Social predictors of repeat adolescent pregnancy and focussed strategies

doi:10.1016/j.bpobgyn.2010.02.016

Best Practice & Research Clinical Obstetrics & Gynaecology

Volume 24, Issue 5, October 2010, Pages 605-616

https://doi.org/10.1016/j.bpobgyn.2010.02.016 Get rights and content

This article begins with an overview of teenage pregnancy within a social context. Data are then presented on conceptions and repeat conceptions in teenagers. Social predictors of repeat teenage pregnancy are grouped according to social ecological theory. A brief summary of prevention of teenage pregnancy in general is followed by a detailed analysis of studies of interventions designed to prevent repeat pregnancy that reached specific quality criteria. The results of some systematic reviews show no significant overall effect on repeat pregnancy, whereas others show an overall significant reduction. Youth development programmes are shown in some cases to lower pregnancy rates but in other cases to have no effect or even to increase them. Features of secondary prevention programmes more likely to be successful are highlighted.

Section snippets

Definitions

Adolescents are defined by the World Health Organization (WHO) as young people aged from 10 to 19 years¹, that is, it includes 3 years before entry into the teen years. Conceptions at ages under 14 are rare. It should be noted that 18- and 19-year-olds have reached the age of majority and are no longer children; they may hold a commercial pilot’s licence, be appointed as a police officer or become a Member of Parliament.² The terms adolescents and teenagers will be used interchangeably in this

Conceptions

Data on conceptions have become increasingly available. These data include births and legal abortions only; miscarriages are known to be the outcome of around 12% of conceptions.22, 23 Conception rates of European adolescents range from 12.4 per 1000 women aged 15–19 years in Italy through to 64.7 per 1000 in the Russian Federation.²⁴ The UK is in the five European countries with the highest conception rates, after the Russian Federation, Bulgaria, Romania and Tajikistan. The European country

Social predictors of repeat adolescent pregnancy

It is not uncommon for a second teenage birth to be planned.¹⁸ Teenage mothers may consider subsequent childbearing to give their first child a sibling or to complete their family before continuing with their education or vocation.

It must be stressed that those adolescents who have repeat births in many ways do not differ from those having a first pregnancy. Some studies show very few differences.⁵² Thus, prediction of a rapid second birth has been largely unsuccessful.*40, *41 In this respect,

Prevention of adolescent pregnancy in general

Traditional approaches such as sex and relationships education and better sexual and reproductive health services are not effective on their own.71, 72 Pregnancy prevention initiatives for teenagers need to address the following three overarching themes⁷³:

•
social disadvantage and dysfunction,
•
values and norms about sexual behaviour and childbearing; perceptions of these norms by adolescents and
•
attachment to parents, groups or institutions that emphasise responsible sexual behaviour.

Strategies for

Prevention of repeat adolescent pregnancy

By definition, prevention of repeat pregnancy cannot include early childhood interventions, as the woman has already become of reproductive age and is sexually active. This probably makes prevention of repeat pregnancy a more difficult proposition than prevention of a first teenage pregnancy.

Features of successful programmes

One of the fundamental aims of a secondary prevention intervention is to convince a teenage mother that delaying a subsequent birth is advantageous to her baby. Cultivation of maternal support is also a key to success. In terms of the process, it appears that individualised, rather than group, counselling is more likely to be successful.⁴¹

Programmes probably more likely to have greater effectiveness in reducing rapid repeat pregnancy include the following components63, *81, 84, 85, *86:

Conclusions

There is no evidence to indicate that prediction of repeat pregnancy differs from prediction of a first pregnancy. The overwhelming impression is the strong association of teenage pregnancy in general with social disadvantage. This makes specific interventions nigh impossible to design, unless they deliver financial aid, re-housing and other social assistance.

Interventions tried to date have met with variable success. There is a strong suggestion that the considerable methodological challenges

Conflict of interest statement

The author confirms that he has no conflicts of interest to declare.

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Cited by (40)

Factors influencing repeated teenage pregnancy: a review and meta-analysis
2017, American Journal of Obstetrics and Gynecology
Citation Excerpt :
Our work is consistent with findings from Rigsby et al,9 in which being a school drop-out was an important RTP risk factor. Our findings did not support other findings of an association with age, income, smoking, substance abuse, low socioeconomic status, and low educational level of parents, for which relationships were no longer seen after metaanalysis.5,9,68 These discrepancies possibly are due to an increased methodologic rigor in our study because previous analyses were based purely on narrative synthesis.9
Existing evidence of predictors of repeated teenage pregnancy has not been assessed rigorously. This systematic review provides a comprehensive evaluation of protective and risk factors that are associated with repeated teenage pregnancy through a metaanalytical consensus.
We used PubMed, EMBASE, CINAHL, ProQuest, PsychINFO, ScienceDirect, Scopus, and Web of Science databases from 1997–2015 and the reference list of other relevant research papers and related reviews.
Eligibility criteria included (1) epidemiologic studies that analyzed factors associated with repeated pregnancy or birth among adolescents <20 years of age who were nulliparous or experienced at least 1 pregnancy, and (2) experimental studies with an observational component that was adjusted for the intervention.
We performed narrative synthesis of study characteristics, participant characteristics, study results, and quality assessment. We also conducted random-effects and quality-effects metaanalyses with meta-regression to obtain pooled odds ratios of identified factors and to determine sources of between-study heterogeneity.
Twenty-six eligible epidemiologic studies, most from the United States (n=24), showed >47 factors with no evidence of publication bias for each metaanalysis. Use of contraception (pooled odds ratio, 0.60; 95% confidence interval, 0.35–1.02), particularly long-acting reversible contraceptives (pooled odds ratio, 0.19; 95% confidence interval, 0.08–0.45), considerably reduced repeated teenage pregnancy risk. Among studies about contraception, the number of follow-up visits (adjusted coefficient, 0.72; P=.102) and country of study (unadjusted coefficient, 2.57; permuted P=.071) explained between-study heterogeneity. Education-related factors, which included higher level of education (pooled odds ratio, 0.74; 95% confidence interval, 0.60–0.91) and school continuation (pooled odds ratio, 0.53; 95% confidence interval, 0.33–0.84), were found to be protective. Conversely, depression (pooled odds ratio, 1.46; 95% confidence interval, 1.14–1.87), history of abortion (pooled odds ratio, 1.66; 95% confidence interval, 1.08–2.54), and relationship factors, such as partner support, increased the repeated teenage pregnancy risk.
Contraceptive use, educational factors, depression, and a history of abortion are the highly influential predictors of repeated teenage pregnancy. However, there is a lack of epidemiologic studies in low- and middle-income countries to measure the extent and characteristics of repeated teenage pregnancy across more varied settings.
The Role of Community Health Workers in Preventing Adolescent Repeat Pregnancies and Births
2016, Journal of Adolescent Health
Citation Excerpt :
An appraisal of CHW training manuals revealed an absence of clear instructions on how to communicate fertility-related issues and subsequent birth prevention strategies [18]. Various evaluations have suggested the need to anchor activities within tangible concepts such as sociocognitive frameworks, developmental theory, and resilience models [2,11,32,33]. Failure of CHW programs has been also related to the absence of supportive supervision and monitoring [8,29,34].
Intervention by community health workers (CHWs) is believed to prevent repeated childbearing among teenagers. This review investigated the effectiveness of CHWs in reducing repeated pregnancies and births among adolescents aged <20 years, 2 years after the delivery of their first child. Through electronic database and hand searching, experimental and/or observational studies were screened with their results undergoing systematic review and meta-analyses. Subgroup analyses were performed to further assess how study characteristics affected the pooled estimates and heterogeneity. A total of 11 eligible articles, from January 1980 to May 2015, were included. Seven studies evaluated repeated births and eight measured repeated pregnancies. Studies showed relevant disparities in terms of selected methodological aspects and program characteristics. Although most studies (n = 9) were either of “strong” or of “moderate” quality, only two of five finding a significant reduction exhibited a high level of quality as the other three failed to adjust results for confounders. Random effects modeling revealed an overall 30% decrease in repeated adolescent births (odds ratio = .70, confidence interval = .49–.99) among CHW-visited areas relative to nonvisited sites. On the other hand, no significant association was detected in terms of repeated pregnancies (odds ratio = .96, confidence interval = .70–1.28).
Prevalence of repeat pregnancies and associated factors among teenagers in KwaZulu-Natal, South Africa
2016, International Journal of Gynecology and Obstetrics
Citation Excerpt :
Teenage mothers who do not initiate LARC have up to a 35-fold increased risk of a repeat pregnancy within 2 years compared with teenagers using LARCs [13]. Interventions to prevent repeat pregnancies include dedicated adolescent prenatal and postnatal clinics, flexible clinic hours, mother and baby pair visits, counselling, home visits, use of social media, telephone reminders, and continuous counselling [18,19]. Nevertheless, these interventions have had limited success even when paired with contraception provision [13].
To determine the prevalence of repeat teenage pregnancy and the interval between first/most recent and repeat pregnancies, as well as to evaluate the sexual/reproductive health characteristics of teenagers with repeat pregnancies.
A prospective observational study was undertaken at a hospital in KwaZulu-Natal, South Africa, between May and September 2013. Teenagers aged 13–19 years who were pregnant, had recently delivered, or had terminated a pregnancy were enrolled. A questionnaire was used to obtain data.
Among 341 participants, 281 (82.4%) were seen for a first pregnancy and 60 (17.6%) for a repeat pregnancy. The interval between first/most recent and repeat pregnancies was 24 months or lower in 45 (75.0%) of repeat pregnancy participants. Only 58 (17.0%) participants had previously used contraception (54 [93.1%] of whom stopped within 12 months) and 28 (8.2%) had used emergency contraception. More participants with repeat pregnancy than with first pregnancy had a positive HIV status (18 [30.0%] vs 26 [9.3%]; P < 0.001), more than one sexual partner in the past 12 months (21 [35.0%] vs 35 [12.5%]; P < 0.001), and a partner at least 5 years older (38 [63.3%] vs 128 [45.6%]; P < 0.001).
High repeat pregnancy rates, low contraception use, and high HIV prevalence among teenagers in South Africa is worrying. Focused interventions targeting teenagers following their first pregnancy need to be urgently implemented.
Discordant pregnancy intentions in couples and rapid repeat pregnancy
2016, American Journal of Obstetrics and Gynecology
Citation Excerpt :
Central to the issue of RRP and unintended pregnancy is the role of male partners and their desire for conception. The bulk of research exploring predictors of RRP in the United States has focused on adolescent or minority populations.7,8,24,25 Boardman et al7 assessed risk factors for unintended and intended RRP among adolescents using data from the 2002 National Survey of Family Growth (NSFG).
Rapid repeat pregnancy (RRP) is a major problem in the United States. Few studies have explored the influence of partner agreement on pregnancy intention and RRP.
We sought to examine the association between couple pregnancy intentions and RRP among women in the United States.
Data came from the 2006 through 2010 National Survey of Family Growth. Multiparous women who cohabited with 1 husband/partner before conception of second pregnancy were included (N = 3463). The outcome, RRP, was categorized as experiencing a second pregnancy within 24 months of the first pregnancy resolution, or ≥24 months from the first pregnancy resolution. Maternal and paternal pregnancy intentions were categorized into 4 dyads: both intended (M+P+); maternal intended and paternal unintended (M+P–); maternal unintended and paternal intended (M–P+); and both unintended (M–P–). Multiple logistic regression was conducted to determine the association between couple pregnancy intentions and RRP.
Nearly half (49.4%) of women had RRP. Approximately 15% of respondents reported discordant couple pregnancy intentions and 22%, maternal and paternal unintendedness. Compared to couples who both intended their pregnancy (M+P+), the odds of RRP was higher when fathers intended pregnancy but not mothers (adjusted odds ratio, 2.51; 95% confidence interval, 1.45–4.35) and lower if fathers did not intend pregnancy but mothers did (adjusted odds ratio, 0.77; 95% confidence interval, 0.70–0.85). No difference was observed between concordant couple pregnancy intentions (M–P– vs M+P+).
Findings highlight the important role of paternal intention in reproductive decisions. Study results suggest that RRP is strongly influenced by paternal rather than maternal pregnancy intentions. Clinicians and public health workers should involve partners in family planning discussions and counseling on optimal birth spacing.
A qualitative evaluation of home-based contraceptive and sexual health care for teenage mothers
2016, Primary Health Care Research and Development
Parental support influencing the timing of repeat pregnancy for adolescent mothers
2023, Family Relations

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5Social predictors of repeat adolescent pregnancy and focussed strategies

Section snippets

Definitions

Conceptions

Social predictors of repeat adolescent pregnancy

Prevention of adolescent pregnancy in general

Prevention of repeat adolescent pregnancy

Features of successful programmes

Conclusions

Conflict of interest statement

Best Pract Res Clin Obstet Gynaecol

J Adolesc Health

J Adolesc Health

Contraception

J Pediatr Adolesc Gynecol

J Pediatr Adolesc Gynecol

J Adolesc Health

J Adolesc Health Care

Obstet Gynecol

Obstet Gynecol

Am J Prev Med

Am J Prev Med

J Adolesc Health

Am J Obstet Gynecol

Lancet

Soc Sci Med

J Adolesc Health

J Adolesc Health

J Adolesc Health

Pregnant adolescents

At what age can I?

Pregnancy during adolescence: a major social problem

Eur J Contracept Reprod Health Care

Teenage childbearing as a cultural prism

Br Med Bull

Abortion law of each nation state

Income, poverty, and health insurance coverage in the United States: 2008

Poverty: key facts

Teenage pregnancy and social disadvantage: systematic review integrating controlled trials and qualitative studies

Br Med J

Psychological and social characteristics of teenagers who have children

The transition to parenthood: special tasks and risk factors for adolescent parents

Do adolescents want babies? The relationship between attitudes and behaviour

J Res Adolesc

Young women’s experiences of repeat childbearing

Pleasure, prophylaxis and procreation: a qualitative analysis of intermittent contraceptive use and unintended pregnany

Perspect Sex Reprod Health

The costs of adolescent childbearing: evidence from Chile, Barbados, Guatemala and Mexico

Stud Fam Plann

Teenage childbearing: an adaptive strategy for the socioeconomically disadvantaged or a strategy for adapting to socioeconomic disadvantage?

Arch Pediatr Adolesc Med

Incidence and outcome of bleeding before the 20th week of pregnancy: prospective study from general practice

Br Med J

What do we know about sexual and reproductive health of adolescents in Europe?

Eur J Contracept Reprod Health Care

Abortion statistics 1985–2008

Delivery statistics 1973–2007

Abortion surveillance-United States, 2004

MMWR

Variations in teenage pregnancy rates in England and Wales

Conceptions in England and Wales, 2007

Health Stat Q

Teenage conceptions by small area deprivation in England and Wales, 2001–2002

Health Stat Q

Teenage pregnancy

Modelling the spatial distribution of teenage conception rates within Wessex

Br J Fam Plann

Spatial variation in teenage conceptions in south and west England

J R Stat Soc

Birth Statistics 2007 Series FM1 no. 36

5
Social predictors of repeat adolescent pregnancy and focussed strategies