Perceived Facilitators and Barriers to Interventions Aimed at Reducing Unintended Pregnancies among Adolescents in Low and Middle Income (Developing) Countries: a Systematic Review of Qualitative Evidence

Background Adolescent pregnancies are most often the result of sexual risk taking. Such pregnancies are in themselves “risks” perpetuating other adverse social outcomes on the adolescents who go through such pregnancies. Of the close to 14 million births among adolescents each year, between one-third and two-thirds are unplanned. Unplanned pregnancies coupled with societal restrictions result in adolescents opting for abortions under unsafe conditions. Objectives The objective of this review is to present the best available evidence on perceived facilitators and barriers to successful outcomes of programs aimed at reducing pregnancies among adolescents in low and middle income countries. Inclusion criteria Types of participants Persons aged between 10 and 19 years residing in low and middle income countries, but during the review process, those up to 25 years, adults and opinion leaders were included. Phenomena of interest Perceived facilitators and barriers to interventions aimed at reducing pregnancies among adolescents in developing countries. Types of studies The review considered studies that used qualitative study designs, including but not limited to: phenomenology, grounded theory, action research, narrative studies, descriptive studies, ethnographies, cultural studies, behavioural studies, case studies and feminist research. Search strategy The search strategy aimed to find both published and unpublished studies in English over the period of January, 1960 to December, 2010. Methodological quality Critical appraisal of papers was conducted using standardized tools from the Joanna Briggs Institute by two independent reviewers. Data collection Data was extracted using standardized tools from the Joanna Briggs Institute. Data synthesis Findings were synthesized on the basis of similarity of meaning using software from the Joanna Briggs Institute. Results Fourteen studies were included in the review which generated 103 findings, grouped into 22 categories and then further grouped into 11 synthesized findings, based on similarity of meaning. Seventeen categories (eight synthesized findings) described perceived barriers and five categories (three synthesized findings) described perceived facilitators. Conclusions Synthesized findings on both the barriers and facilitators encompassed adolescent, parental, community, health facility, care providers, school environment and societal contributing factors. Implications for practice Care providers should be respectful, ensure privacy and confidentiality to adolescents accessing contraceptive methods. Educational curricula should provide information on sexual and reproductive health. Adults should be educated on the importance of their roles and of a stable home in adolescents' lives. Program managers and care providers should collaborate with religious institutions over the course of programs. Adolescents should be educated on adverse effects of contraceptives and counselled on stigma associated with contraceptive use. Adolescent females should be encouraged to go to school and achieve their goals in life. Mothers and grandmothers should be educated on the benefits of female self-reliance. Health educators and care providers should provide information on sources of counselling and support for adolescents in need. Implications for research Further research should be conducted into the following: Cultural/ societal norms perpetuating female subordination to males Perception that unprotected sex is good for health and beauty Misconceptions, myths and stigma associated with contraceptive use Individual level factors that prevent early pregnancy among adolescents Perceptions of love influencing sexual risk taking