Teenage pregnancy and social disadvantage: systematic review integrating controlled trials and qualitative studiesBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b4254 (Published 13 November 2009) Cite this as: BMJ 2009;339:b4254
- Angela Harden, professor of community and family health1,
- Ginny Brunton, research officer2,
- Adam Fletcher, lecturer in young people’s health3,
- Ann Oakley, professor of sociology and social policy2
- 1Institute of Health and Human Development, University of East London, London, E15 4LZ
- 2Social Science Research Unit, Institute of Education, University of London, London WC1H 0NR
- 3Department of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, WC1E 7H
- Correspondence to: A Harden
- Accepted 12 July 2009
Objectives To determine the impact on teenage pregnancy of interventions that address the social disadvantage associated with early parenthood and to assess the appropriateness of such interventions for young people in the United Kingdom.
Design Systematic review, including a statistical meta-analysis of controlled trials on interventions for early parenthood and a thematic synthesis of qualitative studies that investigated the views on early parenthood of young people living in the UK.
Data sources 12 electronic bibliographic databases, five key journals, reference lists of relevant studies, study authors, and experts in the field.
Review methods Two independent reviewers assessed the methodological quality of studies and abstracted data.
Results Ten controlled trials and five qualitative studies were included. Controlled trials evaluated either early childhood interventions or youth development programmes. The overall pooled effect size showed that teenage pregnancy rates were 39% lower among individuals receiving an intervention than in those receiving standard practice or no intervention (relative risk 0.61; 95% confidence interval 0.48 to 0.77). Three main themes associated with early parenthood emerged from the qualitative studies: dislike of school; poor material circumstances and unhappy childhood; and low expectations for the future. Comparison of these factors related to teenage pregnancy with the content of the programmes used in the controlled trials indicated that both early childhood interventions and youth development programmes are appropriate strategies for reducing unintended teenage pregnancies. The programmes aim to promote engagement with school through learning support, ameliorate unhappy childhood through guidance and social support, and raise aspirations through career development and work experience. However, none of these approaches directly tackles all the societal, community, and family level factors that influence young people’s routes to early parenthood.
Conclusions A small but reliable evidence base supports the effectiveness and appropriateness of early childhood interventions and youth development programmes for reducing unintended teenage pregnancy. Combining the findings from both controlled trials and qualitative studies provides a strong evidence base for informing effective public policy.
Contributors: AH, AO, and GB designed the study and obtained funding. AH, AO, and GB wrote the review protocol. AF, GB, and AH conducted the searches, screened titles and full papers, assessed study quality, extracted data, and undertook the statistical and qualitative syntheses. All authors contributed to the drafting of the paper and approved the final submitted version. AH, AO, and GB are the guarantors. All authors had full access to all the data in the study, including statistical reports and tables, and can take responsibility for the integrity of the data and the accuracy of the data analysis.
Funding: The review was funded by the Department of Health. AH was funded by a senior level research scientist in evidence synthesis award from the Department of Health. The researchers operated independently from the funders and the views expressed in this paper are those of the authors and not necessarily those of the Department of Health.
Competing interests: None declared.
Data sharing: Technical appendix available at http://eppi.ioe.ac.uk/cms/Default.aspx?tabid=674.
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