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- Page navigation anchor for RE: Failure to monitor or prevent unintended Pregnancy is the key inter-generational problem, not the pregnancy outcomeRE: Failure to monitor or prevent unintended Pregnancy is the key inter-generational problem, not the pregnancy outcome
We too hold in high regard the observed reduction in teen pregnancy in Canada over time, as pointed out in the letter by Drs. Norman and Munro. Their definition of what constitutes “a considerable proportion of abortions” among teens differs from ours, however. Of all teenage pregnancies in Canada, over 70% are unintended1, and 51% end in induced abortion (IA)2. The document cited by Drs. Norman and Munro, published in 2016 by the Canadian Institute for Health Information (CIHI), under-captured the number of IA performed within Ontario, outside of a hospital setting3. Rather, as subsequently clarified by CIHI4, and noted by others5, the number of IA is much higher, at about 40,000 per year, which is close to that estimated by the algorithm used in our study6.
Our study did not evaluate the economic determinates of having, or not having, an IA. However, we did observe a consistent effect size for the phenomenon of intergenerational IA across income quintiles (Appendix 2 in our paper)6.
While we appreciate the recent provision of Canadian federal funding to address the issues of sexual and reproductive coercion7 and reproductive rights8, we are not sure that such measures can be solely entrusted to governments. As concluded in our paper, and in agreement with Drs. Norman and Munro, education and the widespread availability of highly effective contraception is part of any effective strategy to reduce unintended teenage pregnancy6. Rather than taking “a stab in...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: Failure to monitor or prevent unintended Pregnancy is the key inter-generational problem, not the pregnancy outcomeRE: Failure to monitor or prevent unintended Pregnancy is the key inter-generational problem, not the pregnancy outcome
We read with interest the article published by Liu and colleagues (1), but have three critical concerns.
First, related to the age group of interest, the authors open with an incorrect statement in the Canadian context: "A considerable proportion of [abortions] are among teens aged 19 years or younger." Canada has had remarkable success over the past two decades implementing strategies to reduce teen pregnancy overall. CIHI as cited by the authors, indicated fewer than a 12% of all abortion services occurred among teens.[2]
Second, we were surprised that the authors did not highlight the economic determinants associated with risk to have an abortion. They observed that daughters who were born into the lowest income quintiles at birth were more likely to have a mother who had an abortion, than those born to mothers in higher income quintiles. Socioeconomic status and the ability to afford effective contraception are highly correlated with risk for unintended pregnancy.[3]
Finally, we were most intrigued by the authors’ call for research on “the effectiveness of family-centred interventions (aimed at engaging parents) in reducing sexual behaviour and unprotected sex among teenagers.” It is unfounded to suggest the etiology of the association they describe is known. The best research in the field would suggest the problem is not the occurrence of abortion, but failure to prevent unintended pregnancy.[4] Scientific approaches aim to account for...
Show MoreCompeting Interests: Dr. Norman holds a CIHR-PHAC chair in family planning applied public health research and is supported by the Micheal Smith Foundation for Health Research as a Scholar, at UBC. UBC received a educational grant from Bayer Canada Inc in 2015 to support one year of a post-doctoral fellow working in Dr. Norman's program of research. This fellow was not involved in discussions or preparation of this letter.