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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.

Facts and Figure

Blackpool has the highest teenage pregnancy rates in the UK though significant improvements have been made.

    • In 2015, 108 women under the age of 18 in Blackpool became pregnant. 17 were aged under 16.
    • The under 18 conception rate in 2015 was 43.8 per 1,000 women aged 15-17, significantly higher than the North West and England averages of 24.7 and 20.8 respectively.
    • The under 16 conception rate in Blackpool was 7.7 per 1,000 women, higher than the North West and England averages of 4.6 and 3.7 respectively (Figure 2).
    • Since 2004 the rate has fallen by 39% from 72.0 per 1,000 to 43.8 per 1,000. This compares to a 50% reduction across England (Figure 1).
Figure 1: Trend in under 18 conceptions, rates per 1,000 women aged 15-17, 2004-2015
 200420052006200720082009201020112012201320142015% reduction 2004-15

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 

50%

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 

46%

Blackpool - rate

72.0

66.2

67.1

61.4

61.6

66.8

50.1

58.1

42.9

41.7

37.3

43.8 

39%

Blackpool - number

193

176

182

170

175

183

130

149

112

108

95

108 

44%

Source: ONS, Conceptions statistics tables, 2015
Figure 2: Trend in under 16 conceptions, rates per 1,000 women aged 13-15, 2009-2015
 2009201020112012201320142015% reduction 2009-2015

England

7.3

6.7

6.1

5.6

4.8

4.4

3.7 

49%

North West

8.7

7.8

7.0

6.6

5.8

5.1

4.6 

47%

Blackpool - rate

13.2

7.8

9.9

8.0

6.6

8.1

7.7 

42%

Blackpool - number

33

20

25

20

16

19

17 

48%

Source: ONS, Conceptions statistics tables, 2015

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 2015

Fig1-TPtrend-u18
Source: ONS, Conceptions statistics tables, 2014

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 and Blackpool also has the highest rate of its statistical neighbours.

Figure 4: Under 18 conception rate, 2015 - Comparison of local authorities in England

Fig2-U18 LA comparison
Source: PHE, Sexual and Reproductive Health Profiles

In 2015, the estimated number of conceptions in Blackpool rose by 14% to 108 from 95 in 2014. The number of conceptions do fluctuate year on year and despite 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 and number of under 18 conceptions in Blackpool since 1998.

Figure 5: Trend in under 18 conceptions in Blackpool, rate and number, 1998 to 2015

Fig3-U18conc-rate and number
Source: ONS, Conceptions statistics tables, 2015

The size of the female population of child bearing age (women aged 15-44) will also influence the number of conceptions as there 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 conception rates within Blackpool and pooled data for 2012-14 shows:

    • There were 315 under 18 conceptions in Blackpool over the three year period, a rate of 40.7 per 1,000.
    • 10 wards have significantly higher rates than the national average of 24.9 per 1,000 (Figure 6).
    • 3 wards, Bloomfield, Claremont and Talbot, have significantly higher rates than the Blackpool average of 40.7 per 1,000.
    • 6 of the 10 wards have also had significantly higher rates in 2009-11, 2010-12 and 2011-13: Claremont, Clifton, Hawes Side, Park, Talbot and Victoria.

Figure 6: Wards in Blackpool with significantly higher under 18 conception rates than the national average, 2012-14

Fig4-U18 ward level conceptions12-14
Source: PHE, Teenage pregnancy interactive maps at ward level

Across Blackpool, under 18 abortion rates and maternity rates have fallen by approximately a third over the last 10 years (Figure 7). While the abortion rate has fallen in line with the maternity rate, the proportion of conceptions resulting in an abortion has risen considerably over the same time period, so that by 2014, 43% of conceptions in Blackpool resulted in abortion. The increase in the 2015 conception rate is down to an increase in births so the proportion of conceptions resulting in an abortion fell to 37%.

Nationally, regionally and locally the proportion of conceptions resulting in abortion is generally increasing (figure 8) so although the abortion rate is falling slightly, the decline in conceptions has essentially been among those resulting in a birth.

Figure 7: Outcome of conceptions in under 18's in Blackpool, 2006 to 2015 - Proportion resulting in birth and abortion

Fig5-U18 conc outcomes trend
Source: ONS, Conceptions statistics tables, 2015

Figure 8: Proportion of under 18 conceptions resulting in an abortion - England, North West and Blackpool, 2006 to 2015

Fig6-%conc resulting in abortion
Source: ONS, Conceptions statistics tables, 2015

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/substance misuse harm reduction service has been commissioned, which includes training on risk-taking behaviour for frontline workers working with young people aged under 18 (under 25 if they have a learning disability), and provision of a bus to enable young people to access harm reduction messages and Chlamydia testing in various community settings including schools and colleges.
    • 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 incentive scheme is being piloted to encourage secondary schools to add PSHE, including sex and relationship education (SRE), to their curriculums, with many schools delivering this from Autumn 2015 onwards.
    • 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 provides outreach visits to children's homes to enable Looked After Children to access contraception and sexual health 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.
    • Five GP Practices have also been commissioned to provide Level 2 sexual health services for Blackpool residents.
    • Blackpool Clinical Commissoning Group (CCG) commissions two termination of pregnancy providers  - Marie Stopes and Blackpool Pregnancy Advisory Service.

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)

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