Adolescent Postabortion Groups: Risk Reduction in a School-Based Health Clinic

Profiles of women presenting for abortions in Singapore: focus on teenage abortions and late abortions

OBJECTIVE

Teenage abortions predispose women to adverse pregnancy outcomes in subsequent pregnancies such as anemia, stillbirths, preterm deliveries and low birth weight babies. We aim to profile the women presenting for abortions in our institution and determine risk factors for late presentation for abortions.

STUDY DESIGN

In this retrospective cohort study, all women who underwent an abortion at the National University Hospital, Singapore, from 2005 to 2009 were recruited. Data was obtained from a prepared questionnaire during the mandatory pre-abortion counseling sessions. Profiles of women aged <20 years were compared with those ≥ 20 years old using Chi-square test if the assumptions for Chi-square test were met; otherwise, Fisher's exact test was carried out. Logistic regression was used to investigate the risk factors for second trimester termination of pregnancy.

RESULTS

2109 women presented for induced abortions, of which 1998 had single abortion throughout the course of the study. The mean age of women with single abortion was 29.1 years (sd 7). In the group of women with single abortion, 182 (9.1%) were teenage abortions. In contrast to women ≥ 20 years of age, pregnant teenagers were more likely not to have used any contraception (51.1% vs. 25.2%) and more likely to present late for abortions (39.6% vs. 15.9%). Other risk factors for late presentation for abortions include Malay ethnicity, singlehood, nulliparity and lack of prior usage of contraception.

CONCLUSION

Teenagers are more likely to have no prior contraceptive usage and to present late for abortions. Lack of proper sexual education and awareness of contraceptive measures may have a major contributory factor to such a trend in teenage abortions. Recommendations have been made in order to curb this societal problem.

Systematic review and narrative synthesis of the effectiveness of contraceptive service interventions for young people, delivered in educational settings

STUDY OBJECTIVE

This review was undertaken to determine the effectiveness of contraception service interventions for young people that were delivered in educational settings.

DESIGN

We conducted a systematic review and narrative synthesis.

SETTING

Interventions were included where they were delivered in educational institutions, including schools, colleges, and pupil referral units.

PARTICIPANTS

Young people aged 19 and under. Studies of wider age groups were included if the majority of participants were aged under 19 years.

INTERVENTIONS

We included interventions which consisted of contraceptive service provision, and also interventions to encourage young people to use existing contraceptive services.

MAIN OUTCOME MEASURES

The main outcome measures used in the studies were: rate of teenage pregnancy, rate of contraceptive use, and sexual behavior. Many outcome measures were self reported.

RESULTS

Twenty-nine papers were included which reported on interventions to prevent adolescent pregnancy (and repeat pregnancy), school-based health centers, contraceptive use in college students, and multicomponent interventions. Intensive case management intervention conducted by a culturally matched school-based social worker (along with other components including peer education) were shown to be effective in preventing repeat adolescent pregnancy, at least for the duration of the intervention. Also, school-based health centers appear to be most effective when contraception provision is made available on site.

CONCLUSIONS

The evidence from these papers is limited, in terms of both quality and quantity, along with consistency of findings, but some recommendations in relation to effective interventions can be made.