Teenage pregnancy: will public health cuts negate previous policy success?
Although the UK’s teenage pregnancy rate has fallen, it remains the highest in Western Europe – and cuts to services may hinder efforts to ameliorate this.
The UK has experienced a notable reduction in teenage pregnancy since 1990, when it reached a peak of 48 conceptions per 1000 women aged 18 or under.
Policies and politicsThe UK has experienced a notable reduction in teenage pregnancy since 1990, when it reached a peak of 48 conceptions per 1000 women aged 18 or under. In 2015, this rate had more than halved, to 21 conceptions per 1000. High teenage pregnancy rates were recognised as a health and social care policy priority in 1993, when the UK government introduced the ‘Back to Basics’ campaign. This campaign, which called for a return to ‘traditional morality’, was generally seen as a failure in reducing teen pregnancy rates – and was accompanied by a succession of scandals afflicting John Major’s government. During the 1980s and 1990s, young pregnant women were often demonised as lower-class women who were using pregnancy as a way to access social housing. The alienation and stigmatisation of a social strata was probably counterproductive to the objectives of the policy. The 1997, the Labour government under Tony Blair highlighted teenage pregnancy as a policy interest. The Social Exclusion Unit was commissioned to create the Teenage Pregnancy Strategy(TPS) in 1999. The ten-year strategy, which continued John Major’s promise to halve teenage pregnancy rates, was the first full strategy for sexual health in the UK.
Addressing the right factors
In 2004, social scientist Dr Lisa Arai critiqued the research done by the TPS. She categorised the three risk factors identified by the TPS as structural, technical/educational and sociocultural themes (see Table 1).
Table 1. Categorising the risk factors associated with teenage pregnancy
|Socioeconomic status||Sexual health knowledge and education||Wider messages about sex and reproduction|
|Educational attainment||Information/use of contraception or abortion||Community messages about sex and reproduction|
|Employment||Knowledge about parenthood||Peer group messages about sex and reproduction|
The TPS primarily addressed technical/educational factors through increasing contraception availability and promoting sex and relationship education. However, a qualitative study published in Young Mothers? by Ann Phoenix found that most young women in her study had not fallen pregnant because of ignorance about contraception, but because they had long anticipated motherhood to be the most fulfilling part of their lives.
These women were usually members of communities where teenage pregnancy was common among friends and family, suggesting that they would be familiar with the lifestyle associated with being a young parent as it was part of their culture. This raises a question about linear causation between educational ignorance and teenage pregnancy rates, although the former may be indicated as a factor in multifactorial causation.
National sociocultural background structures and norms are difficult to measure and evaluate, which may explain the TPS focus on immediately visible technical factors. Intervention for only one category of risk factors will reduce teenage pregnancy to a point, but technical factors are part of a multifactorial causation. Effective policy should aim to influence all amenable risk factors.
A qualitative study found that most young women had not fallen pregnant because of ignorance about contraception, but because they had long anticipated motherhood would be the most fulfilling part of their lives.
Where are we now?
The UK’s teenage pregnancy rates have continued to fall since the 1990s, suggesting the TPS was successful in addressing at least some factors associated with its prevalence.
However, since the TPS came to an end in 2010, public health spending has been drastically cut. This has brought many preventive strategies to a close, which is often felt most by the poorest, who are at highest risk of teenage pregnancy.
Funding for sexual health services was transferred from the NHS to local authority budgets in 2013/14, and cuts continue. Of course, this affects more than teen pregnancy rates. Other sexual health-related issues, predominantly sexually transmitted infections (STIs), are also impacted. This comes at a time when people are accessing sexual health services more than ever before, record levels of STIs are being diagnosed, difficult-to-treat antibiotic-resistant strains of infection are being detected, and the need for quality contraception and HIV testing is more important than ever.
What does the future hold?
Without the financial provision for preventive care, and with cuts to social care leading to more people living in poverty, the UK can expect to see a rise in various public health challenges. Inevitably, this will incur a cost to society – both financially and socially.
The opinions expressed in this blog are those of the individual authors and do not represent the views of The Health Policy Partnership.