Cochrane for Clinicians

Putting Evidence into Practice

Preventing Unintended Adolescent Pregnancy

 

Am Fam Physician. 2017 Apr 1;95(7):422-423.

Author disclosure: No relevant financial affiliations.

Clinical Question

Which interventions are effective in preventing unintended adolescent pregnancy and its antecedent risk behaviors?

Evidence-Based Answer

Among adolescents, educational interventions increase reported condom use at most recent intercourse (number needed to treat [NNT] = 21; Strength of Recommendation [SOR]: B, based on inconsistent or limited-quality patient-oriented evidence), whereas contraceptive-promoting interventions increase use of hormonal contraception (NNT = 5; SOR: A, based on consistent, good-quality patient-oriented evidence). Combining these interventions lowers the risk of unintended pregnancy compared with existing conventional population-wide activities alone1 (NNT = 25; SOR: B, based on inconsistent or limited-quality patient-oriented evidence).

Practice Pointers

Unintended adolescent pregnancy is associated with adverse physical and psychological outcomes for mother and child, lower lifelong socioeconomic and educational achievement, and higher medical costs.2 Births among adolescents have been decreasing over time in most countries, including the United States, primarily because of lower rates of sexual activity and higher rates of contraception use.24 However, the rate of unintended adolescent pregnancy in the United States is higher than in many other industrialized countries and disproportionately affects minority and impoverished youth.3,4

This Cochrane review included 53 trials with 105,368 adolescents across community, home, school, and clinic settings in varied cultural and economic contexts.1 Unintended pregnancy was significantly reduced over medium- and long-term follow-up periods among participants who were randomized to receive a combination of educational and contraceptive-promoting interventions compared with those who received standard sex education, general counseling, or no intervention (relative risk [RR] = 0.66; 95% confidence interval [CI], 0.5 to 0.87; NNT = 25; 95% CI, 17 to 67; n = 1,905). However, among those receiving m

Author disclosure: No relevant financial affiliations.

REFERENCES

show all references

1. Oringanje C, Meremikwu MM, Eko H, Esu E, Meremikwu A, Ehiri JE. Interventions for preventing unintended pregnancies among adolescents. Cochrane Database Syst Rev. 2016;(2):CD005215....

2. Dalby J, Hayon R, Carlson J. Adolescent pregnancy and contraception. Prim Care. 2014;41(3):607–629.

3. Finer LB, Zolna MR. Declines in unintended pregnancy in the United States, 2008–2011. N Engl J Med. 2016;374(9):843–852.

4. The World Bank. Adolescent fertility rate (births per 1,000 women ages 15–19). United NationsPopulation Division, World Population Prospects. http://data.worldbank.org/indicator/SP.ADO.TFRT. Accessed May 20, 2016.

5. Gavin L, Moskosky S, Carter M, et al. Providing quality family planning services: recommendations of CDC and the U.S. Office of Population Affairs. MMWR Recomm Rep. 2014;63(RR-04):1–54.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.

A collection of Cochrane for Clinicians published in AFP is available at http://www.aafp.org/afp/cochrane.

 

 

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