The what, why and how of health and development

UK teen pregnancy success story threatened by cuts

With the rate of teenage pregnancy in England halving since the government’s ambitious Teenager Pregnancy Strategy was launched in 1998, the programme is widely viewed as a public health success story.

It should rightly be celebrated. Any drop in the number of teenagers falling pregnant, who if they went on to have children would be less likely to take up further education and employment opportunities, is a good thing.

A look at the figures shows that as the numbers have fallen, however, the stark differences in the rate of conception between poorer and richer areas of England have persisted. In 2004, the most deprived 20 percent of local authorities in England saw, on average, 56 conceptions per 1,000 girls aged 15–17. This compared to 25 in the 20 percent least deprived. Another way of looking at it, for every single girl pregnant in the richer areas, 2.24 would conceive in the poorer areas.

Using more up-to-date data, this ratio gap grows slightly. Taking the latest government data on the 20 percent most and least deprived local authorities – available up to 2014 – and comparing it to 2015 data on pregnancy among 15-17-year-old girls, we can see that for every pregnant girl aged between 15 and 17 in the areas with least deprivation, there are now 2.54 girls getting pregnant in the most deprived areas.

This correlation between deprivation and teenager conception is no new thing. Research carried out by the Office for National Statistics has long examined this correlation, and also shown a link between high unemployment rates and child poverty with under 18 conception rates.

Why is there a link between deprivation and teen pregnancy?

One reason for this is the perception of motherhood held by young women. A study carried out back in 2004 by the Joseph Rowntree Foundation concluded that ‘young women who perceived their lives as insecure were more likely to view motherhood as something that might “change their life” in a positive way. Those who were certain that their future life would develop through education and employment were more likely to opt for abortion.’

Other reasons include personal factors such as low self-esteem, lower educational and occupational aspirations, less knowledge of contraception and sexual health services and higher gender power differentials’, according to one ONS report from 2002.

“Easy access to sexual health services is also likely to have a role,” explains Senior Policy and Public Affairs Officer Laura Russell at the sexual health charity Family Planning Association. “There is a correlation between good contraception services and lowering rates of teenage conceptions.”

The impact of local authority budget cuts

Since the 2012 government reforms, improvements in health – including contraceptive services – have largely fallen under the remit of local authorities, paid for by a ring-fenced budget. Following the announcement from the Treasury earlier this year that public health budgets for councils are to be cut by 7 percent – or 200 million – some medical organisations have been concerned about the wider impact this will have on conception and healthcare in general.

Plus with councils of less well-off areas less able to raise significant funds through council tax, as suggested by the Treasury, people living in these authorities might be disproportionally affected.

The Advisory Group on Contraception (AFG), an expert group of clinicians and advocacy group, argue that cuts to contraceptive care in primary care settings means there will be “tighter restrictions on who can access the service and what contraceptive methods are available”.

Using figures provided by the Department for Health, they point out that there is an £11 saving for every £1 spent on contraception, arguing it is “a false economy” to cut funding to this area.

However, a survey carried out by AFG in 2014 found that around a third of local authorities reported having no plan in place to reduce the rate of unintended pregnancies, leading to concerns it is not being prioritised. A spokesperson for the group also confirmed that an update to this survey is due to be published later this year.

The British Medical Journal has also carried out investigations into the impact of public health cuts on sexual health services. For those with access to BMJ articles (not me!), you can find more details here.

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