Impact of a community contraceptive counselling intervention on adolescent fertility rates: a quasi-experimental study

Abstract

Background: From 2000 to 2008, in urban areas in Spain, adolescent fertility and abortion rates underwent unprecedented increases, consecutive to intensive immigration from developing countries. To address unmet needs for contraception information and services, a community-based, gender-sensitive and culturally adapted brief counselling intervention (SIRIAN program) was launched in some deprived neighbourhoods with a high proportion of immigrants in Barcelona. Once a randomized controlled trial demonstrated its effectiveness in increasing the use of contraceptives, we aim to examine its population impact on adolescent fertility rates. Methods: Quasi-experimental study with comparison group, using population data from 2005 to 2016. Five neighbourhoods in the lowest tercile of Disposable Household Income were intervened in 2011-13. The comparison group included the three neighbourhoods which were in the same municipal district and in the lowest Disposable Household Income tercile, and displayed the highest adolescent fertility rates. Generalized linear models were fitted to assess absolute adolescent fertility rates and adjusted by immigrant population between pre-intervention (2005-10) and post-intervention periods (2011-16); Difference in Differences and relative pre-post changes analysis were performed. Results: In 2005-10 the intervention group adolescent fertility rate was 27.90 (per 1000 women 15-19) and 21.84 in the comparison group. In 2011-16 intervention areas experienced great declines (adolescent fertility rate change: − 12.30 (− 12.45 to − 12.21); p < 0.001), while comparison neighbourhoods remained unchanged (adolescent fertility rate change: 1.91 (− 2.25 to 6.07); p = 0.368). A reduction of − 10.97 points (− 13.91 to − 8.03); p < 0.001) is associated to the intervention. Conclusion: Adolescent fertility rate significantly declined in the intervention group but remained stable in the comparison group. This quasi-experimental study provide evidence that, in a country with universal health coverage, a community counselling intervention that increases access to contraception, knowledge and sexual health care in hard-to-reach segments of the population can contribute to substantially reduce adolescent fertility rates. Reducing adolescent fertility rates could become a feasible goal in cities with similar conditions.

Results of the National Contraception Survey Conducted by Sociedad Española de Contracepción (2020)

“…Health education actions in terms of sexuality and contraception are increasingly implemented, and this can either exert an influence on the users' behaviours or not [19][20][21]. A number of already published studies indicate that the decision to use a given contraceptive method over another is usually influenced by the advice of a health professional [22,23].…”

“…Access to contraceptive methods in Spain is affordable, considering that some of them are fully funded by the National Health System. However, access to counselling on contraception and sexual education are not uniformly egalitarian throughout the country, as they depend on regional policies [19]. Thus, while they are practically fully funded in some regions, there are deficits in others [26].…”

“Educação sexual e infecções sexualmente transmissíveis em adolescentes do ensino médio em Goiânia – Goiás” / "sex education and sexually transmitted infections in high school adolescents in Goiânia - Goiás"

“…A eficácia de aconselhamento de variadas formas como sessões de conversas individuais, panfletos e orientações, foi percebida por Diez et al (2020), na qual houve uma queda significativa nas taxas de fertilidade em adolescentes, redução de gravidez na adolescência, aumento do uso de contraceptivos, redução das atividades sexuais e idade superior da sexarca, quando uma boa adesão a técnica. Essa pesquisa, entretanto, demandou um longo trabalho, além de associação intensa com o serviço público de saúde.…”

SARC e LARC: grau de conhecimento e frequência de uso em complexo hospitalar de referência no Paraná / SARC and LARC: degree of knowledge and frequency of use in a reference hospital complex in Paraná

“…O não uso e/ou uso típico de contraceptivos estão entre as razões para ocorrência desses eventos. Para potencializar tanto o emprego dos contraceptivos quanto o seu uso perfeito, é imprescindível informar e educar as pacientes sobre suas opções e características de cada método (7,11) . Os focos do processo informativo podem ser determinados a partir de uma avaliação da população-alvo, compreendendo seu perfil etário e socioeconômico (9) , grau de conhecimento prévio sobre o tema (10) , presença e causas de gestações indesejadas (4) e tipos de contraceptivos mais utilizados.…”

“…Dentre as consequências da carência de informação sobre os contraceptivos reversíveis, tem-se as gestações não planejadas (11)(12) . Esses eventos geram impactos sociais e individuais como prejuízos financeiros -tanto familiar quanto pública -e despreparo da estrutura familiar para receber a criança (2,13) .…”