This annual report - Taranaki District Health Board

throughout pregnancy, birth and the postpartum period. In group antenatal care (4studies), a model developed in the USA, a group of eight to twelve women of similargestation meet regularly at a hospital or community venue for antenatal care andeducation. One stable group leader, usually a midwife, facilitates discussion according toan overall session plan and a second midwife simultaneously performs antenatal clinicalassessments. A Young Women’s Clinic (4 studies) is a variant of standard antenatal careand consists of a community or hospital-based multidisciplinary team includingobstetricians, midwives and social workers. The narrative review found that there wasinsufficient evidence to assess the effectiveness of a MGP model of care for youngwomen. The Group Antenatal Care model was associated with increases in antenatal visitattendance and breastfeeding initiation, and decreases in the risk of preterm birth. AYoung Women’s Clinic model may also increase antenatal visit attendance and decreasethe incidence of preterm birth.Addressing barriers to maternity services among teenage mothersLoxton et al. examined barriers to antenatal care among young women in Australia throughqualitative interviews with service providers and a review of the literature [255]. Commonbarriers across service types included a lack of knowledge, literacy problems, cost,transport, previous negative experiences with service providers, a lack of social and familysupport and absence of services such as supported accommodation and child care.Barriers occurred in complex relationships with each other. The more barriers a youngwoman faced, and/or the more adversities she experienced, the more difficult it was for herto access services, and the more difficult it was for service providers to accommodate herneeds. A wide variety of facilitators to access were identified and best practicerecommendations made, including the provision of a ‘one stop shop’ incorporating groupsupport, classes, referral and drop-in services for young women and providing a focal pointfor local service networking; peer support programmes that decreased social isolation andincreased confidence among young women; healthcare services; an integrated homevisiting service for multiple types of service; and education programmes. Given thecomplexity of young women’s lives the authors advised that services should take accountof individual circumstances and no single service model was recommended.Programmes for teenage parentsIn their recent Cochrane review, Barlow et al. evaluated the effectiveness of programmesfor teenage parents in improving psychosocial outcomes for the parents anddevelopmental outcomes in their children [256]. It included eight RCTs with 513participants, providing 47 comparisons of outcome between intervention and controlconditions. Statistically significant differences in favour of the intervention group wereidentified in 19 of these outcomes, including important infant and child outcomes such asthe infant’s response to the parent, the clarity of the infant’s cues and the child’s ability tounderstand and respond to language. The diversity of programmes in terms of theirduration and content meant that only four of the studies could be combined in the metaanalysis.Statistically significant findings in favour of the intervention were found for: parentresponsiveness to the child (standard mean difference (SMD) -0.91, 95% CI -1.52 to -0.30,p=0.04); infant responsiveness to mother at follow-up (SMD -0.65, 95% CI -1.25 to -0.06,p=0.03); and an overall measure of parent-child interactions post-intervention (SMD -0.71,95% CI -1.31 to -0.11, p = 0.02), and at follow-up (SMD -0.90, 95% CI -1.51 to -0.30,p=0.004). The authors concluded that, due to variations in the study populations, theinterventions and the measures used, there were limits to the conclusions that could bedrawn, however they considered that there was some evidence that parentingprogrammes may be effective in improving a number of aspects of parent-child interaction.In another study, Harden et al. systematically reviewed the literature relating to teenagepregnancy, parenthood and social exclusion, with the aims of identifying research to informpolicy and practice, and assessing the effectiveness on interventions that target the socialexclusion associated with teenage pregnancy and parenting [162]. The report includes anin-depth review of parenting support interventions and their effectiveness in improvingsocial inclusion. The review included 38 studies: 18 evaluations of interventions and 20qualitative studies of young people’s views. Ten of these parenting support studiesIn-Depth Topic: Adversity in Pregnancy - 296