This annual report - Taranaki District Health Board

provided sound evidence for the value of particular interventions: two looking at welfaresanctions or bonuses, four looking at the effects of educational and career developmentprogrammes, three examining holistic, multi-agency support, and one on the effects ofday-care. A meta-analysis using a random effects model suggested that educational andcareer development interventions were associated with a 213% increase in the number ofyoung parents in education or training in the short term (RR 3.13, 95% CI 1.49 to 6.56).Welfare sanction/bonuses programmes and day-care also had positive short term effectsbut none of these interventions identified long term effects. The authors concluded that theprovision of day-care appeared to be the most promising approach for the prevention ofrepeat pregnancy.In the same review, the qualitative research highlighted the diversity of needs andpreferences among teenage parents, the struggles against negative stereotypes, theheavy reliance on family support, the continuation of problems that existed beforeparenthood, and the wider costs and benefits of education and employment. Threerecurrent themes in the experiences of young parents were identified: dislike of school;poor material circumstances and unhappy childhoods; and low expectations for the future.Preventing repeat teenage pregnancyThe Families Commission has identified preventing repeat teenage pregnancy as a priorityarea [163]. Corcoran and Pillai examined the effectiveness of secondary pregnancyprevention programmes [257]. Sixteen controlled trials were included in the meta-analysis,all conducted in the United States. Most of the studies assessed ‘comprehensive’programmes which offered an array of services, including case management and referral;education about pregnancy, labour and delivery, contraception, and infant health; andindividual counselling. A quarter involved home visiting. The mean age of participants was16.75 years. At the first follow-up period at which outcome (repeat pregnancy rate) wasassessed (average 19.13 months), interventions produced a 50% reduction in the odds ofpregnancy compared to comparison–control conditions (random effects model OR 0.4795% CI 0.32 to 0.70), but by second follow-up (average 31 months, 8 of 16 studies), theeffect had waned (random effects model OR 0.66, 95% CI 0.43 to 1.02). No single type ofintervention (home visits, school-based interventions, support groups or peer-basedincentives) emerged as more effective. Similarly, a 2010 review identified a number ofprogramme components that demonstrated some effectiveness in reducing rapid repeatpregnancy: multi-session home visiting by a nurse; a multidisciplinary youth-orientedapproach; contraception teaching; easy access to services; targeting young women atantenatal and postnatal consultations in relation to their first pregnancy; combinedmother/infant care; and integrated clinical and social services [161].Box 5. Key points emerging from the literature on interventions aimed at supportingteenage parents during pregnancy and the postnatal period Promoting early and sustained access to services, providing sessions specifically tailored toyoung parents, a multi-agency approach ensuring clear referral pathways between agencies,prevention of repeat unplanned conception, smoking cessation and addressing alcohol andother drug use, encouragement and support for breastfeeding and addressing mental healthproblems and other social problems are recommended. The Group Antenatal Care model has been associated with increases in antenatal visitattendance and breastfeeding initiation, and decreases in the risk of preterm birth. Educational and career development interventions are associated with significant increases inthe number of young parents in education or training in the short term. The provision of day care appears to be associated with reductions in repeat teenagepregnancy. Comprehensive repeat teenage pregnancy prevention programmes have been effective intrials, although the effect appears to wane. No single model emerges as the most effective. Parenting programmes may be effective in improving a number of aspects of parent-childinteraction.In-Depth Topic: Adversity in Pregnancy - 297