Intervention Now to Eliminate Repeat Unintended Pregnancy in Teenagers (INTERUPT): a systematic review of intervention effectiveness and cost-effectiveness, and qualitative and realist synthesis of implementation factors and user engagement

Abstract

BackgroundUnintended repeat conceptions can result in emotional, psychological and educational harm to young women, often with enduring implications for their life chances. This study aimed to identify which young women are at the greatest risk of repeat unintended pregnancies; which interventions are effective and cost-effective; and what are the barriers to and facilitators for the uptake of these interventions.MethodsWe conducted a mixed-methods systematic review which included meta-analysis, framework synthesis and application of realist principles, with stakeholder input and service user feedback to address this. We searched 20 electronic databases, including MEDLINE, Excerpta Medica database, Applied Social Sciences Index and Abstracts and Research Papers in Economics, to cover a broad range of health, social science, health economics and grey literature sources. Searches were conducted between May 2013 and June 2014 and updated in August 2015.ResultsTwelve randomised controlled trials (RCTs), two quasi-RCTs, 10 qualitative studies and 53 other quantitative studies were identified. The RCTs evaluated psychosocial interventions and an emergency contraception programme. The primary outcome was repeat conception rate: the event rate was 132 of 308 (43%) in the intervention group versus 140 of 289 (48%) for the control group, with a non-significant risk ratio (RR) of 0.92 [95% confidence interval (CI) 0.78–1.08]. Four studies reported subsequent birth rates: 29 of 237 (12%) events for the intervention arm versus 46 out of 224 (21%) for the control arm, with an RR of 0.60 (95% CI 0.39–0.93). Many repeat conceptions occurred in the context of poverty, low expectations and aspirations and negligible opportunities. Qualitative and realist evidence highlighted the importance of context, motivation, future planning and giving young women a central and active role in the development of new interventions.ConclusionsLittle or no evidence for the effectiveness or cost-effectiveness of any of the interventions to reduce repeat pregnancy in young women was found. Qualitative and realist evidence helped to explain gaps in intervention design that should be addressed. More theory-based, rigorously evaluated programmes need to be developed to reduce unintended repeat pregnancy in young women.Trial registrationPROSPERO, CRD42012003168. Cochrane registration number: i = fertility/0068Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-017-0904-7) contains supplementary material, which is available to authorized users.

Time trends in and factors associated with repeat adolescent birth in Uganda: Analysis of six demographic and health surveys

“…This study and another systematic review highlighted the limited information on factors associated with repeat adolescent births in LMICs [21]. Poverty is associated with repeat adolescent pregnancies and births in both LMIC and high-income settings and has a high chance of reverse causality [20,21]. Poverty perhaps deprives the girl of the power to make decisions over further births, family planning use, access to abortion or by increasing chances of her deciding to complete her family size early due to lack of viable alternatives [20,21].…”

“…Poverty is associated with repeat adolescent pregnancies and births in both LMIC and high-income settings and has a high chance of reverse causality [20,21]. Poverty perhaps deprives the girl of the power to make decisions over further births, family planning use, access to abortion or by increasing chances of her deciding to complete her family size early due to lack of viable alternatives [20,21]. Our study further supports that household poverty and young age at first birth appear to be major factors associated with repeat adolescent births.…”

“…Experiencing another birth before 20 years of age (= repeat adolescent childbirth) may therefore push the adolescent woman and her offspring into worse outcomes than what she experienced following the first birth. Repeat pregnancy in adolescence is more common in settings of high poverty, low educational attainment or its discontinuation, early union or being in a union, none use of long acting reversible contraceptives and previous abortion or non-live birth, among others [20][21][22][23].…”

Myeloma patients' experiences of haematopoietic stem cell transplant: A qualitative thematic synthesis

“…However, the inclusion of these studies fitted with our use of criterion sampling, an approach often used in qualitative evidence synthesis to 'construct a comprehensive understanding of all the studies that meet certain pre-determined criteria' (Suri, 2011, p.69). We aimed for inclusivity and therefore did not apply criteria for selecting only studies with the best evidence as outlined by Aslam et al (2017) who illustrate their use of the CART criteria (comprehensiveness, accuracy, relevance, timeliness) (Tennison, 2006), employed when there is a large number of studies.…”

A 5-year evaluation of the emergency contraception enhanced community pharmacy service provided in Wales

“…Prompt access is of clinical significance, as the sooner EC is taken the more effective it is 1. Previous studies found that access was a barrier to EC use and that the longer opening hours, weekend openings and more accessible locations of pharmacies allowed most users to access EC within 24 hours;9 12 18 19 our study demonstrates that there remain barriers to access on Sunday. Possible reasons for this are fewer pharmacies being open and shorter opening times among those pharmacies that are open.…”