Friday, June 14, 2002
Pregnancy prevention an utter failure: study
Unprotected, undeterred: 'We obviously don't have it right yet,' researcher concludesAdrian Humphreys
Sex education classes, abstinence programs and family planning clinics fail to keep young people from having sex, have no impact on the use of birth control and do nothing to reduce the number of adolescent pregnancies, according to a new Canadian study.
The alarming findings call into question efforts to reduce the high number of young women -- aged 11 to 18 years old -- who are getting pregnant, and suggests the debate over whether to push education or abstinence is moot, as neither meets its goal.
"We were disappointed to find that the adolescent pregnancy prevention programs failed," said Dr. Alba DiCenso, professor in the school of nursing at McMaster University in Hamilton and chief author of the study.
"They failed to delay the initiation of sexual intercourse, failed to improve the use of birth control and failed to reduce pregnancy rates. In short, they failed to achieve their intended effect," she said of her substantial study, to be published today in the British Medical Journal.
"None of the innovative approaches that were evaluated improved things," she said.
The study assimilated and analyzed the findings of 26 previous studies of adolescents in Canada and the United States from 1970 to 2000 that tested the effectiveness of prevention strategies. All the studies were conducted in the United States except for one in Canada.
For the 9,642 young women and the 7, 418 young men, there was no delay in when they first had sex, regardless of what intervention method they were exposed to. The result was consistent across the studies.
Nor were there any increases in the number of youths consistently using birth control, bringing inevitable results.
There were 43 pregnancies per 1,000 young women in Canada. That compares favourably to the 93 pregnancies per 1,000 young women in the United States and the 63 per 1,000 in Britain, but stands in stark contrast to the eight per 1,000 in the Netherlands.
Five studies, one of a school-based sex education program and four of abstinence programs, evaluated programs targeting the sexual behaviour of males and found higher pregnancy rates among their female partners. That suggests the abstinence model in particular may have particularly poor outcomes with males, the study says.
"We obviously don't have it right yet," said Dr. DiCenso.
Despite the disappointing outcomes, educators and community health advocates should not give up and ignore the problems, she said, since adolescent sex can have serious consequences for the individuals and the entire community.
The study only deals with methods that have been evaluated in a sound scientific study and as such does not look at other possible interventions that may be newer or untested.
"So there might be wonderful interventions out there that have never been evaluated and are working, but we can only work with what we have in terms of reported evidence," she said.
Now that researchers know that an array of traditional and widely used methods are not preventing early sexual experimentation and adolescent pregnancies, work needs to focus on finding other solutions, she said.
The study suggests seeking greater input from adolescents on what interventions are effective and how information should be presented.
A study last year by Dr. DiCenso interviewed adolescents in Ontario about sex education.
"What we learned is that they certainly do want to learn the facts but they don't appreciate scare tactics and would like to learn more about negotiation, communication and about relationships and communicating in ways that promote positive relationships," she said.
"We find they do not have the social resistance skills and when they are feeling pressured they find it difficult. Are there ways of learning to communicate, learning to be able to express what you ought to say and not to feel coerced?"
The dramatic difference in pregnancy rates between countries suggests that lessons may also be learned by comparing how sex issues are handled elsewhere and more widely apply the best approaches.
"And it would be interesting to look at studies that compare adolescents who have become pregnant with those who haven't to see whether we can identify any characteristics of the adolescents who are at higher risk of becoming pregnant," said Dr. DiCenso.
That may enable health officials to create programs that specifically target an identified at-risk group to reinforce a more widely used general program.
"My hunch is that whatever we come up with, it is not going to be a single bullet."
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