Meet the Experts

Interventions to reduce unintended pregnancy rates

Anna Glasier (GB)

[Glasier] University of Edinburgh, Edinburgh

In societies in which the average woman is sexually active from ages 16 to 45 and has only two children, a considerable number of years are spent trying to avoid pregnancy. Interventions designed to reduce unintended pregnancies are many, but successful ones are few and most target teenagers. In an effort to reduce teenage pregnancy rates, the U.S. government funded abstinence-only sex education programs for over a decade until 2009. In a review of such programs (1) only 5 out of 14 were found to be effective with respect to any outcome and only one (from Chile) reduced pregnancies or births. Contraception is not perfect and the methods most commonly in use today have relatively high failure rates. In an exploration of the recent decline in adolescent pregnancy rates in the United States between 1995 and 2002, (2) reported that decline was primarily attributable to improved contraceptive use. Improving contraceptive uptake, provided the methods are long-acting, does seem able to prevent unintended pregnancy. Educating the population about the risks of unprotected sex and the action needed to avoid unwanted pregnancy seems an attractive strategy. In a Cochrane review however it was unclear whether educational interventions had any effect on unintended pregnancy among adolescents. (3) Single interventions are often ineffective and comprehensive behavioural interventions are needed that take account of the social context. A multifaceted policy intervention involving both health and education agencies has been effective in significantly reducing conception rates (ending in both childbirth and abortions) in the UK (Wellings et al 2016). References: 1. Manlove J, et al. Programs to improve adolescent sexual and reproductive health in the US: a review of the evidence. Adolescent Health, Medicine and Therapeutics 2015;6: 47–79. 2. Santelli JS, et al. Explaining recent declines in adolescent pregnancy in the United States: the contribution of abstinence and improved contraceptive use. Am J Public Health 2007; 97:150-6. 3.Oringanje C et al. Interventions for preventing unintended pregnancies among adolescents. Cochrane Database of Systematic Reviews 2016, Issue 2. Art. No.: CD005215. 4. Wellings K et al. Changes in conceptions in individuals younger than 18 years and the circumstances of young mothers in England in 2000–12: an observational study. Lancet 2016; 388:586-95.