Interventions Achieving Statistically Significant Impact on Rapid Repeat Pregnancy or Birth Among High-Quality Evaluations (n=14)
| Intervention Description | Evaluation | Country | Outcome Measured During Postpartum Period | Repeat Pregnancy or Birth Rate | P Value | |
|---|---|---|---|---|---|---|
| Intervention | Control | |||||
| Contraceptive Services and Information | ||||||
| Proactive monitoring of contraceptive use, contraceptive education, and inclusion of partner and families | Sullivan 199218 | US | Pregnancy <18 months | 12% | 28% | <.003 |
| Proactive monitoring of contraceptive use, contraceptive education, and inclusion of partner and families | Rabin 199136 | US | Pregnancy over 9 years | 9% | 70% | <.001 |
| Postpartum Contraceptive Services | ||||||
| Postpartum check-ups and provision of contraceptive services within 2 months of index birth in school setting | Seitz 199333 | US | Birth <24 months | 12% | 36% | <.005 |
| Education on the use of LAM and, for intervention group participants only, education on the use of EC in the event of unprotected intercourse and provision of take-home supply of EC | Shaaban 201322 | Egypt | Pregnancy <6 months | 0.3%a | 5% | <.001 |
| Education on the use of LAM and support/increased messaging to transition to another modern method by 6 months postpartum (a sub-intervention of a larger birth spacing intervention evaluated by Ahmed 201539) | Ahmed 201539 | Bangladesh | Birth <24 months | 14%b | 17%b | <.01 |
| Planning Interventions | ||||||
| Preparation of contraceptive plan in the antenatal period (a sub-intervention of a larger pregnancy spacing intervention evaluated by Olds 200224) | Gray 2006 study17 (secondary analysis of Olds 200224) | US | Pregnancy 13–24 months | –c | –c | –c |
| Home visitation by nurses to help women plan the timing of the next pregnancy, rather than avoid unintended pregnancies | Olds 200224 | US | Pregnancy <24 months | 29% | 41% | <.02 |
| Home visitation by nurses to help women plan the timing of the next pregnancy, rather than avoid unintended pregnancies | Kitzman 199725 | US | Pregnancy <24 months | 36% | 47% | <.01 |
| Training adolescents in “if-then” planning for oral contraceptive use | Martin 201121 | UK | Pregnancy <24 months | 7% | 12% | <.02 |
| Community-Based Social and Behavioral Change Communication | ||||||
| Education on postpartum fertility return before return of menses. This was a sub-intervention of birth spacing intervention evaluated by Ahmed 2015. | Cooper 2014 study16 (analysis of sub-intervention carried out in Ahmed 201539) | Bangladesh | Birth <24 months | 14%d | 17% | <.01 |
| Interpersonal counseling and community education on the benefits of healthy pregnancy spacing and potential consequences of short pregnancy intervals, with a focus on adolescents and young adults ages 15–24 | Sebastian 201237 | India | Pregnancy at 9 months | 10.5%e | 16.4% | <.01 |
| Group discussions in homes of influentials to promote positive views of contraceptives and encourage discussions with husbands and friends | Kincaid 200057 | Bangladesh | Contraceptive continuation over 2.5 years | –f | –f | –f |
| Motivating, Mentoring, and Goal Setting | ||||||
| Assistance to adolescents to prepare plans for achieving short- and long-term life goals (a sub-intervention of a larger pregnancy spacing intervention evaluated by Olds 200224) | Gray 2006 study17 (secondary analysis of Olds 200224) | US | Pregnancy 7–12 months | –c | –c | –c |
| Use of mentorship curriculum by women from the community who made home visits to postpartum adolescents every 2 weeks until infant's first birthday | Black 200619 | US | Birth <24 months | 11% | 24% | <.05 |
| Cell phone counseling emphasizing teens' own goals and needs, positive youth assets, healthy relationships, and positive reproductive health practices | Katz 201123 | US | Pregnancy <24 months | 26%g | 39%g | <.01 |
| Motivational interviewing of adolescents, emphasizing personal goals and self-efficacy | Barnet 200920 | US | Birth <24 months | –h | –h | –h |
| Provision of skills training and job placement for adolescent mothers over age 16 and educational support for mothers under age 16 | Drayton 200040 | Jamaica | Pregnancy over 4 years | 37% | 60% | <.05 |
Abbreviations: EC, emergency contraception; LAM, Lactational Amenorrhea Method.
↵a Shaaban 2013 reported 2 pregnancies among 579 participants in the intervention group, for a pregnancy rate of 0.3%. The article reported a pregnancy rate of 0.8%, but it is likely a transcription error.
↵b At 3 months postpartum, contraceptive use was 36% (of which 23% was LAM use) in the intervention group compared with 11% (with no LAM use) in the comparison group. In the intervention group, in part due to LAM users' transition to another method at 6 months postpartum, contraceptive use remained significantly higher in the intervention group than the comparison group at 24 months postpartum (46% vs. 35%, respectively; P<.001).
↵c The study indicated that adolescents with a prenatal contraceptive plan were significantly less likely to conceive at 13–24 months postpartum than adolescents without a plan. 18.6% of adolescents who prepared such a plan did not conceive by 13-24 months, while 0% of those who conceived by 13-24 months had prepared a prenatal contraceptive plan (P<.005). Adolescents who formulated short- and long-term goals were significantly less likely to conceive at 7–12 months postpartum than those who did not formulate such goals (P<.05).
↵d Sub-intervention analyzed in Cooper 201416 focused on improving knowledge of postpartum fertility return. The analysis found that 98% of women knew fertility could return before return of menses, and women stated this information motivated them to begin using contraceptives.
↵e 93% of those in the intervention group reported counseling on use of spacing methods after delivery, whereas 69% of those in the control group reported such counseling (P<.01). Women in the intervention group who knew at least 2 spacing messages and at least 2 spacing methods were more likely to adopt a modern method postpartum (P<.05).
↵f Outcome measured was contraceptive continuation for 2.5 years at any point in a woman's life, not necessarily during the postpartum period. In the intervention group, contraceptive continuation for 2.5 years was 43.9% vs. 25.5% in the comparison group (P<.001).
↵g Among adolescents ages 15–17 years.
↵h Controlling for baseline difference, adolescents who received motivational interviews and home visits were more likely to defer a repeat birth than those in the control group (hazards ratio, 0.4; P<.05).