哪些结构干预措施已在中低收入国家评估过青少年避孕措施的使用?
Which Structural Interventions for Adolescent Contraceptive Use Have Been Evaluated in Low- and Middle-Income Countries?
机构信息
Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
EPPI-Centre, UCL Social Research Institute, University College London, London WC1H 0NR, UK.
出版信息
Int J Environ Res Public Health. 2022 Sep 16;19(18):11715. doi: 10.3390/ijerph191811715.
Reducing adolescent childbearing is a global priority, and enabling contraceptive use is one means of achieving this. Upstream factors, e.g., gender inequalities, fertility norms, poverty, empowerment and schooling, can be major factors affecting contraceptive use. We conducted a systematic map to understand which structural adolescent contraception interventions targeting these upstream factors have been evaluated in LMICs. We searched eight academic databases plus relevant websites and a 2016 evidence gap map and screened references based on set inclusion criteria. We screened 6993 references and included 40 unique intervention evaluations, reported in 138 papers. Seventeen evaluations were reported only in grey literature. Poverty reduction/economic empowerment interventions were the most common structural intervention, followed by interventions to increase schooling (e.g., through legislation or cash transfers) and those aiming to change social norms. Half of the evaluations were RCTs. There was variation in the timing of endline outcome data collection and the outcome measures used. A range of structural interventions have been evaluated for their effect on adolescent contraceptive use/pregnancy. These interventions, and their evaluations, are heterogenous in numerous ways. Improved understandings of how structural interventions work, as well as addressing evaluation challenges, are needed to facilitate progress in enabling adolescent contraceptive use in LMICs.
减少青少年生育是全球的重点工作,而促进避孕药具的使用是实现这一目标的手段之一。上游因素,如性别不平等、生育规范、贫困、赋权和教育,可以成为影响避孕药具使用的主要因素。我们进行了系统制图,以了解针对这些上游因素的结构性青少年避孕干预措施在中低收入国家已进行了哪些评估。我们在八个学术数据库以及相关网站和 2016 年的证据差距图中进行了搜索,并根据设定的纳入标准筛选参考文献。我们筛选了 6993 条参考文献,纳入了 40 项独特的干预评估,发表在 138 篇论文中。有 17 项评估仅在灰色文献中报告。减贫/经济赋权干预是最常见的结构性干预措施,其次是增加教育(例如通过立法或现金转移)和旨在改变社会规范的干预措施。一半的评估是 RCT。结局数据收集的时间和使用的结局指标存在差异。已经对一系列结构性干预措施对青少年避孕措施使用/怀孕的效果进行了评估。这些干预措施及其评估在许多方面都存在差异。需要更好地了解结构性干预措施的工作原理,并解决评估挑战,以促进在中低收入国家促进青少年避孕药具使用的进展。