Factors associated with teenage pregnancy in the European Union countries: a systematic review

Factors associated with teenage pregnancy in the European Union

countries: a systematic review

M. Imamura1, J. Tucker1, P. Hannaford2, M. Astin3, K.W.M. Bloemenkamp4, H. Karro5, J. Olsen6, M. Temmerman7, M. Oliveira da Silva8,

On Behalf of The REPROSTAT 2 Group8

1Dugald Baird Centre for Research on Women’s

Health, Department of Obstetrics and Gynaecology, University of Aberdeen,

Aberdeen, UK, 2Department of General Practice and Primary Care,

University of Aberdeen, Aberdeen, UK, 3IMMPACT, Department of Public Health, University of Aberdeen, Aberdeen,

UK, 4Department of

Obstetrics, Leiden University Medical Centre, Leiden, Netherlands, 5Tartu

University Women’s Clinic, Tartu, Estonia, 6Department of Epidemiology,

Unversity of California, Los Angeles, Los Angeles, USA, 7Internal

Centre for Reproductive Health, Ghent University, Ghent, Belgium, 8Instituto de

Medicina, Faculdade de Medicina de Lisboa, Lisbon, Portugal

Objective To

identify factors associated with teenage pregnancy in 25 contemporary European

Union (EU) countries.

Methods The search strategy included electronic

bibliographic databases (1995 to 2005), bibliographies of selected articles and

requests to all country representatives of the research team for relevant

reports and publications. Primary outcome measure was conception. Inclusion

criteria were quantitative studies of individual-level factors associated with

teenage pregnancy (13-19 years) in EU countries. Studies that only used

intermediate measures of conception such as sexual behaviour were excluded.

There were no language restrictions.

Results Of 4444 studies identified and

screened, 20 met the inclusion criteria. Most of the included studies took place

in UK and Nordic countries. Six broad groups of factors emerged:

sociodemographic, family structure and stability, educational, psychosocial,

sexual health knowledge, attitude and behaviour, and service accessibility and

acceptability. The well-recognised factors of socioeconomic disadvantage,

disrupted family structure and low educational level and aspiration appear

consistently associated with teenage pregnancy. However, evidence that access to

services in itself is a protective factor remains inconsistent. Although further

associations with diverse risk-taking behaviours and lifestyle, sexual health

knowledge, attitudes and behaviour are reported, the independent effect of these

factors too remains unclear.

Conclusion Included studies varied widely in terms

of methods and definitions used. This heterogeneity within the studies leaves

two outstanding issues. First, we cannot synthesise or generalise key findings

as to how all these factors interact with one another and which factors are the

most significant. Second, it is not possible to examine any variations in

factors associated with teenage pregnancy between EU countries, or potential

variations between age sub-groups. Future research ensuring comparability and

generalisability of results related to teenage sexual health outcomes will help

gain insight into the international variation in observed pregnancy rates and

better inform interventions.

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