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Teenagers´unintended pregnancies and contraception
Linköpings universitet, Institutionen för klinisk och experimentell medicin.
2010 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Teenage pregnancies are often not intended, and there is a high risk that unintended pregnancies will lead to abortion. The wide-spread availability of Youth Clinics, the subsidizing of contraceptives and the introduction of new and effective contraceptives have failed to lower the abortion rates. The aim of this thesis was to study possible risk groups and to highlight underlying reasons for contraceptive failure.

Methods: Study I and II were quantitative studies with the aims of investigating whether teenagers who sought emergency contraception (Paper I) and teenage mothers (Paper II) were at risk for new unintended pregnancies during a 12-month follow-up period.

Study III and IV were qualitative studies. The aim in study III was to see how contraceptive use was documented in medical records (MRs) concerning teenagers who had attended for induced abortion. In study IV the aim was to find out reasons for non- use or inconsistent use of contraceptives among teenagers attending for abortion.

Results: In study I and II data were collected from medical and antenatal records. The results showed that both groups, despite contraceptive counselling, were at high risk for new unintended pregnancies leading to abortion. Attendance at the postpartum visit was low and 24% of the teenage mothers did not receive any recommendation about using a particular contraceptive method. Within 12 months 25% had a new pregnancy and of these one third led to legal abortion.

In Study III two themes were generated from the analysis of the MRs; ‘Contraceptive methods previously used’ and ‘Plan for future contraceptive use’. All MRs did not contain information about contraceptive use. In study IV one theme was generated from the analysis of the interview text: ‘Struggling with feelings of uncertainty and patterns of behaviour’.

Conclusion: Teenagers using emergency contraceptive pills and teenage mothers were at high risk for unintended pregnancies. Contraceptive failure in teenagers who have had an abortion may be due to in part to the absence of contraceptive counselling at abortion visits and in part to problems with contraceptive use due to insufficient knowledge and not knowing what do when side-effects occurs.

 

Ort, förlag, år, upplaga, sidor
Linköping: Linköping University Electronic Press , 2010. , s. 83
Serie
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1179
Nyckelord [en]
Teenagers, unintended pregnancies, legal abortion, contraceptive counselling, postpartum visit, Chlamydia trachomatis
Nyckelord [sv]
Tonåringar, oplanerade graviditeter, preventivmedel, preventivmedelsrådgivning, abort, kvalitativ innehållsanalys, Teenagers, adolescents, unintended pregnancies, contraception, contraceptive counselling, induced abortion, qualitative content analysis
Nationell ämneskategori
Reproduktionsmedicin och gynekologi
Identifikatorer
URN: urn:nbn:se:liu:diva-56478ISBN: 978-91-7393-413-8 (tryckt)OAI: oai:DiVA.org:liu-56478DiVA, id: diva2:319591
Disputation
2010-05-28, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 13:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2010-05-20 Skapad: 2010-05-18 Senast uppdaterad: 2010-05-20Bibliografiskt granskad
Delarbeten
1. Young women requesting emergency contraception are, despite contraceptive counseling, a high risk group for new unintended pregnancies
Öppna denna publikation i ny flik eller fönster >>Young women requesting emergency contraception are, despite contraceptive counseling, a high risk group for new unintended pregnancies
2001 (Engelska)Ingår i: Contraception, ISSN 0010-7824, E-ISSN 1879-0518, Vol. 64, nr 1, s. 23-27Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Since its introduction in Sweden in 1994, emergency contraception has become a welcome addition to the campaign against unwanted pregnancy. In addition to an unplanned pregnancy, unprotected sexual intercourse may also involve the risk of contracting sexually transmitted diseases (STD). The aim of this study was to assess the short- and long-term risk of unintended pregnancy and to determine the frequency of chlamydia infections in women receiving emergency contraception. Between September 1998 and February 1999 young women aged 15-25 years had the opportunity to obtain emergency contraception (Yuzpe method) at a youth clinic in the city of Orebro where the opening hours were extended to include Saturdays and Sundays. A follow-up visit 3 weeks after treatment, which included contraceptive counseling, was offered to all participants. At both visits, a pregnancy test and a chlamydia test were performed, and the women completed a questionnaire. After the initial visit, the young women where monitored for new pregnancies during the following 12 months. One pregnancy occurred in the 134 young women who received emergency contraception during the study period. None of the women had a positive chlamydia test. Of those requesting emergency contraception, 54% did so because no contraception was used, 32% because of a ruptured condom, 11% because of missed oral contraceptives (OC), and 5% had mixed reasons. At long-term follow-up 1 year after the initial visit, 10 of the 134 young women had experienced an unplanned pregnancy that terminated in legal abortion in 9 women. All these women had either started and terminated OC or had never commenced the prescribed OC. Young women who request emergency contraception are, despite a planned follow-up with contraceptive counseling, a high risk group for new unintended pregnancies. In Sweden they do not seem to be a high risk group for STD.

Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:liu:diva-52308 (URN)10.1016/S0010-7824(01)00225-6 (DOI)11535209 (PubMedID)
Tillgänglig från: 2009-12-15 Skapad: 2009-12-15 Senast uppdaterad: 2017-12-12
2. Teenage mothers - a high-risk group for new unintended pregnancies
Öppna denna publikation i ny flik eller fönster >>Teenage mothers - a high-risk group for new unintended pregnancies
Visa övriga...
2006 (Engelska)Ingår i: Contraception, ISSN 0010-7824, E-ISSN 1879-0518, Vol. 74, nr 6, s. 471-475Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Introduction: One of the targets of national health programs is to prevent unintended pregnancies, especially among teenagers. It is well established that these often lead to abortion. Preventive programs aimed at decreasing abortion rates should identify target groups at risk for unintended pregnancies. Purpose: This study was conducted to determine whether young mothers under 20 years of age constitute a group at risk for new unintended pregnancies. Methods: A retrospective cohort study comprising teenagers giving birth to their first child from 1996 to 2000 was performed at Örebro University Hospital, Sweden. Data were collected from antenatal and medical records with particular regard to compliance with the postpartum visit and to whether a contraceptive method was prescribed. Information concerning repeat pregnancies during the 12 months after delivery was obtained. Results: A total of 250 deliveries were recorded, 70% of the mothers attended the postpartum visit, and 71% received contraceptive prescriptions. At the 12-month follow-up, 56 (25%) had a new pregnancy, and of those, 20 (36%) had a legal abortion, making the abortion rate fivefold higher than expected in this age group. Conclusion: This study shows that teenagers giving birth constitute a high-risk group for future unintended pregnancies and legal abortion. © 2006 Elsevier Inc. All rights reserved.

Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:liu:diva-37186 (URN)10.1016/j.contraception.2006.07.014 (DOI)33893 (Lokalt ID)33893 (Arkivnummer)33893 (OAI)
Tillgänglig från: 2009-10-10 Skapad: 2009-10-10 Senast uppdaterad: 2017-12-13
3. Contraceptive counselling to teenagers at abortion visits: A qualitative content analysis
Öppna denna publikation i ny flik eller fönster >>Contraceptive counselling to teenagers at abortion visits: A qualitative content analysis
2009 (Engelska)Ingår i: The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception, ISSN 1473-0782, Vol. 14, nr 5, s. 357-364Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

OBJECTIVE: Contraceptive counselling at the time of an abortion is crucial for preventing new unintended pregnancies especially in teenagers. What is discussed on this occasion should be recorded in the patient's file. In this study we examined what was documented in medical records (MRs) about previous contraceptive use and further plans as a reflection of what was discussed between the gynaecologist and the teenager. METHODS: Thirty-six MRs were consecutively selected in 2006. The study design was descriptive, retrospective and qualitative. Data were analysed using qualitative content analysis. The text areas were transcribed and analysed in several steps. RESULTS: Two themes were generated from the analysis: 'Contraceptive methods previously used' and 'Plan for future contraceptive use'. Information on previous contraceptive use was absent in ten MRs. In five MRs data about future contraceptive use were missing and eight teenagers had not started a contraceptive method at follow-up. CONCLUSION: The MR often lacked information about contraception; this could be a reflection of insufficient contraceptive counselling at the abortion-visit. Both contraceptive counselling and documentation thereof must be improved to enhance contraceptive use in teenagers.

Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:liu:diva-52310 (URN)10.3109/13625180903171815 (DOI)000277147800006 ()19916762 (PubMedID)
Tillgänglig från: 2009-12-15 Skapad: 2009-12-15 Senast uppdaterad: 2010-05-20
4. Teenagers´ Struggles with Contraceptive Use: What improvements can adults make?
Öppna denna publikation i ny flik eller fönster >>Teenagers´ Struggles with Contraceptive Use: What improvements can adults make?
2010 (Engelska)Ingår i: EUROPEAN JOURNAL OF CONTRACEPTION AND REPRODUCTIVE HEALTH CARE, ISSN 1362-5187, Vol. 15, nr 4, s. 271-279Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective: To study experiences with contraceptives of teenagers at an out-patient abortion clinic and to explore the reasons behind their choices.

Methods: Twelve teenagers who had applied for induced abortion were interviewed three to four weeks after abortion. The interviews comprised open questions about contraceptive experiences focusing on hindrance for contraceptive use. Qualitative content analysis was used.

Results: One theme was identified: Struggling with feelings of uncertainty and patterns of behaviour. Three categories emerged from the analysis. Uncertainty dealt with decisions and behaviours that varied with time and between the different individuals. Influences on contraceptive use dealt with the persons that the participants had discussed contraceptives with, how they acquired knowledge about contraceptive use and the nature of their behaviour. Anxiety dealt with the side effects of contraception and feelings of fear related to contraceptive use.

Conclusion: The participants had feelings of uncertainty, anxiety and fear towards contraceptive use which led to non use and inconsistent use. Guidance from health care providers and access to youth clinics varied and was not satisfactory. Parents were supportive of contraceptive use but not active in the process of getting their child to start using it. Friends and the Internet were the main sources for acquiring information.

Ort, förlag, år, upplaga, sidor
Informa Healthcare, 2010
Nyckelord
Contraception, Abortion, Contraceptive counselling, Contraceptive failure, Teenagers, Qualitative content analysis, Tonåringar, oplanerade graviditeter, preventivmedel, abort, innehållsanalys
Nationell ämneskategori
Reproduktionsmedicin och gynekologi
Identifikatorer
urn:nbn:se:liu:diva-56477 (URN)10.3109/13625187.2010.493623 (DOI)000280900400007 ()
Projekt
Doktorsavhandling
Tillgänglig från: 2010-05-18 Skapad: 2010-05-18 Senast uppdaterad: 2011-01-12

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