Lack of information poor relationships and lack of

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Lack of informationPoor relationships and lack of support systems/ family structure (Religion and extracurricular protective)Multiple sexual partners (especially adolescent males)Rapid repeat pregnancySexual coercionDifferent norms of sexual behavior for girls and boysEarly marriageDeanet al.Reproductive Health2014,11(Suppl 3):S2Page 4 of 17
examined any interventions to reduce rates of primaryand repeat adolescent pregnancy. Although abstinence-based education has been widely publicized, abstinence-focused sex-education programs insignificantly reducethe risk of pregnancy during adolescence [40,41,72].Expanded sexual-education programs delivered by adultsalso did not show an effect in preventing adolescentpregnancy [43,48,51,73], except in one study in Chile[42]. School or health-centre based interventions to pro-mote contraceptive use also had no effect on preventingteenage pregnancy, regardless of whether the interven-tion involved free provision[74], long-acting or emer-gency contraception with ease of access [75,76], or peercounselling [49].Comprehensive interventions, such as theChildrensAid Society Carrera Programwhich was carried out incommunity-centres and provided educational and voca-tional support, sex education, medical care, sports andarts, free STI testing and condoms are very successful,reducing the risk of teen pregnancy by 41% [52].Another highly successful program (risk reduction of57%) focused on youth development through commu-nity service, and personal development [39]. Conditionalcash transfers for girls to return to school [77] and theuse of text messages for education and reminders [78]may be promising as well. The pooled analysis for allinterventions to reduce the incidence of adolescentpregnancies showed only a 15% decrease (Figure 2).Interventions to prevent repeat second pregnancies toteenage mothers include parenting skills training, andencourage teenage mothers to complete their education,regardless of whether they are carried out in health cen-tres, support groups, or during home visits. One particu-larly successful program (risk reduction 89%) alsoincluded comprehensive medical care and referral ser-vices for day-care and housing [69]. Another effectiveFigure 2Prevent teen pregnancy: evidence from controlled trialsCitation to the included studies Allen 1997 [39], Anderson 1999 [40], Boekello1999 [41], Cabezon 2005 [42], Eison 1990 [43], Ferguson 1998 [44], Hahn 1994 [45], Handle 1987 [46], Herceg-brown 1986 [47], Howard 1990 [48], Jay1984[49], Kirby 1997 [50], Kirby 1997a [50], Kirby 1997b [50], Kirby 1997c [50], Kirby 1997d [50], Mitchell-dicenso 1997 [51], Philliber 2002 [52], Trenholm2007a [53], Trenholm 2007b [53], Trenholm 2007c [53], Trenholm 2007d [53], Wight 2002 [54], Wu 2003 [55].Deanet al.Reproductive Health2014,11(Suppl 3):S2Page 5 of 17
program (Second chance club- 84% decreased risk) tooka unique approach: it was conducted in high schoolthrough individualized case management and group ses-sions, and focused on school involvement and commu-nity outreach, but also provided medical care [62].

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