Changes in conceptions in women younger than 18 years and the circumstances of young mothers in England in 2000–12: an observational study
Kaye Wellings, Melissa J Palmer, Rebecca S Geary, et al.Lancet Volume 388, Issue 10044, 6-12 August 2016, p.586-95http://www.sciencedirect.com/science/article/pii/S0140673616304494In 1999, the UK Government launched a 10-year, nationwide Teenage Pregnancy Strategy 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. 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.The authors used routinely collected data and data from Britain’s National Surveys of Sexual Attitudes and Lifestyles (NATSAL) to examine progress towards these goals. They found that a 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.Specifically, conception 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. The association between conception in women younger than 18 years and lower socioeconomic status weakened slightly between the second and third NATSAL. 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 the second and third NATSAL.The scale of the decline in conception rates in women younger than 18 years, and its association with intervention-related investment and with both demographic and behavioural factors, suggest a combined influence of both public health intervention and secular trends on the decline in conceptions in women younger than 18 years in England.Implications of all the available evidenceThe trend towards postponement of key life events such as completion of education, leaving home, starting employment, and settling with a partner is now near universal. These factors seem to have contributed to a global trend towards fewer early pregnancies. Coincidental with this, focused and sustained efforts to lower the prevalence of early pregnancy by raising awareness, changing social norms, and increasing access to education and reliable contraception seem to have accelerated the trend towards fewer teenage pregnancies.