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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.

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 seen significant improvement in teenage pregnancy and now ranks 22nd highest out of upper-tier local authorities in England.

    • In 2021, 46 women under the age of 18 in Blackpool became pregnant. 10 were aged under 16.
    • The under 18 conception rate in 2021 was 20 per 1,000 women aged 15-17, still significantly higher than the England average of 13.1 but similar to the North West average of 16.4
    • The under 16 conception rate in Blackpool was 4.6 per 1,000 women, higher than the England and North West averages of 2.1 and 2.9 respectively, but not significantly so(Figure 2).
    • Since 2004 the Blackpool under 18 conception rate has fallen by 72% from 72.0 per 1,000 to 20.0 per 1,000. This compares to a 69% reduction across England (Figure 1).
Figure 1: Trend in under 18 conceptions, rates per 1,000 women aged 15-17, 2004-2021
 200420052006200720082009201020112012201320142015201620172018201920202021 Reduction 04-21

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 

16.7

15.7 13.0 13.1

69%

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 

21.7

19.4 16.7 16.4

64%

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 

36.9

31.1 28.8 20.0

72%

Blackpool - number

193

176

182

170

175

183

130

149

112

108

95

108 

82 

74 

79

68 65 46

76%

Source: ONS, Conceptions statistics tables, 2021
Figure 2: Trend in under 16 conceptions, rates per 1,000 women aged 13-15, 2009-2021
 2009201020112012201320142015201620172018201920202021Reduction 09-21

England

7.3

6.7

6.1

5.6

4.8

4.4

3.7 

3.1 

2.7 

2.5

2.5 2.0 2.1

71%

North West

8.7

7.8

7.0

6.6

5.8

5.1

4.6 

3.8 

3.5 

3.3

3.0 2.7 2.9

67%

Blackpool - rate

13.2

7.8

9.9

8.0

6.6

8.1

7.7 

5.2 

7.5 

7.6

4.7 5.6 4.6

65%

Blackpool - number

33

20

25

20

16

19

17 

11 

16 

17

11 13 10

70%

Source: ONS, Conceptions statistics tables, 2021

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 an issue for Blackpool.

Figure 3: Trend in under 18 conceptions rate, 2004 to 2021

Fig1-TPtrend-u18 to 2021
Source: ONS, Conceptions statistics tables, 2021

Figure 4 compares the under 18 conception rate across all upper tier local authorities in England. It can clearly be seen that Blackpool is in the highest quintile nationally. 

Figure 4: Under 18 conception rate, 2021 - Comparison of local authorities in England

Fig2-U18 LA comparison 2021
Source: ONS, Conceptions statistics tables, 2021

In 2021, the estimated number of under 18 conceptions in Blackpool fell by 29% from 65 in 2020 to 46. 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 2021

Fig5-All&U18 conc trend-EngBl-2021
Source: ONS, Conceptions statistics tables, 2021

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 show gradually rising numbers of young women in the 15-19 age group until the late-2020s, which may have an impact on teenage pregnancy and abortions. At the same time, numbers of women in both the 20-24 and 25-29 age groups are predicted to decline.

Variation within Blackpool

There is wide variation in teenage conceptions within Blackpool. ONS conception data for 2018-2020 shows that there are areas within Blackpool that have significantly higher proprtions of teenage conceptions than either the Blackpool or national averages (figure 6):

Figure 6: Under 18 conceptions in Blackpool by ward, compared Blackpool median, 2018-2020

U18 conceptions 2018-20-compared to Bpl
Source: ONS Conception statistics, England and Wales by Ward, 2018-2020 

Across Blackpool, under 18 abortion rates and maternity rates are continuing to fall (figure 7). Over the last ten years the abortion rate has gone down by over 70%, from 24.2 per 1,000 in 2011 to 7.0 per 1,000 in 2021. The maternity rate has fallen by 60% from 33.9 per 1,000 to 13.1 per 1,000 over the same period. The proportion of conceptions resulting in an abortion also fell; in 2011 two fifths (41.6%) of conceptions resulted in an abortion, by 2021 this had fallen to a third (34.8%).  Nationally the proportion of conceptions resulting in an abortion has risen slightly from 49.3% in 2011 to 53.4% in 2021 (figure 8).

Figure 7: Outcome of conceptions in under 18's in Blackpool, 2006 to 2021 - Proportion resulting in birth and abortion

Fig5-U18 conc outcomes trend 2021
Source: ONS, Conceptions statistics tables, 2021

Figure 8: Proportion of under 18 conceptions resulting in an abortion - England, North West and Blackpool, 2006 to 2021

Fig6-%conc resulting in abortion-2021
Source: ONS, Conceptions statistics tables, 2021

High Risk Groups

The individual risk factors associated with young women experiencing pregnancy before 18 are:3

    • Free school meals eligibility: a poverty indicator
    • Persistent school absence by Year 9
    • Slower than expected academic progress
    • First sex before 16
    • Looked after children and care leavers
    • Experience of sexual abuse and exploitation
    • Lesbian or bisexual experience
    • Alcohol
    • Experience of a previous pregnancy

The individual risk factors associated with young men experiencing fatherhood are:

    • To have been subjected to violent forms of punishment at home and are twice as likely to have been sexually abused
    • To have pre-existing serious anxiety, depression and conduct disorders
    • To have poor health and nutrition
    • To drink, smoke and misuse other substances

As with Adverse Child Experience analysis, young people who have experienced a number of these factors will be at significantly greater risk.

Current Services

    • Blackpool Council commissions a young people's sexual health and substance misuse harm reduction service. 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.
    • Provision of Relationships, Sex and Health Education (RSHE) became statutory from September 2020. However, due to the COVID-19 pandemic, schools were given until September 2021 to fully implement these requirements. Whilst sex education is statutory in secondary schools, primary schools may choose if they teach sex education in their setting. Following a pilot programme, a PSHE Support Officer works with schools to develop the PSHE provision across the authority and give PSHE leads a network of best practice, access to high quality training and a suite of quality assured schemes of work, lesson plans and resources.  Also see Sexual Health and Relationships section.
    • 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.
    • Two GP Practices, Adelaide Street and Stoneyhill, have also been commissioned to provide Level 2 sexual health services for Blackpool residents.
    • Lancashire & South Cumbria Integrated Care Board (ICB) commissions two termination of pregnancy providers - Marie Stopes and National Unplanned Pregnancy Advisory Service (NUPAS).

National and local strategies

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] PHE, Teenage Pregnancy Prevention Framework, Supporting young people to prevent unplanned pregnancy and develop healthy relationships, May 2018