Summary

Teenage conception includes all conceptions before the mother’s 20th birthday, but the national focus is on conception under 18 as most potential mothers in this age group are in fulltime education or training. The conception rate is the number of pregnancies that start before the mother’s 18th birthday (per 1,000 young women aged 15 to 17) and includes pregnancies that end either in birth or in termination.

In Merton, the under 18 conception rate was 27.6 per 1,000 (2011), below that of London and England and Wales. The rate had reduced 45.9% from the 1998 rate of 51 per 1,000. The latest rolling quarterly average for June 2012 was 24.7. However, this masks a variation across the borough with the rates of some wards in line with Inner London. Evidence suggests it is the most disadvantaged, vulnerable young women with the greatest number of risk factors who are most likely to have a conception aged under 18 and are more likely to see the pregnancy through. This is supported by a strong association locally (74%) between women aged under 19 giving birth and living in more deprived areas. This in turn perpetuates the cycle of poor outcomes including health outcomes, not just for young parents but for their babies as well.

The recent data (2011) on rates of abortion in Merton shows that the rate was higher (16.4 per 1,000 population) than England (15.1 per 1,000 population) but lower than London (17.5 per 1,000 population). In addition, teenage abortion rates are declining, as illustrated in the second graph below, in line with the conception rates, which is indicative that services in place are having a real impact on teenage conception rates. However, more than half of conceptions to young people under 18 in Merton in 2011 resulted in terminations, which was lower than London (61%) but higher than England (49.3%) proportions. The three-year rolling averages from the 1998 baseline show that the proportions of teenage conceptions leading to terminations are increasing in Merton. The proportion of all teenage conceptions leading to abortions has increased by 9% since the 1998 baseline, although lower than London and England at 13% and 16% respectively.

Key commissioning recommendations

A joint young people’s sexual health and substance misuse needs assessment was carried out in Merton in 2013 which highlighted local needs and gaps. The needs assessment indicated improvements could be made in relation to:

  • improving access to contraceptive services, condoms, emergency contraception and STI testing for young people
  • continuing to raise the profile of services in schools, but for interventions to be provided in youth settings that ensure privacy
  • Improving training for frontline professionals on talking to children, young people and parents about sensitive issues highlighted as a local need.
  • increasing access and referral to sexual health services from mainstream and targeted youth support services.
  • further integrating sexual health services with substance misuse prevention services.

Key facts on teenage pregnancy

Teenage conception includes all conceptions before the mother’s 20th birthday, but the national focus is on conception under 18 as most potential mothers in this age group are in fulltime education or training. The conception rate is the number of pregnancies that start before the mother’s 18th birthday (per 1,000 young women aged 15 to 17) and includes pregnancies that end either in birth or in termination.

Evidence indicates that high rates of teenage pregnancy are most often associated with low educational attainment and disengagement from school, economic deprivation, and poor mental health. Young people at increased risk of early parenthood and teenage pregnancy include children of teenage mothers, looked after young people, young people misusing alcohol, young people involved in crime, those with low self-esteem and some black and minority ethnic (BME) groups. Early onset of sexual activity, poor contraceptive use and repeat abortions are other significant risk factors. Teenage conception rates for England and Wales have also seen a dramatic fall since the launch of the national teenage pregnancy strategy. The UK now has the lowest levels of teenage pregnancy since records began. In 2011, the rate fell to 30.7 per 1,000 women.

In Merton, the under 18 conception rate was 27.6 per 1,000 (2011), below that of London and England and Wales. The rate had reduced 45.9% from the 1998 rate of 51 per 1,000. The latest rolling quarterly average for June 2012 was 24.7.

Under 18 conception rate in Merton, 1998-2011

  

However, this masks variation across the borough with the rates of some wards in line with inner London. The electoral wards with the highest under 18 conception rates (aggregated data for 2009-11) were Pollards Hill (78.7) and Cricket Green (54.1) As ward conception numbers are relatively small (even when aggregated for three years) rates may vary markedly from year to year and should be interpreted with some caution. Merton has set a new local teenage pregnancy target of 27 per 1,000 for 15 to 17 year olds by the year 2015.

Evidence suggests it is the most disadvantaged, vulnerable young women with the greatest number of risk factors who are most likely to have a conception aged under 18 and are more likely to see the pregnancy through. This is supported by a strong association locally (74%) between women aged under 19 giving birth and living in more deprived areas. This in turn perpetuates the cycle of poor outcomes including health outcomes, not just for young parents but for their babies as well.

Deliveries to Merton women aged under 19 years have been gradually decreasing though the variation is due to small numbers as shown in the graph below. However, delivery data does not provide a full picture of under-18 conceptions. Consistently, data suggests that about 60% of under-18 conceptions locally lead to termination (59.5% in Merton in 2011 – there is some year on year variation). Therefore knowledge of the number of terminations is important.

Teenage deliveries April 2009-December 2012 quarters (aged 15-17).

  

Source: Hospital Episodes Statistics, 2012

The recent data (2011) on rates of abortion in Merton shows that the rate was higher (16.4 per 1,000 population) than England (15.1 per 1000 population) but lower than London (17.5 per 1,000 population). In addition, teenage abortion rates are declining as illustrated in the graph below, in line with the conception rates, which is indicative that services in place are having a real impact on teenage conception rates.

Teenage abortion rates in Merton.

  

Source: ONS

However more than half of conceptions to young people under 18 in Merton in 2011 resulted in terminations, which was lower than London (61%) but higher than England (49.3%) proportions. Three-year rolling averages from the 1998 baseline show that the proportions of teenage conceptions leading to terminations are increasing in Merton as shown in graph below. The proportion of all teenage conceptions leading to abortions has increased by 9% since the 1998 baseline, although lower than London and England at 13% and 16% respectively.

 

Percentage of teenage conceptions leading to abortions.

  

Source: Teenage Pregnancy Unit

What works and best practice

In July 2006 the Government produced guidance on the effective delivery of local teenage pregnancy strategies.1This set out 10 key factors local areas needed to take into account to deliver an effective local strategy. The factors were based on both international evidence and learning from areas achieving significant reductions in their under-18 conception rates.

Of the key factors the strongest empirical evidence for the reduction of teenage conceptions is high-quality education about relationships and sex, and access to and correct use of effective contraception23 One fifth of births conceived to under-18 conceptions are second or subsequent births. Early intervention programmes such as the Family Nurse Partnership can help to prevent second conceptions and increase young parents’ take-up of work, education or training. The provision of supported housing may also increase participation rates, boost self-esteem and delay further motherhood. As teenage pregnancy contributes to poor outcomes, and can further exacerbate vulnerability, the continued reduction of teenage conceptions is now recognised as a Public Health Outcome. This is reflected in the new Framework for Sexual Health Improvement in England (2013).

LBM will continue to support the delivery of this framework through the well-established Teenage Pregnancy and Substance Misuse Partnership Board and is guided by locally agreed annual action plans that focus on both primary preventive measures and secondary prevention. This includes:

  • The delivery of a young people’s sexual health service in education and youth settings alongside the mainstream contraception and sexual health clinics (CASH) service.
  • Supporting the delivery of effective sex and relationships education.
  • Increasing access to emergency contraception and condoms.
  • Further development of the successful South West London Gettingiton sexual health website.
  • Workforce training and development on early identification of young people at risk.
  • Supporting teenage parents through the forthcoming Family Nurse Partnership and increasing access to children’s centres.

Key commissioning recommendations

A joint young people’s sexual health and substance misuse needs assessment was carried out in Merton in 2013 which highlighted local needs and gaps. The needs assessment indicated improvements could be made in relation to:

  • improving access to contraceptive services, condoms, emergency contraception and sexually transmitted infections (STI) testing for young people.
  • continuing to raise the profile of services in schools, but for interventions to be provided in youth settings that ensure privacy
  • improving training for frontline professionals on talking to children, young people and parents about sensitive issues – highlighted as a local need
  • increasing access and referral to sexual health services from mainstream and targeted youth support services
  • further integrating sexual health services with substance misuse prevention services.

Further sources

Charter of Fundamental Rights of the European Union (2010). Official Journal of the European Union; C 83 pp. 389-403.

Department of Health (2013). A Framework for Sexual Health Improvement in England.

The Royal College of Paediatrics and Child Health (2010). Not just a Phase: A guide to the participation of children and young people in health services.

References

1. ^ Department for Education and Skills and Department of Health (2006). Teenage Pregnancy Next Steps: Guidance for Local Authorities and Primary Care Trusts on Effective Delivery of Local Strategies.

2. ^ Kirkby, D. (2007). Emerging Answers 2007: Research Findings on Programs to Reduce Teen Pregnancy and Sexually Transmitted Diseases, cited in Teenage Pregnancy Strategy: Beyond 2010, Department for Children, Schools and Families (2010).

3. ^ Santelli, J.S., Duberstein Lindberg, L., Finer, L.B. and Singh, S. (2007). National Campaign to Prevent Teen and Unplanned Pregnancy, Washington D.C.: Explaining Recent Declines in Adolescent Pregnancy in the United States: The Contribution of Abstinence and Improved Contraceptive Use. American Journal of Public Health, 2007 January; 97(1): 150-156.