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.