability sample surveys: Natsal-1 (1990–91), Natsal-2 (1999–2001), and Natsal-3 (2010–12) were used to assess the prevalence of risk factors and their association with conception in women younger than 18 years in women aged 18–24 years; and the prevalence of participation in education, work, and training in young mothers.FindingsConception rates in women younger than 18 years declined steadily from their peak in 1996–98 and more rapidly from 2007 onwards. More deprived areas and those receiving greater Teenage Pregnancy Strategy-related investment had higher rates of conception in 1994–98 and had greater declines to 2009–13. Regression analyses assessing the association between Teenage Pregnancy Strategy funding and decline in conception rates in women younger than 18 years showed an estimated reduction in the conception rate of 11·4 conceptions (95% CI 9·6–13·2; p<0·0001) per 1000 women aged 15–17 years for every £100 Teenage Pregnancy Strategy spend per head and a reduction of 8·2 conceptions (5·8–10·5; p<0·0001) after adjustment for socioeconomic deprivation and region. The association between conception in women younger than 18 years and lower socioeconomic status weakened slightly between Natsal-2 and Natsal-3. The prevalence of participation in education, work, or training among young women with a child conceived before age 18 years was low, but the odds of them doing so doubled between Natsal-2 and Natsal-3 (odds ratio 1·99, 95% CI 0·99–4·00).InterpretationA sustained, multifaceted policy intervention involving health and education agencies, alongside other social and educational changes, has probably contributed to a substantial and accelerating decline in conceptions in women younger than 18 years in England since the late 1990s.FundingMedical Research Council, Wellcome Trust, Economic and Social Research Council, and Department of Health.

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“…These researchers projected that if the CHOICE model was adopted nationally among all sexually active teens in the U.S., the pregnancy rate of 67.8 per 1,000 teens (in 2008) [ 33 ] could be reduced to 29.6. [ 33 , 34 ] Confirmation of this assertion was a recent paper showing reductions in teenage pregnancy and abortion rates in England as LARC usage increases [ 35 ].…”

Section: Introductionmentioning

confidence: 93%

LARC methods: entering a new age of contraception and reproductive health

Shoupe

2016

Contracept Reprod Med

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Association between long-acting reversible contraceptive use, teenage pregnancy, and abortion rates in England

Cited by 11 publications

References 5 publications

Does counselling improve uptake of long-term and permanent contraceptive methods in a high HIV-prevalence setting?

Does counselling improve uptake of long-term and permanent contraceptive methods in a high HIV-prevalence setting?

Changes in conceptions in women younger than 18 years and the circumstances of young mothers in England in 2000–12: an observational study

LARC methods: entering a new age of contraception and reproductive health

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