Abortion care for adolescent and young women

Abstract

Background: Unintended pregnancy among adolescents (10-19years) and young women (20-24years) is a global public health problem. Adolescents face challenges in accessing safe abortion care.

Objective: To determine, via a systematic data review, whether abortion care for adolescent and young women differs clinically from that for older women.

Methods: In a comprehensive data review, the Cochrane Central Register of Controlled Trials, MEDLINE, and POPLINE databases were searched from the earliest data entered until November 2012. Randomized controlled trials and observational studies comparing effectiveness, safety, acceptability, and long-term sequelae of abortion care between adolescent/young women and older women were identified. Two reviewers independently extracted data, and the Cochrane guidelines and Newcastle-Ottawa Scale were used for quality assessment.

Results: In total, there were 25 studies including 346 000 women undergoing first- and second-trimester medical abortion, vacuum aspiration, or dilation and evacuation. Effectiveness and overall complications were similar among age groups. However, younger women had an increased risk for cervical laceration and a decreased risk of uterine perforation and mortality. Satisfaction and long-term depression were similar between age groups. Except for less uptake of intrauterine devices among adolescents, age did not affect post-abortion contraception.

Conclusions: Evidence from various healthcare systems indicates that abortion is safe and efficacious among adolescent and young women. Clinical services should promote access to safe abortion for adolescents.

Keywords: Abortion; Adolescents; Contraception; Effectiveness; Post-abortion care; Safety; Systematic review; Youth.