A cohort of teenagers offered information and access to free contraceptives had much lower pregnancy rates than the national average. Participants (and their parents) had to agree to participate and, although they appeared to be at higher “risk” than the control population, selection bias cannot be ruled out. Nevertheless, the differences in pregnancy rates were striking (34 vs. 159 per thousand) and suggest that a system that overcomes all three of the above barriers (financial, information and access) is more effective than a narrow emphasis on “education” alone. A general learning point may be that it is important to identify and address all material barriers when designing an intervention. I think that is consistent with the theory of constraints, but others might wish to comment.
— Richard Lilford, CLAHRC WM Director
- Secura GM, Madden T, McNicholas C, Mullersman J, Buckel CM, Zhao Q, Peipert MD. Provision of no-cost, long-acting contraception and teenage pregnancy. N Engl J Med. 2014; 371(14): 1316-23.
- Michie S, van Stralen MM, West R. The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implement Sci. 2011; 6: 42.