Perceived Facilitators and Barriers to Interventions Aimed at Reducing Unintended Pregnancies among Adolescents in Low and Middle Income (Developing) Countries: a Systematic Review of Qualitative Evidence.

BACKGROUND Adolescent pregnancies are most often the result of sexual risk taking. Such pregnancies are in themselves "risks" perpetuating other adverse social outcomes on the adolescents who go through such pregnancies. Of the close to 14 million births among adolescents each year, between one-third and two-thirds are unplanned. Unplanned pregnancies coupled with societal restrictions result in adolescents opting for abortions under unsafe conditions. OBJECTIVES The objective of this review is to present the best available evidence on perceived facilitators and barriers to successful outcomes of programs aimed at reducing pregnancies among adolescents in low and middle income countries. INCLUSION CRITERIA Persons aged between 10 and 19 years residing in low and middle income countries, but during the review process, those up to 25 years, adults and opinion leaders were included.Perceived facilitators and barriers to interventions aimed at reducing pregnancies among adolescents in developing countries.The review considered studies that used qualitative study designs, including but not limited to: phenomenology, grounded theory, action research, narrative studies, descriptive studies, ethnographies, cultural studies, behavioural studies, case studies and feminist research. SEARCH STRATEGY The search strategy aimed to find both published and unpublished studies in English over the period of January, 1960 to December, 2010. METHODOLOGICAL QUALITY Critical appraisal of papers was conducted using standardized tools from the Joanna Briggs Institute by two independent reviewers. DATA COLLECTION Data was extracted using standardized tools from the Joanna Briggs Institute. DATA SYNTHESIS Findings were synthesized on the basis of similarity of meaning using software from the Joanna Briggs Institute. RESULTS Fourteen studies were included in the review which generated 103 findings, grouped into 22 categories and then further grouped into 11 synthesized findings, based on similarity of meaning. Seventeen categories (eight synthesized findings) described perceived barriers and five categories (three synthesized findings) described perceived facilitators. CONCLUSIONS Synthesized findings on both the barriers and facilitators encompassed adolescent, parental, community, health facility, care providers, school environment and societal contributing factors. IMPLICATIONS FOR PRACTICE IMPLICATIONS FOR RESEARCH: Further research should be conducted into the following.