Postpartum Contraceptive Use Among Adolescent Mothers in Seven States

Wilson, Ellen; Fowler, Christina; Koo, Helen P.

doi:10.1016/j.jadohealth.2012.05.004

Cited by 60 publications

(47 citation statements)

References 27 publications

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“…Policy documents from the UK were also used to explore elements of the theory areas under investigation, applying the criteria of relevance and rigor. Identified quantitative studies that were not synthesised in any 'pooled' analysis Twenty-one additional quantitative studies [112][113][114][115][123][124][125][126][127][128][143][144][145][146][147][148][149][150][151][152][153] were identified as included studies, but were not synthesised in any 'pooled' analysis as they did not report on or contain data relevant to the outcomes under investigation. We extracted data on other risk factors but had insufficient data to perform metaregression with any statistical integrity.…”

Section: Realist Synthesismentioning

confidence: 99%

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

Whitaker¹,

Hendry

Aslam

et al. 2016

Health Technol Assess

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BackgroundThe UK has one of the highest rates of teenage pregnancies in Western Europe. One-fifth of these are repeat pregnancies. Unintended conceptions can cause substantial emotional, psychological and educational harm to teenagers, often with enduring implications for life chances. Babies of teenage mothers have increased mortality and are at a significantly increased risk of poverty, educational underachievement and unemployment later in life, with associated costs to society. It is important to identify effective, cost-effective and acceptable interventions.ObjectivesTo identify who is at the greatest risk of repeat unintended pregnancies; which interventions are effective and cost-effective; and what the barriers to and facilitators of the uptake of these interventions are.Data sourcesWe conducted a multistreamed, mixed-methods systematic review informed by service user and provider consultation to examine worldwide peer-reviewed evidence and UK-generated grey literature to find and evaluate interventions to reduce repeat unintended teenage pregnancies. We searched the following electronic databases: MEDLINE and MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library (Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and the Health Technology Assessment Database), EMBASE (Excerpta Medicadatabase), British Nursing Index, Educational Resources Information Center, Sociological Abstracts, Applied Social Sciences Index and Abstracts, BiblioMap (the Evidence for Policy and Practice Information and Co-ordinating Centre register of health promotion and public health research), Social Sciences Citation Index (supported by Web of Knowledge), Research Papers in Economics, EconLit (American Economic Association’s electronic bibliography), OpenGrey, Scopus, Scirus, Social Care Online, National Research Register, National Institute for Health Research Clinical Research Network Portfolio and Index to THESES. Searches were conducted in May 2013 and updated in June 2014. In addition, we conducted a systematic search of Google (Google Inc., Mountain View, CA, USA) in January 2014. Database searches were guided by an advisory group of stakeholders.Review methodsTo address the topic’s complexities, we used a structured, innovative and iterative approach combining methods tailored to each evidence stream. Quantitative data (effectiveness, cost-effectiveness, risk factors and effect modifiers) were synthesised with reference to Cochrane guidelines for evaluating evidence on public health interventions. Qualitative evidence addressing facilitators of and barriers to the uptake of interventions, experience and acceptability of interventions was synthesised thematically. We applied the principles of realist synthesis to uncover theories and mechanisms underpinning interventions (what works, for whom and in what context). Finally, we conducted an overarching narrative of synthesis of evidence and gathered service user feedback.ResultsWe identified 8664 documents initially, and 816 in repeat searches. We filtered these to 12 randomised controlled trials (RCTs), four quasi-RCTs, 10 qualitative studies and 53 other quantitative studies published between 1996 and 2012. None of the RCTs was based in the UK. The RCTs evaluated an emergency contraception programme and psychosocial interventions. We found no evidence for effectiveness with regard to condom use, contraceptive use or rates of unprotected sex or use of birth control. Our 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 goup, with a non-significant risk ratio (RR) of 0.92 [95% confidence interval (CI) 0.78 to 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 a RR of 0.60 (95% CI 0.39 to 0.93). Many repeat conceptions occurred in the context of poverty, low expectations and aspirations, and negligible opportunities. Service user feedback suggested that there were specific motivations for many repeat conceptions, for example to replace loss or to please a partner. Realist synthesis highlighted that context, motivation, planning for the future and letting young women take control with connectedness and tailoring provide a conceptual framework for future research.LimitationsIncluded studies rarely characterised adolescent pregnancy as intended or unintended, that is interventions to reduce repeat conceptions rarely addressed whether or not pregnancies were intended. Furthermore, interventions were often not clearly defined, had multiple aims and did not indicate which elements were intended to address which aims. Nearly all of the studies were conducted in the USA and focused largely on African American or Hispanic and Latina American populations.ConclusionsWe found no evidence to indicate that existing interventions to reduce repeat teenage pregnancy were effective; however, subsequent births were reduced by home-based interventions. 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 repeat teenage pregnancy in the UK.Study registrationThis study is registered as PROSPERO CRD42012003168. Cochrane registration number: i=fertility/0068.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Realist Synthesismentioning

confidence: 99%

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

Whitaker¹,

Hendry

Aslam

et al. 2016

Health Technol Assess

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“…1,[6][7][8] Teenagers who get pregnant again in less than two years are less likely to return to school or become economically self-sufficient than those who start reproduction later, and their children have a higher probability of presenting behavioral and emotional problems when compared to other children. 3,[9][10][11][12] Women starting motherhood during adolescence tend to have a greater number of children throughout their reproductive life. 4,10 Generally, the first pregnancy is not planned, and sometimes unwanted; thus, it is high the probability of the following pregnancies acquire the unwanted character of the first.…”

Section: Introductionmentioning

confidence: 99%

“…The discontinuation ofncontraceptive puts teenage mothers in high risk, since many get pregnant again within 12 months after childbirth. [9][10][11] Some reasons may be described as determinant factors for this discontinuation, such as: the teenager does not like the side effects of the oral contraceptives, the unplanning sexual activities and the absence of receiving advice from the health team regarding the immediate postpartum. 2,5,14,15 The understanding of factors that contribute to teenage pregnancy and its repetition are fundamental to the development of adequate interventions.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of rapid repeat pregnancy and associated factors in adolescents in Caruaru, Pernambuco

Albuquerque

Pitangui

Rodrigues

et al. 2017

Rev. Bras. Saude Mater. Infant.

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“…Compared with adolescent mothers with only one child, young mothers with more than one child have lower levels of education, are more likely to live in poverty, and have increased dependence on governmental support (Rotermann 2007;Patchen et al 2013;Gill et al 2016). Lack of postpartum contraception (Al-Sahab et al 2012;Kingston et al 2012;Pinzon and Jones 2012;Wilson et al 2013;Whitaker et al 2016;Sober et al 2017), experiencing intimate partner violence (IPV), and having mental health and substance abuse issues (Harrison et al 2014;SmithBattle and Freed 2016) have been identified as key factors associated with multiple pregnancies among youth.…”

Section: Introductionmentioning

confidence: 99%

“It was kind of like if it happens it happens. It wasn’t planned, it wasn’t intentional”: Young mothers’ experiences with subsequent pregnancy in Ottawa, Canada

Fortier

Foster

2017

FACETS

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Young mothers constitute a vulnerable population in Canada. Teens with children are at significant risk of subsequent pregnancy, a dynamic that can exacerbate health, emotional, and socio-economic challenges. We aimed to understand better the dynamics shaping "rapid repeat pregnancy" among young mothers in Ottawa, explore young mothers' subsequent pregnancy experiences, and identify how services could be improved in Canada's capital. In 2016, we conducted in-depth interviews with 10 young mothers and semi-structured interviews with 10 key informants working with pregnant and parenting youth. We analyzed interviews for content and themes using a multi-phased, iterative process. Four major themes emerged: (1) young mothers often plan their pregnancies actively or passively; (2) violence before, during, and after pregnancy is common; (3) mental health and substance abuse issues shape pregnancy risk; and (4) becoming pregnant often serves as a source of motivation for young mothers. Our results further indicate that young mothers have difficulty finding youthfriendly, non-judgmental support services and that integrated, multidisciplinary services offering individually tailored support and building on women's strengths will likely be more successful in helping young mothers prevent subsequent pregnancies. Increasing awareness about existing services and supporting efforts that approach teen pregnancy comprehensively and holistically appear warranted.

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Postpartum Contraceptive Use Among Adolescent Mothers in Seven States

Cited by 60 publications

References 27 publications

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

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

Prevalence of rapid repeat pregnancy and associated factors in adolescents in Caruaru, Pernambuco

“It was kind of like if it happens it happens. It wasn’t planned, it wasn’t intentional”: Young mothers’ experiences with subsequent pregnancy in Ottawa, Canada

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