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Demonstration Projects Show Results in Reducing Repeat Youth Pregnancy

First published online:

| DOI: https://doi.org/10.1363/4505313_1

Interventions supported by the federal Title XX Adolescent Family Life (AFL) program that use innovative, multifaceted approaches to address adverse outcomes associated with adolescent childbearing seem to be effective among pregnant and parenting youth.1 In an evaluation of 12 demonstration projects, adolescents who received enhanced services as part of AFL program interventions were less likely than others to experience a repeat pregnancy within 12 months of baseline data collection, and were more likely to have used long‐acting reversible contraceptives and to have received regular child care in the four weeks prior to the follow‐up survey. Specific characteristics of interventions were found to be associated with these outcomes.

The AFL program supports the development and implementation of demonstration projects aimed at reducing repeat pregnancies and increasing educational attainment, contraceptive use and receipt of child care among pregnant and parenting adolescents. To evaluate the effectiveness of program‐funded interventions, researchers selected projects with experimental or quasi‐experimental designs; 12 projects in 10 states met the criteria. The investigators used baseline and 6–24‐month follow‐up survey data from 1,038 English‐ or Spanish‐speaking female project participants who were aged 19 or younger at baseline—509 in intervention groups and 529 in comparison groups. All participants had received a standard set of core services, including prenatal and postnatal care, pregnancy testing, and various types of counseling and education; in addition, youth in intervention groups had received enhanced services, such as case management and home visits. Intent‐to‐treat analyses examined differences between intervention and comparison adolescents in several outcomes; additional analyses examined outcomes by specific project characteristics.

Overall, 46% of adolescents were black, 46% were Hispanic and 8% were members of other racial or ethnic groups; the mean age of youth in the sample was 17.1 years. A smaller proportion of adolescents in intervention groups than of those in comparison groups were parenting, rather than pregnant, at baseline (43% vs. 49%). In addition, intervention group youth were younger than comparison group youth (mean age, 16.8 vs. 17.3) and had had fewer years of schooling (mean, 10.3 vs. 10.7).

At follow‐up, 15% of intervention group youth and 14% of comparison group youth had experienced a repeat pregnancy; a smaller proportion of intervention group youth had had a repeat pregnancy within 12‐months of project intake (10% vs. 20%). Greater proportions of adolescents in intervention groups than of those in comparison groups had used long‐acting reversible contraceptives in the four weeks prior to the survey (39% vs. 32%) and had received regular child care during that time (70% vs. 58%). Multivariate analyses controlling for age and whether the adolescent was pregnant or was a mother at baseline confirmed that differences across groups in short‐term repeat pregnancy, use of long‐acting reversible contraceptives and regular use of child care were significant; no differences were found in longer term repeat pregnancy (i.e., after 12 months from project intake), school discontinuation or educational attainment.

In additional analyses that focused on specific characteristics of interventions, exposure to messages tailored toward adolescent culture and increased frequency of home visits were associated with reduced odds of short‐term repeat pregnancy among youth (odds ratios, 0.3 and 0.7, respectively). Use of long‐acting reversible contraceptives was positively associated with messages tailored to adolescent culture; activities at school during school hours and home visits by social workers; frequency of school‐based activities, home visits and meetings with case managers; and the proportion of adolescents completing the intervention (1.1–1.9). Repeat pregnancy after 12 months from intake was not associated with any specific project characteristics.

The researchers comment that their findings provide preliminary evidence that AFL program–funded demonstration projects are effective in preventing short‐term repeat pregnancy, and in increasing use of effective contraceptives and regular child care. Yet, they acknowledge that their study had several limitations, such as baseline differences between the intervention and comparison groups and a lack of generalizability to AFL projects overall because of selection criteria. The researchers conclude that "much remains to be learned about the ingredients needed for long‐term program effects on repeat pregnancy and how to improve educational outcomes."—J. Rosenberg