WHO Guidelines on Preventing Early Pregnancy and Poor Reproductive Outcomes Among Adolescents in Developing Countries

doi:10.1016/j.jadohealth.2013.03.002

Journal of Adolescent Health

Volume 52, Issue 5, May 2013, Pages 517-522

https://doi.org/10.1016/j.jadohealth.2013.03.002 Get rights and content

Abstract

Adolescent pregnancy and its consequences represent a major public health concern in many low-middle income countries of the world. The World Health Organization has recently developed evidence-based guidelines addressing six areas: preventing early marriage; preventing early pregnancy through sexuality education, increasing education opportunities and economic and social support programs; increasing the use of contraception; reducing coerced sex; preventing unsafe abortion; and increasing the use of prenatal care childbirth and postpartum care. In each of these areas, World Health Organization recommends directions for future research. The summary concludes with a brief look at global and regional initiatives that provide a window of opportunity for stepping up action in this important area.

Section snippets

The WHO Guidelines: Rationale and Methods

The new guidelines were developed according to WHO's Grading of Recommendations, Assessment Development and Evaluation process that includes a systematic review of the evidence that informs the formulation of recommendations by an expert panel [7], [8]. Earlier policy and programmatic guidelines on adolescent pregnancy exist, but they tend to focus on single issues (e.g., preventing early marriage or providing sexuality education) rather than all the major determinants of adolescent pregnancy

Preventing early marriage

WHO's recommendation in this field are informed by 21 ungraded studies conducted in several LMICs [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31].

In some parts of world, girls are expected to marry and begin child-bearing in their early or middle teenage years. Parents feel pressured by prevailing norms, traditions, and economic constraints. The most important way of addressing this is keeping girls in school. Many

Discussion: Challenges and Opportunities

The development of the WHO's guidelines focusing on LMICs was a challenge because of the limited evidence of effective interventions in important areas. As recently stated in The Lancet series on adolescent health, “…enhancing the research capacity of investigators in low-income and middle income countries is crucial if these regions are to develop effective evidence-based policies and programs to ensure the wellbeing of their young people” [75]. The huge heterogeneity of the demographic,

Acknowledgments

WHO's Department of Maternal, Newborn, Child, and Adolescent Health led the development of the WHO Guidelines. The guidelines were developed in conjunction with the Guttmacher Institute, the International Centre for Research on Women, FHI 360, the Population Council, and Centro Rosarino de Estudios Perinatales (Argentina). Their development was supported financially by the United Nation Population Fund, the U.S. Agency for International Development, and the International Planned Parenthood

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In recent years, there has been a growing recognition that developing preconception care provides an opportunity to significantly reduce maternal and child mortality and morbidity. This involves targeting multiple risk factors through a large array of medical, behavioural and social interventions. In this study, we created a Causal Loop Diagram (CLD) to describe several pathways by which a set of preconception interventions may lead to women's improved health and better pregnancy outcomes. The CLD was informed by a scoping review of meta-analyses. It summarises evidence on the outcomes and interventions related to eight preconception risk factors. The authors reviewed literature from two databases (PubMed and Embase) and used the framework developed by Arksey and O'Malley. The CLD includes 29 constructs categorised into five different levels (mortality, causes of death, preconception risk factors, intermediate factors, interventions or policies). The model indicates interconnections between five sub-systems and highlights the role of preventing early and rapidly repeated pregnancies, as well as optimising women's nutritional status in the preconception period. It also shows the prevention of preterm birth as a privileged route for lowering child mortality and morbidity. The CLD demonstrates the potential benefits of strategies that address multiple preconception risk factors simultaneously and can be used as a tool to promote the integration of preconception care into efforts to prevent maternal and child mortality. With further improvements, this model could serve as a basis for future research on the costs and benefits of preconception care.
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CommentaryWHO Guidelines on Preventing Early Pregnancy and Poor Reproductive Outcomes Among Adolescents in Developing Countries

Abstract

Section snippets

The WHO Guidelines: Rationale and Methods

Preventing early marriage

Discussion: Challenges and Opportunities

Acknowledgments

Lancet

Lancet

J Adolesc Health

J Adolesc Health

Eval Program Plan

J Adolesc Health

Lancet

Lancet

WHO Guidelines for preventing early pregnancy and poor reproductive outcomes in adolescents in developing countries

Growing up global: The changing transitions to adulthood in developing countries

Child bearing in adolescents aged 12-15 years in low resource countries: A neglected issue. New estimates form demographic and household surveys in 42 countries

Acta Obstet Gynecol Scand

Progress for children. A report card for adolescents

Early marriages, adolescent and young pregnancies. Report by the Secretariat. A 65/13

WHO handbook for guideline development

Accountability for maternal, newborn and child health. An update on progress in priority countries – 2012

Evaluation of community-based rural livelihoods programme in Badakhshan, Afghanistan

Change in knowledge, perception, and attitudes of the villagers towards gender roles and gender relations: An evaluation of Gender Quality Action Learning Programme

Incentive schemes for school attendance in rural Bangladesh

The effects of schooling incentive programs on household resource allocation in Bangladesh (Report No. 133)

The effectiveness of adolescent development program of Bangladesh Rural Advancement Committee in strengthening awareness regarding social issues among rural adolescent girls in Bangladesh: An empirical study

Studies Home Commun Sci

Communicating with rural adolescents about sex education: Experiences from BRAC, Bangladesh

Providing microfinance and social space to empower adolescent girls: An evaluation of BRAC's ELA Centres. Working Paper No. 3. 1–42

Providing new opportunities to adolescent girls in socially conservative settings: The Ishraq program in rural Upper Egypt. 1–46

Impact study of the New Horizons Program in Egypt. 1–42

Evaluation of Berhane Hewan: A program to delay child marriage in rural Ethiopia

Intl Perspect Sex Reprod Health

Adolescent girls in India choose a better future: An impact assessment

Catalyzing change: Improving youth sexual and reproductive health through DISHA, an integrated program in India

Improving the reproductive health of married and unmarried youth in India: Evidence of effectiveness and costs from community-based interventions

Demographic evaluation of a development programme in rural Uttar Pradesh: A field study sponsored by the Rockefeller Foundation

Education and HIV/AIDS prevention: Evidence from a randomized evaluation in Western Kenya. Background Paper to the 2007 World Development Report

A gift for RH Project, Nepal: Endline evaluation

Youth reproductive health in Nepal: Is participation the answer?

Long-term evaluation of the Tostan Programme in Senegal: Kolda, Thies and Fatick regions. (Working Paper)

Evaluation of ‘Integrated Action on Poverty and Early Marriage’ Programme in Yemen

The short-term impacts of a schooling conditional cash transfer program on the sexual behavior of young women

Health Econ

Interventions for preventing unintended pregnancies among adolescents

Cochrane Database of Systematic Reviews

Education for contraceptive use by women after childbirth

Cochrane Database of Systematic Reviews

Young people, pregnancy and social exclusion: A systematic synthesis of research evidence to identify effective, appropriate and promising approaches for prevention and support

Commentary
WHO Guidelines on Preventing Early Pregnancy and Poor Reproductive Outcomes Among Adolescents in Developing Countries