Preventing teenage pregnancy : Evidence from systematic reviews
We have recently undertaken an update of the review of reviews (Evidence briefing 2003) on behalf of NICE and in this chapter we briefly summarise the findings of the first review, report in more detail on the results of our recent update and look at the implications of both. Aims and objectives: The purpose of our study was to: • Conduct an update of the first edition of the review of reviews on teenage pregnancy and parenthood • Identify and evaluate all relevant systematic reviews, syntheses, meta-analyses and review-level papers published since the searches for the first edition (December 2001) • Highlight new findings on ‘what works’ to prevent teenage pregnancies • Identify gaps in the evidence • Highlight emerging issues pertinent to the scope of the work and identify areas that would merit further development and research Scope of the review: We conducted a systematic review of reviews which included: • Evaluations of interventions to prevent teenage/adolescent pregnancy, increase contraceptive use and/or delay the onset of sexual intercourse, and/or to delay or reduce repeat pregnancies. • Evaluations of interventions to improve outcomes for teenage parents and their children •Reported outcome measures relevant to teenage pregnancy prevention including pregnancy rates, contraceptive use, sexual behaviour and knowledge/attitudes We excluded single studies and reviews focusing on interventions specifically for the prevention of Human immunodeficiency virus (HIV) and/or sexually transmitted infections (STIs) and those reporting findings from developing countries were excluded. Narrative synthesis of reviews included We describe the quality assessment and rating of the reviews and critically appraise the evidence. We report findings from the first evidence briefing and our update. Our findings include a variety of settings which included schools, clinics, primary care, the community and homes. We discuss the reviews included in this update and the first briefing which considered a variety of interventions. These included: Education/information interventions primarily to increase knowledge Skills/self-esteem approaches to equip participants with the necessary social skills in terms of relationships and decision-making Peer education approaches, which can be educational, motivational, support or skills-based, and use ‘peers’ as facilitators Abstinence programmes that either wholly or partly promote an abstinence message. Programmes involving parental participation Other approaches such as access, multi-agency support, clinical/social service, employment/training We summarise findings from these reviews on what works to prevent teenage pregnancy, where the gaps are and implications for practice and research. Whilst our review does address school based sex education programmes, we provide an overview on effective approaches and service and programme characteristics in a variety of settings based on the evidence.