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
||Sexual health knowledge and education
||Wider messages about sex and reproduction
||Information/use of contraception or abortion
||Community messages about sex and reproduction
||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.
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.
Sandra Evans is a former Researcher for The Health Policy Partnership.
The opinions expressed in this blog are those of the author and do not necessarily represent the views of The Health Policy Partnership.