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Teenage Conceptions

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Introduction

Teenage pregnancy refers to under-18 conceptions, including those leading to live births and terminations. Teenage mothers are less likely to finish their education, are more likely to bring up their child alone and in poverty and have a higher risk of poor mental health than older mothers. Infant mortality rates for babies born to teenage mothers are around 60% higher than for babies born to older mothers. The children of teenage mothers have an increased risk of living in poverty and poor quality housing and are more likely to have accidents and behavioural problems. There is a growing recognition that socio-economic disadvantage can be both a cause and a consequence of teenage motherhood. Qualitative research in the UK points to poor material circumstances, unhappiness at home or at school, and low expectations for the future as factors associated with high teen pregnancy rates1.

Much of the reduction in teenage conception can be attributed to the Teenage Pregnancy Strategy with the most substantial reductions in the most deprived areas, where rates were originally highest. Participation in work, education, or training by young women who became mothers before age 18 years doubled over the period of the Teenage Pregnancy Strategy. The programme had many components, and while it's still not known which were more effective than others, the combination of sex and relationships education, increased access to contraception, and social inclusion strategies are necessary elements2.

As well as being included in the Public Health Outcomes Framework, teenage pregnancy has also been included as a child poverty strategy indicator in the "A New Approach to Child Poverty: Tackling the Causes of Disadvantage and Transforming Families' Lives" document, published jointly between the Department for Work and Pensions and Department for Education, April 2011.

More background information and advice on tackling teenage pregnancy is provided in Public Health England's joint paper with the Local Government Association (LGA) published January 2016 'Good progress but more to do - Teenage pregnancy and young parents'

Facts and Figure

Blackpool has the 6th highest teenage pregnancy rates in England though significant improvements have been made.

    • In 2017, 74 women under the age of 18 in Blackpool became pregnant. 16 were aged under 16.
    • The under 18 conception rate in 2017 was 32.9 per 1,000 women aged 15-17, significantly higher than the North West and England averages of 21.9 and 17.8 respectively.
    • The under 16 conception rate in Blackpool was 7.5 per 1,000 women, higher than the North West and England averages of 3.5 and 2.7 respectively (Figure 2).
    • Since 2004 the rate has fallen by 54% from 72.0 per 1,000 to 32.9 per 1,000. This compares to a 57% reduction across England (Figure 1).
Figure 1: Trend in under 18 conceptions, rates per 1,000 women aged 15-17, 2004-2017
 20042005200620072008200920102011201220132014201520162017% reduction 2004-17

England

41.6

41.4

40.6

41.4

39.7

37.1

34.2

30.7

27.7

24.3

22.8

20.8 

18.8 

17.8 

57%

North West

46.0

46.9

44.2

46.6

44.8

42.6

39.6

35.3

31.6

27.6

26.8

24.7 

22.4 

21.9 

52%

Blackpool - rate

72.0

66.2

67.1

61.4

61.6

66.8

50.1

58.1

42.9

41.7

37.1

43.7 

34.6 

32.9 

54%

Blackpool - number

193

176

182

170

175

183

130

149

112

108

95

108 

82 

74 

62%

Source: ONS, Conceptions statistics tables, 2017
Figure 2: Trend in under 16 conceptions, rates per 1,000 women aged 13-15, 2009-2017
 200920102011201220132014201520162017% reduction 2009-2017

England

7.3

6.7

6.1

5.6

4.8

4.4

3.7 

3.1 

2.7 

63%

North West

8.7

7.8

7.0

6.6

5.8

5.1

4.6 

3.8 

3.5 

60%

Blackpool - rate

13.2

7.8

9.9

8.0

6.6

8.1

7.7 

5.2 

7.5 

43%

Blackpool - number

33

20

25

20

16

19

17 

11 

16 

52%

Source: ONS, Conceptions statistics tables, 2017

Figure 3 shows Blackpool's under 18 conception rate compared with the North West and England. It demonstrates that while significant improvements have been made, teenage pregnancy remains a significant problem for Blackpool.

Figure 3: Trend in under 18 conceptions rate, 1998 to 2017

Fig1-TPtrend-u18 to 2017
Source: ONS, Conceptions statistics tables, 2017

Figure 4 compares the under 18 conception rate across all lower tier local authorities in England. It can clearly be seen that Blackpool is in the highest quintile nationally. Blackpool has the 3rd highest rate of its statistical neighbours.

Figure 4: Under 18 conception rate, 2017 - Comparison of local authorities in England

Fig2-U18 LA comparison 2017
Source: ONS, Conceptions statistics tables, 2017

In 2017, the estimated number of conceptions in Blackpool fell by 10% to 74 from 82 in 2016. The number of conceptions do fluctuate year on year and despite occasional increases the general trend continues to fall from the high rate of 81 per 1,000 in 2003. Figure 5 shows the trend in the rate of all age conceptions and under 18 conceptions in Blackpool and England since 2001.

Figure 5: Trend in all age and under 18 conceptions in England and Blackpool, 2001 to 2017

Fig5-All&U18 conc trend-EngBl
Source: ONS, Conceptions statistics tables, 2017

The size of the female population of child bearing age (women aged 15-44) will also influence the number of conceptions as these are peak age groups for maternities (25-29 and 30-34) and abortions (20-24) and the relative sizes of these groups will impact upon the number and rate of conceptions. Projected population estimates for females in Blackpool shows falling numbers of young women in the 15-24 age group until the mid-2020s which may have an impact on teenage pregnancy and abortions.

Variation within Blackpool

There is wide variation in teenage pregnancies within Blackpool and pooled data for 2011/12-2015/16 shows:

    • 2.3% (195) of all babies born in Blackpool had a mother aged under 18 years in the 5 year period 2011/12-15/16.
    • This is significantly higher the the 1.1% of deliveries to young mothers nationally.
    • At a lower level, there are areas within Blackpool that have significantly higher proportions of young mother than either the Blackpool or national averages. (Figure 6).
    • Areas who have over 3 times as as many deliveries to young mothers than the national average are concentrated around Claremont, Bloomfield, Talbot and Park.

Figure 6: % of deliveries where mother is aged under 18 years by MSOA in Blackpool, 2011/12-2015/16 (5 years pooled)

Deliveries u18-ward 1516
Source: PHE, Local Health

Across Blackpool, under 18 abortion rates and maternity rates have fallen over the last 10 years (Figure 7). The abortion rate has more than halved, going from 25.3 per 1,000 in 2008 to 11.1 per 1,000 in 2017. The proportion of conceptions resulting in an abortion has also fallen over the same period; in 2008 two fifths (41%) of conceptions resulted in an abortion, by 2017 this has fall to a third (33.8%). Nationally the opposite is true, the proportion of conceptions resulting in an abortion has risen slightly from 49.7% to 52% over the same period (figure 8).

Figure 7: Outcome of conceptions in under 18's in Blackpool, 2006 to 2017 - Proportion resulting in birth and abortion

Fig5-U18 conc outcomes trend-2017
Source: ONS, Conceptions statistics tables, 2017

Figure 8: Proportion of under 18 conceptions resulting in an abortion - England, North West and Blackpool, 2006 to 2017

Fig6-%conc resulting in abortion 2017
Source: ONS, Conceptions statistics tables, 2017

High Risk Groups

The likelihood of teenage pregnancy is associated with factors such as3:

    • Early onset of sexual activity
    • Poor contraceptive use
    • Mental health/conduct disorder/involvement in crime
    • Alcohol and substance misuse
    • Repeat abortions
    • Low educational attainment
    • Disengagement from school
    • Living in care
    • Daughter of a teenage mother
    • Parental aspirations

Current Services

    • A young people's sexual health and substance misuse harm reduction service has been commissioned. Blackpool Young People’s Service Family Practitioners provide Brief Interventions and 1:1 Therapeutic support for young people at risk of poor sexual outcomes and young people misusing substances to improve their outcomes.
    • Staff in Primary Care have been trained to fit and remove contraceptive implants and intrauterine systems/devices and local enhanced service agreements are in place with a number of GP practices in Blackpool for both their registered and non-registered patients. These LARC methods of contraception are more reliable than user-dependent methods like oral contraceptives and are less likely to lead to unintended conceptions.
    • A PSHE support scheme for Primary schools is being piloted to ensure that they are prepared for statutory Relationships Education and Health Education, which comes into force in September 2020.  Support is also available to Secondary schools to ensure that they are prepared for statutory Relationships and Sex Education and Health Education in September 2020.
    • Blackpool's main clinical sexual health service is delivered from Whitegate Health Centre. This includes the provision of an open access Level 1, 2 and 3 service which is open to anyone of any age, irrespective of where they live. Elements of a Level 1 service include the provision of emergency oral contraception, sexual history taking and Chlamydia testing.  The service also offers a domiciliary service which provides joint visits with mental health, vulnerable children, drug and alcohol and learning disabilities services. 
    • Connect Young People's Service provides a Level 2 open access clinical service for anyone aged under 25, which includes sexually transmitted infection (STI) screening, contraception service and management of uncomplicated infections.
    • Three GP Practices have also been commissioned to provide Level 2 sexual health services for Blackpool residents.
    • Blackpool Clinical Commissioning Group (CCG) commissions two termination of pregnancy providers - Marie Stopes and National Unplanned Pregnancy Advisory Service (NUPAS).

National and local strategies

    • Teenage pregnancy strategy: Beyond 2010 (Department of Health & Department for Children, Schools and Families, 2010) - This updated strategy document focuses on the factors we know can reduce teenage pregnancy rates when they are implemented robustly and consistently, with each delivery partner understanding and taking responsibility for their particular contribution to the overall Strategy. 
    • Contraceptive services for under-25s (National Institute for Health and Care Excellence, 2014) - The guidance aims to improve access to high quality contraceptive services, especially for young people up to the age of 25.
    • NICE advice [LGB17] What can local authorities achieve by improving contraceptive services, March 2014
    • Blackpool Health and Wellbeing Board Sexual Health Strategy 2017-2020 and the accompanying Action Plan sets out Blackpool's measures to deliver their objectives of improving sexual health and reducing sexual health inequalities (still to be finalised)
    • PHE, Teenage pregnancy prevention framework, January 2018 - Guidance for local teenage pregnancy prevention programmes to help young people avoid unplanned pregnancies and develop healthy relationships.
    • PHE, Teenage mothers and young fathers: support framework, April 2019 - This framework helps local healthcare commissioners and service providers review support arrangements for young parents in their area.

Recommendations

Build knowledge and resilience among young people by:

    • Establishing consistent PSHE/SRE in secondary schools and FE colleges
    • Ensuring the needs of looked after children are a priority to promote their sexual health
    • Ensuring key professionals are appropriately trained and delivering appropriate sexual health interventions
    • Increasing effectiveness of school nursing service and nurses to Pupil Referral Units
    • Encouraging healthy relationships as part of PHSE
    • Encouraging sexual health and alcohol harm reduction are jointly addressed

Improve sexual health outcomes for young people by:

    • Ensuring young people with a learning disability have positive sexual health awareness
    • Ensuring young people receive evidence based interventions to address risk-taking behaviour
    • Ensuring open access to sexual health clinical services and commissioning domiciliary contraceptive services for high-risk groups
    • Encouraging uptake of LARC

Continue to reduce the rate of under 16 and under 18 conceptions by:

    • Improving targeted work
    • Implementing the national Teenage Pregnancy Strategy
    • Reducing second pregnancies
    • Reducing the risks of sexual exploitation and violence

 


[1] A Harden et al. Teenage pregnancy and social disadvantage: Systematic review integrating controlled trials and qualitative studies. BMJ, 339 (2009), p. b4254

[2] Skinner SR, Marino JL (2016) England's Teenage Pregnancy Strategy: a hard-won success, The Lancet, Vol 388, No. 10044, p538-540, August 2016

[3] DfES, Teenage Pregnancy: Accelerating the Strategy to 2010, Dept for Education and Skills, 2006