Skip to main content

Advertisement

SpringerLink
Log in

Ineffective Pregnancy Prevention During Adolescence: Assisting Healthcare Providers in Portugal With Individualized Risk Assessment

  • Original Paper
  • Published:
The Journal of Primary Prevention Aims and scope Submit manuscript

Abstract

In this study, we describe the relative contributions of and interactions between individual risk factors associated with ineffective pregnancy prevention among female adolescents in Portugal. Our sample consisted of 856 sexually experienced female adolescents (10–19 years) who did not intend to become pregnant. Of these, 379 were pregnant, and the residual (477) had never been pregnant. We used classification tree analysis to describe the interplay among a set of established sociodemographic, familial, reproductive, and relationship factors as predictors of ineffective pregnancy prevention. The tree model showed good predictive properties. Seven profiles predicted one-half to all the cases of ineffective pregnancy prevention. Ineffective pregnancy prevention was predicted by adolescents’ grade level and different combinations of variables, specifically female age, age at the time of first sexual intercourse, religious beliefs, place of residence, maternal pregnancy before age 20, household structure in childhood, and partner’s age difference. According to our findings, limiting assessments to the cumulative presence of risk factors may be insufficient to accurately identify adolescents at elevated risk of unwanted pregnancy, as the impact of any given risk factor may vary according to other factors. Our findings may contribute to the development of a risk assessment tool that may support healthcare providers’ efforts to provide individualized risk assessment for adolescent patients and, thus, to better support pregnancy prevention.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  • Alferes, V. (2002). Inquéritos: Tamanho da amostra e intervalos de confiança (Inquiries: Sample size and confidence intervals)- SPSS Syntax Files. http://www.fpce.uc.pt/nucleos/niips/spss_prc/inq_ic/ic_f_n.htm

  • Araújo-Pedrosa, A. (2009). Gravidez e transição para a maternidade na adolescência: Determinantes individuais e psicossociais da ocorrência de gravidez e da adaptação. Estudo com adolescentes da Região Autónoma dos Açores (Pregnancy and transition to motherhood during adolescence: Individual and psychosocial determinants of pregnancy and adaptation. A study with adolescents from the Azores Islands) [Unpublished doctoral dissertation]. University of Coimbra.

  • Araújo-Pedrosa, A., Canavarro, M. C., & Pereira, M. (2003). Entrevista de avaliação clínica para as utentes da Unidade de Intervenção Psicológica da Maternidade Doutor Daniel de Matos, HUC (Clinical assessment interview for patients of the Unit of Psychological Intervention, Maternity Doutor Daniel de Matos, UCH) [Unpublished manuscript].

  • Araújo-Pedrosa, A., Pires, R., Carvalho, P., Canavarro, M. C., & Dattilio, F. M. (2011). Ecological contexts in adolescent pregnancy: The role of individual, sociodemographic, familial and relational variables in understanding risk of occurrence and adjustment patterns. Contemporary Family Therapy, 33, 107–127. https://doi.org/10.1007/s10591-011-9148-4

    Article  Google Scholar 

  • Akers, A. Y., Gold, M. A., Borrero, S., Santucci, A., & Schwarz, E. B. (2010). Providers’ perspectives on challenges to contraceptive counseling in primary care settings. Journal of Women’s Health, 19(6), 1163–1170. https://doi.org/10.1089/jwh.2009.1735

    Article  PubMed  PubMed Central  Google Scholar 

  • Black, D. S., Sun, P., Rohrbach, L. A., & Sussman, S. (2011). Decision-making style and gender moderation of the self-efficacy-condom use link among adolescents and young adults. Archives of Pediatric and Adolescent Medicine, 165, 320–325. https://doi.org/10.1001/archpediatrics.2011.17

    Article  Google Scholar 

  • Brauner-Otto, S. R., & Axinn, W. G. (2010). Parental family experiences, the timing of first sex, and contraception. Social Science Research, 39, 875–893. https://doi.org/10.1016/j.ssresearch.2010.06.015

    Article  PubMed  PubMed Central  Google Scholar 

  • Bitzer, J et al., 2016 Bitzer, J., Abalos, V., Apter, B., Martin, R., Black, A., & on behalf of the Global CARE (Contraception: Access, Resources, Education) Group (2016). Targeting factors for change: Contraceptive counselling and care of female adolescents. The European Journal of Contraception & Reproductive Health Care, 21(6), 417-430, https://doi.org/https://doi.org/10.1080/13625187.2016.1237629

  • Brindis, C. D., Geierstanger, S. P., Wilcox, N., McCarter, V., & Hubbard, A. (2005). Evaluation of a peer provider reproductive health service model for adolescents. Perspectives in Sexual and Reproductive Health, 37(2), 85–91. https://doi.org/10.1363/psrh.37.085.05

    Article  Google Scholar 

  • Bronfenbrenner, U., & Morris, P. A. (1998). The ecology of developmental processes. In R. M. Lerner (Ed.), Handbook of child psychology: Vol 1 Theoretical models of human development.Wiley.

    Google Scholar 

  • Canavarro, M. C. (2001). Consulta de acompanhamento psicológico - Relatório de actividades referentes ao ano de 2000 (Psychological Counselling Appointments - Activity report for the year 2000) [Unpublished manuscript].

  • Canavarro, M. C., & Pereira, A. I. (2001) Gravidez e maternidade da adolescência: Perspectivas teóricas Pregnancy and motherhood during adolescence: Theoretical perspectives. In M. C. Canavarro (Eds), Psicologia da gravidez e maternidade Psychology of pregnancy and maternity Quarteto.

  • Canavarro, M. C., Silva, N., Diniz, E., Pereira, M., Koller, S. H., & Pires, R. (2020). Sociodemographic, sexual, and reproductive variables associated with pregnancy among adolescents from low socioeconomic background. Journal of Community Psychology, 48, 1732–1750. https://doi.org/10.1002/jcop.22364

    Article  PubMed  Google Scholar 

  • Carvalho, P. (2012). Factores de influência individuais, psicossociais e relacionais para a ocorrência de gravidez na adolescência em Portugal Continental (Individual, psicossocial, and relational risk factors for adolescent pregnancy in Portugal´s mainland) [Unpublished doctoral dissertation]. University of Beira Interior.

  • Catallozzi, M., Simon, P. J., Davidson, L. L., Breitbart, V., & Rickert, V. I. (2011). Understanding control in adolescent and young adult relationships. Archives of Pediatric and Adolescent Medicine, 165, 313–319. https://doi.org/10.1001/archpediatrics.2011.32

    Article  Google Scholar 

  • Cavallaro, F. L., Benova, L., Owolabi, O. O., & Ali, M. (2019). A systematic review of the effectiveness of counselling strategies for modern contraceptive methods: What works and what doesn’t? BMJ Sexual and Reproductive Health. https://doi.org/10.1136/bmjsrh-2019-200377

    Article  PubMed  Google Scholar 

  • Churchill, D., Allen, J., Pringle, M., Hippisley-Cox, J., Ebdon, D., Macpherson, M., & Bradley, S. (2000). Consultation patterns and provision of contraception in general practice before teenage pregnancy: Case-control study. British Medical Journal, 321, 486–489. https://doi.org/10.1136/bmj.321.7259.486

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Coker, A. L., Richter, D. L., Valois, R. F., McKeown, R. E., & Garrison, C. Z. (1994). Correlates and consequences of early initiation of sexual intercourse. Journal of School Health, 64, 372–377. https://doi.org/10.1111/j.1746-1561.1994.tb06208.x

    Article  CAS  Google Scholar 

  • Commendador, K. A. (2010). Parental influences on adolescent decision making and contraceptive use. Pediatric Nursing, 36(3), 147–156. http://www.medscape.com/viewarticle/726737

  • Eurostat (2021). Live births by mother's age and country of birth. https://ec.europa.eu/eurostat/databrowser/view/demo_facbc/default/table?lang=en

  • Ewing, S., Ryman, S., Gillman, A., Weiland, B., Thayer, R., & Bryan, A. (2016). Developmental cognitive neuroscience of adolescent sexual risk and alcohol use. AIDS and Behavior, 20, 97–108. https://doi.org/10.1007/s10461-015-1155-2

    Article  Google Scholar 

  • Ferri, C., Flach, P., & Hernández-Orallo, J. (2002). Learning decision trees using the area under the ROC curve. In C. Sammut, & A. Hoffmann (Eds.), Proceedings of the 19th International Conference on Machine Learning (pp. 139–146). Morgan Kaufmann.

  • Field, A. (2009). Discovering statistics using SPSS. Sage.

    Google Scholar 

  • French, R. S., & Cowan, F. M. (2009). Contraception for adolescents. Best Practice & Research Clinical Obstetrics & Gynecology, 23, 233–247. https://doi.org/10.1016/j.bpobgyn.2008.12.002

    Article  Google Scholar 

  • Gasser, T., Kneip, A., & Köhler, W. (1991). A flexible and fast method for automatic smoothing. Journal of the American Statistical Association, 86(415), 643–652. https://doi.org/10.1080/01621459.1991.10475090

    Article  Google Scholar 

  • Griffin, A., & Christie, D. (2017). Adolescent neurological development and implications for health and well-being. Healthcare, 5(4), 62. https://doi.org/10.3390/healthcare5040062

    Article  PubMed Central  Google Scholar 

  • Grilo, M. L. (2014). Atitudes e comportamentos sexuais na adolescência (Adolescent sexual attitudes and behaviors). [Unpublished master dissertation]. Universidade de Lisboa.

  • Hellerstedt, W. L., Smith, A. E., Shew, M. L., & Resnick, M. D. (2000). Perceived knowledge and training needs in adolescent pregnancy prevention. Archives of Pediatric and Adolescent Medicine, 154, 679–684. https://doi.org/10.1001/archpedi.154.7.679

    Article  CAS  Google Scholar 

  • Instituto Nacional de Estatística [INE]. (2009). Tipologia de áreas urbanas (TIPAU) [Urban area typology]. http://goo.gl/mdsOJG

  • Instituto Nacional de Estatística [INE]. (2020). Nados-Vivos (n.º) por idade da mãe: anual – 2019 [Live births (no.) by mother’s age: Annual - 2019]. https://www.ine.pt/xportal/xmain?xpid=INE&xpgid=ine_indicadores&indOcorrCod=0008099&contexto=bd&selTab=tab2

  • Jamieson, L. K., & Wade, T. J. (2011). Early age of first sexual intercourse and depressive symptomatology among adolescents. Journal of Sex Research, 48, 450–460. https://doi.org/10.1080/00224499.2010.509892

    Article  PubMed  Google Scholar 

  • Kass, G. V. (1980). An exploratory technique for investigating large quantities of categorical data. Applied Statistics, 29(2), 119–127. https://doi.org/10.2307/2986296

    Article  Google Scholar 

  • Lemon, S. C., Roy, J., Clark, M. A., Friedmann, P. D., & Rakowski, W. (2003). Classification and regression tree analysis in public health: Methodological review and comparison with logistic regression. Annals of Behavioral Medicine, 26, 172–181. https://doi.org/10.1207/S15324796ABM2603_02

    Article  PubMed  Google Scholar 

  • Lewis, R. J. (2000). An introduction to classification and regression tree (CART) analysis. Paper presented at the Annual Meeting of the Society for Academic Emergency Medicine, San Francisco, CA. http://goo.gl/D0p2jz

  • Luster, T., & Haddow, J. L. (2005). Adolescent mothers and their children: An ecological perspective. In T. Luster & L. Ogaki (Eds.), Parenting: An ecological perspective Routledge.Boston.

    Google Scholar 

  • Miller, B. C., Benson, B., & Galbraith, K. A. (2001). Family relationships and adolescent pregnancy risk: A research synthesis. Developmental Review, 21, 1–38. https://doi.org/10.1006/drev.2000.0513

    Article  CAS  Google Scholar 

  • Miller, K. S., Clark, L. F., & Moore, J. S. (1997). Sexual initiation with older male partners and subsequent HIV risk behavior among female adolescents. Family Planning Perspectives, 29, 212–214. https://doi.org/10.2307/2953397

    Article  CAS  PubMed  Google Scholar 

  • Ministry of Education: Bureau for European Affairs and International Relations. (1999). The Portuguese education system: The system today and plans for the future. http://goo.gl/a7caxQ

  • Palen, L.-A., Smith, E., Caldwell, L. L., Plisher, A. J., Wegner, L., & Vergani, T. (2008). Inconsistent reports of sexual intercourse among South African high school students. Journal of Adolescent Health, 42, 221–227. https://doi.org/10.1016/j.jadohealth.2007.08.024

    Article  Google Scholar 

  • Pereira, A. I. (2001). Contextos relacionais de vulnerabilidade e protecção para a gravidez na adolescência (Relational risk and protective factors for adolescent pregnancy) [Unpublished master’s thesis]. University of Coimbra.

  • Pereira, J. I. F., Pires, S. A. R., Araújo-Pedrosa, F. A., & Canavarro, M. C. C. S. P. (2018). Reproductive and relational trajectories leading to pregnancy: Differences between adolescents and adult women who had an abortion. European Journal of Obstetrics & Gynecology and Reproductive Biology, 224, 181–187. https://doi.org/10.1016/j.ejogrb.2018.03.052

    Article  Google Scholar 

  • Pinho, P. J. (2006). Relatório de actividades do estágio da carreira técnica superior de saúde em Psicologia Clínica (Probation report for access to the Portuguese technical health career in Clinical Psychology). [Unpublished manuscript]

  • Pires, R., Araújo-Pedrosa, A., & Canavarro, M. C. (2014). Examining the links between perceived impact of pregnancy, depressive symptoms, and quality of life during adolescent pregnancy: The buffering role of social support. Maternal and Child Health Journal, 18, 789–800. https://doi.org/10.1007/s10995-013-1303-0

    Article  PubMed  Google Scholar 

  • Pires, R., Araújo-Pedrosa, A., Pereira, J., & Canavarro, M. C. (2014). Preventing adolescent pregnancy: Biological, social, cultural, and political influences on age at first sexual intercourse. Journal of Primary Prevention, 35(4), 239–254. https://doi.org/10.1007/s10935-014-0344-5

    Article  Google Scholar 

  • Pires, R., Pereira, J., Araújo-Pedrosa, A., Bombas, T., Vilar, D., Vicente, L., & Canavarro, M. C. (2014). Trajetórias relacionais e reprodutivas conducentes à gravidez na adolescência: A realidade nacional e regional portuguesa Relational and reproductive trajectories leading to adolescent pregnancy in portugal: A national and regional characterization. Acta Médica Portuguesa, 27(5), 543–555

    Article  Google Scholar 

  • Rostosky, S. S., Wilcox, B. L., Wright, M. L. C., & Randall, B. A. (2004). The impact of religiosity on adolescent sexual behavior. Journal of Adolescent Research, 19(6), 677–697. https://doi.org/10.1177/0743558403260019

    Article  Google Scholar 

  • Simões, M. R. (1994). Investigações no âmbito da aferição nacional do teste das Matrizes Progressivas de Raven (Raven’s Progressive Matrices: Aferition studies) [Unpublished doctoral dissertation]. University of Coimbra.

  • United Nations Population Fund. (2013). The state of world population 2013: Motherhood in childhood – Facing the challenge of adolescent pregnancy. https://www.unfpa.org/sites/default/files/pub-pdf/EN-SWOP2013-final.pdf

  • United Nations Population Fund. (2018). The state of world population 2018: The power of choice - Reproductive rights and the demographic transition. https://www.unfpa.org/sites/default/files/pub-pdf/UNFPA_PUB_2018_EN_SWP.pdf

  • United Nations Population Fund. (2020). The state of world population 2020: Against my will – Defining the practices that harm women and girls and undermine equality. United Nations Population Fund. https://www.unfpa.org/sites/default/files/pub-pdf/UNFPA_PUB_2020_EN_State_of_World_Population.pdf

  • Vasilenko, S. A., & Espinosa-Hernández, G. (2019). Multidimensional profiles of religiosity among adolescents: Associations with sexual behaviors and romantic relationships. Journal of Research on Adolescence, 29(2), 414–428. https://doi.org/10.1111/jora.12444

    Article  PubMed  PubMed Central  Google Scholar 

  • Wang, R.-H., & Chiou, C.-J. (2008). Relative contribution of intrapersonal and partner factors to contraceptive behavior among Taiwanese female adolescents. Journal of Nursing Scholarship, 40, 131–136. https://doi.org/10.1111/j.1547-5069.2008.00217.x

    Article  PubMed  Google Scholar 

  • World Health Organization. (1975). Pregnancy and abortion in adolescence: Report of a WHO meeting. http://whqlibdoc.who.int/trs/WHO_TRS_583.pdf

  • World Health Organization. (2004). Contraception: Issues in adolescent health and development. http://goo.gl/R4nHVS

  • World Health Organization. (2007). Adolescent pregnancy – Unmet needs and undone deeds. https://www.who.int/maternal_child_adolescent/documents/discussion/en/

  • Zapata, L. B., Tregear, S. J., Curtis, K. M., Tiller, M., Pazol, K., Mautone-Smith, N., & Gavin, L. E. (2015). Impact of contraceptive counseling in clinical settings: A systematic review. American Journal of Preventive Medicine, 49(2), S31–S45. https://doi.org/10.1016/j.amepre.2015.03.023

    Article  PubMed  PubMed Central  Google Scholar 

  • Zink, T. M., Shireman, T. I., Ho, M., & Buchanan, T. (2002). High-risk teen compliance with prescription contraception: An analysis of Ohio Medicaid claims. Journal of Pediatric and Adolescent Gynecology, 15, 15–21. https://doi.org/10.1016/S1083-3188(01)00134-6

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Education Sciences, University of Coimbra, Rua Do Colégio Novo, 3000-115, Coimbra, Portugal

    Raquel Pires, Joana Pereira, Anabela Araújo-Pedrosa  & Maria Cristina Canavarro

  2. Psychological Intervention Unit of the Maternity Doctor Daniel de Matos, Centro Hospitalar E Universitário de Coimbra, EPE, Coimbra, Portugal

    Anabela Araújo-Pedrosa

  3. Sexual, Maternal, and Child Health Division, Directorate-General of Health, Lisbon, Portugal

    Lisa Vicente

  4. Obstetric Service of the Maternity Alfredo da Costa, Centro Hospitalar de Lisboa Central, EPE, Lisbon, Portugal

    Lisa Vicente

  5. Obstetric Service of the Maternity Daniel de Matos, Centro Hospitalar E Universitário de Coimbra, EPE, Coimbra, Portugal

    Teresa Bombas

Authors
  1. Raquel Pires
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joana Pereira
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anabela Araújo-Pedrosa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lisa Vicente
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Teresa Bombas
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maria Cristina Canavarro
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed significantly to the conception and design, acquisition of the data, or the analysis and interpretation of the data and to the drafting of the article or revising it critically for important intellectual content. All authors have agreed to the by-line order of authorship and to the submission of this version of the manuscript to this journal. We confirm that this work is original and has not been published elsewhere, nor is it currently under consideration for publication elsewhere.

Corresponding author

Correspondence to Raquel Pires.

Ethics declarations

Conflict of Interest

The authors declare they have no conflicts of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the national research committees (Comissão Nacional de Proteção de Dados, Direção-Geral de Inovação e Desenvolvimento Curricular) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The sample was collected among 48 public health services and 22 public schools after approval by their Ethics Committees and Direction Boards. Detailed information about the study’s aims and procedures was provided to all potential participants, and written informed consent was obtained from those who agreed to participate and parents/legal guardians of minors, as well written informed assent by underaged adolescents.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This study was conducted within the Relationships, Development & Health research group of the R&D Unit Center for Research in Neuropsychology and Cognitive Behavioral Intervention. Raquel Pires, Joana Pereira, and Anabela Araújo-Pedrosa were supported by doctoral scholarships from the Portuguese Foundation for Science and Technology (FCT-SFRH/BD/63949/2009, SFRH/BD/89435/2012, and SFRH/BD/3168/2000, respectively). These doctoral scholarships were co-financed by the European Social Fund. The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pires, R., Pereira, J., Araújo-Pedrosa , A. et al. Ineffective Pregnancy Prevention During Adolescence: Assisting Healthcare Providers in Portugal With Individualized Risk Assessment. J Primary Prevent 42, 385–407 (2021). https://doi.org/10.1007/s10935-021-00637-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10935-021-00637-0

Keywords

Search

Navigation