Abstract
SummaryBackgroundIn 2000, a 10-year Teenage Pregnancy Strategy was launched in England to reduce conceptions in women younger than 18 years and social exclusion in young parents. We used routinely collected data and data from Britain's National Surveys of Sexual Attitudes and Lifestyles (Natsal) to examine progress towards these goals.MethodsIn this observational study, we used random-effects meta-regression to analyse the change in conception rates from 1994–98 to 2009–13 by top-tier local authorities in England, in relation to Teenage Pregnancy Strategy-related expenditure per head, socioeconomic deprivation, and region. Data from similar probability sample surveys: Natsal-1 (1990–91), Natsal-2 (1999–2001), and Natsal-3 (2010–12) were used to assess the prevalence of risk factors and their association with conception in women younger than 18 years in women aged 18–24 years; and the prevalence of participation in education, work, and training in young mothers.FindingsConception rates in women younger than 18 years declined steadily from their peak in 1996–98 and more rapidly from 2007 onwards. More deprived areas and those receiving greater Teenage Pregnancy Strategy-related investment had higher rates of conception in 1994–98 and had greater declines to 2009–13. Regression analyses assessing the association between Teenage Pregnancy Strategy funding and decline in conception rates in women younger than 18 years showed an estimated reduction in the conception rate of 11·4 conceptions (95% CI 9·6–13·2; p<0·0001) per 1000 women aged 15–17 years for every £100 Teenage Pregnancy Strategy spend per head and a reduction of 8·2 conceptions (5·8–10·5; p<0·0001) after adjustment for socioeconomic deprivation and region. The association between conception in women younger than 18 years and lower socioeconomic status weakened slightly between Natsal-2 and Natsal-3. The prevalence of participation in education, work, or training among young women with a child conceived before age 18 years was low, but the odds of them doing so doubled between Natsal-2 and Natsal-3 (odds ratio 1·99, 95% CI 0·99–4·00).InterpretationA sustained, multifaceted policy intervention involving health and education agencies, alongside other social and educational changes, has probably contributed to a substantial and accelerating decline in conceptions in women younger than 18 years in England since the late 1990s.FundingMedical Research Council, Wellcome Trust, Economic and Social Research Council, and Department of Health.
Highlights
At the end of the 20th century, concern for high rates of teenage conception in the UK compared with other western European countries, together with the strong association between early parenthood and deprivation, provided the impetus to public health efforts to prevent teenage pregnancy
As an indicator of the extent of Teenage Pregnancy Strategy-related local activity, we obtained from the Department for Children, Schools and Families the Teenage Pregnancy Strategy annual Local Implementation Grant awarded to each top-tier local authority for the financial year(s) 1999–2000 and 2010–11, the amount reflecting the challenge in terms of conception rates in women younger than 18 years and the size of the population
The results for all three surveys show the proportion of women in education, work, or training at the time of interview was higher by a considerable order of magnitude in those who did not conceive a child before 18 years than in those who did
Summary
At the end of the 20th century, concern for high rates of teenage conception in the UK compared with other western European countries, together with the strong association between early parenthood and deprivation, provided the impetus to public health efforts to prevent teenage pregnancy. In 1999, the UK Government launched a 10-year, nationwide Teenage Pregnancy Strategy[1] in England with the dual aims of achieving a 50% reduction in conception rates in women younger than 18 years by 2010, and mitigating social exclusion in teenage parents by increasing their participation in education, employment, or training.[2] A strong rationale for the strategy was the desire to halt the cycle of deprivation resulting from the increment of disadvantage conferred by early pregnancy additional to that experienced before conception.[3,4,5,6]. We used routinely collected data and data from Britain’s National Surveys of Sexual Attitudes and Lifestyles (Natsal) to examine progress towards these goals
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