Impact of a community contraceptive counselling intervention on adolescent fertility rates: a quasi-experimental study

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• dc.contributor.author Díez, Elia
• dc.contributor.author López, María José
• dc.contributor.author Pérez, Glòria
• dc.contributor.author García Subirats, Irene, 1982-
• dc.contributor.author Nebot, Laia
• dc.contributor.author Carreras Collado, Ramón
• dc.contributor.author Villalbí, Joan R.
• dc.date.accessioned 2021-04-09T07:11:25Z
• dc.date.available 2021-04-09T07:11:25Z
• dc.date.issued 2020
• dc.description.abstract Background: From 2000 to 2008, in urban areas in Spain, adolescent fertility and abortion rates underwent unprecedented increases, consecutive to intensive immigration from developing countries. To address unmet needs for contraception information and services, a community-based, gender-sensitive and culturally adapted brief counselling intervention (SIRIAN program) was launched in some deprived neighbourhoods with a high proportion of immigrants in Barcelona. Once a randomized controlled trial demonstrated its effectiveness in increasing the use of contraceptives, we aim to examine its population impact on adolescent fertility rates. Methods: Quasi-experimental study with comparison group, using population data from 2005 to 2016. Five neighbourhoods in the lowest tercile of Disposable Household Income were intervened in 2011-13. The comparison group included the three neighbourhoods which were in the same municipal district and in the lowest Disposable Household Income tercile, and displayed the highest adolescent fertility rates. Generalized linear models were fitted to assess absolute adolescent fertility rates and adjusted by immigrant population between pre-intervention (2005-10) and post-intervention periods (2011-16); Difference in Differences and relative pre-post changes analysis were performed. Results: In 2005-10 the intervention group adolescent fertility rate was 27.90 (per 1000 women 15-19) and 21.84 in the comparison group. In 2011-16 intervention areas experienced great declines (adolescent fertility rate change: - 12.30 (- 12.45 to - 12.21); p < 0.001), while comparison neighbourhoods remained unchanged (adolescent fertility rate change: 1.91 (- 2.25 to 6.07); p = 0.368). A reduction of - 10.97 points (- 13.91 to - 8.03); p < 0.001) is associated to the intervention. Conclusion: Adolescent fertility rate significantly declined in the intervention group but remained stable in the comparison group. This quasi-experimental study provide evidence that, in a country with universal health coverage, a community counselling intervention that increases access to contraception, knowledge and sexual health care in hard-to-reach segments of the population can contribute to substantially reduce adolescent fertility rates. Reducing adolescent fertility rates could become a feasible goal in cities with similar conditions.
• dc.format.mimetype application/pdf
• dc.identifier.citation Díez E, López MJ, Perez G, Garcia-Subirats I, Nebot L, Carreras R, et al. Impact of a community contraceptive counselling intervention on adolescent fertility rates: a quasi-experimental study. BMC Public Health. 2020 Jan 8; 20(1): 26. DOI: 10.1186/s12889-019-8122-1
• dc.identifier.doi http://dx.doi.org/10.1186/s12889-019-8122-1
• dc.identifier.issn 1471-2458
• dc.identifier.uri http://hdl.handle.net/10230/47067
• dc.language.iso eng
• dc.publisher BioMed Central
• dc.rights Copyright © The Author(s). 2020. Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by/4.0/
• dc.subject.keyword Adolescence
• dc.subject.keyword Health inequalities
• dc.subject.keyword Neighbourhood/place
• dc.subject.keyword Public health policy
• dc.subject.keyword Reproductive health
• dc.title Impact of a community contraceptive counselling intervention on adolescent fertility rates: a quasi-experimental study
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion