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Meta-Analysis
. 2017 Aug 15;15(1):155.
doi: 10.1186/s12916-017-0904-7.

Intervention Now to Eliminate Repeat Unintended Pregnancy in Teenagers (INTERUPT): a systematic review of intervention effectiveness and cost-effectiveness, and qualitative and realist synthesis of implementation factors and user engagement

Rabeea'h W Aslam  1 , Maggie Hendry  2 , Andrew Booth  3 , Ben Carter  4 , Joanna M Charles  5 , Noel Craine  6 , Rhiannon Tudor Edwards  5 , Jane Noyes  7 , Lupetu Ives Ntambwe  8 , Diana Pasterfield  2 , Jo Rycroft-Malone  9 , Nefyn Williams  2 , Rhiannon Whitaker  10
Affiliations
Meta-Analysis

Intervention Now to Eliminate Repeat Unintended Pregnancy in Teenagers (INTERUPT): a systematic review of intervention effectiveness and cost-effectiveness, and qualitative and realist synthesis of implementation factors and user engagement

Rabeea'h W Aslam et al. BMC Med. .

Abstract

Background: Unintended repeat conceptions can result in emotional, psychological and educational harm to young women, often with enduring implications for their life chances. This study aimed to identify which young women are at the greatest risk of repeat unintended pregnancies; which interventions are effective and cost-effective; and what are the barriers to and facilitators for the uptake of these interventions.

Methods: We conducted a mixed-methods systematic review which included meta-analysis, framework synthesis and application of realist principles, with stakeholder input and service user feedback to address this. We searched 20 electronic databases, including MEDLINE, Excerpta Medica database, Applied Social Sciences Index and Abstracts and Research Papers in Economics, to cover a broad range of health, social science, health economics and grey literature sources. Searches were conducted between May 2013 and June 2014 and updated in August 2015.

Results: Twelve randomised controlled trials (RCTs), two quasi-RCTs, 10 qualitative studies and 53 other quantitative studies were identified. The RCTs evaluated psychosocial interventions and an emergency contraception programme. The primary outcome was repeat conception rate: the event rate was 132 of 308 (43%) in the intervention group versus 140 of 289 (48%) for the control group, with a non-significant risk ratio (RR) of 0.92 [95% confidence interval (CI) 0.78-1.08]. Four studies reported subsequent birth rates: 29 of 237 (12%) events for the intervention arm versus 46 out of 224 (21%) for the control arm, with an RR of 0.60 (95% CI 0.39-0.93). Many repeat conceptions occurred in the context of poverty, low expectations and aspirations and negligible opportunities. Qualitative and realist evidence highlighted the importance of context, motivation, future planning and giving young women a central and active role in the development of new interventions.

Conclusions: Little or no evidence for the effectiveness or cost-effectiveness of any of the interventions to reduce repeat pregnancy in young women was found. Qualitative and realist evidence helped to explain gaps in intervention design that should be addressed. More theory-based, rigorously evaluated programmes need to be developed to reduce unintended repeat pregnancy in young women.

Trial registration: PROSPERO, CRD42012003168 . Cochrane registration number: i = fertility/0068.

Keywords: Adolescent; Childbearing; Complex interventions; Contraceptives; Pregnancy; Prevention.

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Conflict of interest statement

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All authors consent to publish this manuscript.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Overview of review methods
Fig. 2
Fig. 2
CART criteria
Fig. 3
Fig. 3
PRISMA flow diagram
Fig. 4
Fig. 4
Forest plot of comparison (proportion of repeat pregnancy)
Fig. 5
Fig. 5
Forest plot od comparison (acceptablity of intervention)
See this image and copyright information in PMC

References

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