Long-term abortion and birth rates for 14- to 25-year-olds before and after the implementation of prescription-free emergency contraceptives in Finland
Juha Luukkonen, Olivia McEvoy, Pekka Martikainen, Sini P Laakso, Hanna RemesAbstract
Background
Public health interventions increasing access to emergency contraceptives (ECs) have been deemed mostly unsuccessful in preventing abortions. However, the assessment of these interventions has mostly ignored potential variation in responses by age at intervention or socio-economic background.
Methods
We used Finnish-population register data to assess annual abortion and live-birth rates for women aged 14–25 years during 1994–2010 by age and parental education. Changes in rates were assessed around the introduction of prescription-free ECs in 2002 with interrupted time-series regressions. We also assessed cohort-wise hazards of abortions and births by age 25 years for cohorts of 1980–94 (aged 8-22 years at the time of intervention).
Results
After the introduction of prescription-free ECs, the increasing annual rates of abortions and live births turned into a clear decline for ages 15–19 years, with a less consistent decline for young people whose parents had low educational attainment. Conversely, the abortion rates continued to increase for ages 20–24 years, with larger increases by lower parental education. Comparing cohorts exposed to the intervention at different ages, we observed lower abortion and live-birth risks by age 19 years among the cohorts who were ≤15 years old at the time of the intervention.
Conclusion
The clear reversal in adolescent abortion rates suggests the prescription-free ECs worked as intended, but the intervention was far less successful among young adults and those with lower socio-economic background. Evaluations of public health interventions need to consider population subgroups.