J R Soc Med 2004;97:121-123
doi:10.1258/jrsm.97.3.121
© 2004 Royal Society of Medicine
Teenage pregnancy rates: high compared with where and when?
Debbie A Lawlor PhD MFPHM
Mary Shaw MA PhD
Department of Social Medicine, University of Bristol, Canynge Hall,
Whiteladies Road, Bristol BS8 2PR, UK
Correspondence to: DA Lawlor E-mail:
d.a.lawlor{at}bristol.ac.uk
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INTRODUCTION
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In the past decade teenage pregnancy has become a key policy
area in
several industrialized countries. During the 1990s,
both Britain and the USA
identified teenage pregnancy as a national
public health issue, alongside
cardiovascular disease, cancer
and mental health, requiring targeted
interventions.
1,2
A reason
for this concern was that rates of teenage pregnancy were perceived
to
be higher than those in other developed
countries
2,3—a
notion
that has been taken up and inflated by the media. For example:
`Britain... has a sky-high level of teenage pregnancies.' [Daily
Mail, 8 March 2001]
`The sexual behaviour of our children and teenagers has now reached such
unprecedented levels of recklessness and damage that it is becoming a horror
story running out of control.' [Daily Mail 28 June 2002]
In our opinion, such claims are based on selective comparisons. Here we
argue that, contrary to the way in which it is frequently presented, the
teenage pregnancy rate in Britain is neither high nor dramatically
increasing.
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GEOGRAPHICAL COMPARISONS
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When rates of teenage pregnancy are judged `high' in England,
the
comparison is usually with our European neighbours.
Figure 1 comes from the Teenage
Pregnancy Unit report of
1999
3 and
shows the
live birth rate to women aged 15–19. The rate
in the UK is indeed higher
than that in many other countries.
However, it is also substantially lower
than those in New Zealand
and the USA. Further, despite the fact that current
policy in
the UK aims to halve teenage pregnancy rates (defined as conception
rates)
for under 18s by
2010,
3 these figures
are for live births. A
country with a rate similar to or higher than that of
Britain
might seem to do `better' because pregnant teenagers have greater
access
to termination services (or use them
more).
4
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Figure 1. Live birth rate to women aged 15–19, 1999 figures (Ref.
3)
[Source: Eurostat & Centre for Sexual Health Research,
Southampton]
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A closer look at international comparisons reveals a more complex picture.
Singh and Darroch looked at rates of `adolescent pregnancy' (again the rates
examined by these workers are in fact live births) in 46 industrialized
countries over the period 1970–1995, using the UN system of
classification of level of
development.5 As can
be seen in Table 1, the birth
rate to those aged 15–19 (per 1000) varies considerably between
countries—from 3.9, 5.7 and 6.9 in Japan, Switzerland and Italy, to
54.3, 54.4 and 56.2 in Ukraine, the USA and Armenia. Although it is often
stated that Britain has the highest teenage birth rate in Europe (see for
example the Teenage Pregnancy Unit report from which
Figure 1 is abstracted), this
applies only to western European countries. Singh and Darroch further
categorize these rates into five groups—very low (<10.0); low
(10.0–19.9); moderate (20.0–34.9); high (35.0–49.9); and
very high (
50.0). In this full international comparison the England and
Wales rate comes into the `moderate'
category.5
View this table:
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Table 1. Birth rate per 1000 to women aged 15–19 and percentage change
1970–95: percentage of births to 15–19-year-olds (of all births),
1995 and percentage change 1980–1995
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Singh and Darroch also calculate changes in the birth rate to
15–19-year-olds between 1970 and 1995, where data were available.
Substantial increases in the rate are seen for some countries of the former
Soviet Union (Belarus, Lithuania, Ukraine, Russian Federation, Georgia and
Armenia). In most countries, however, the rate has declined, often
substantially (see Table
1). In England and Wales, the birth rate to 15–19-year-olds
fell by 43% between 1970 and 1995. Moreover, the percentage of all births
which were births to 15–19-year-olds also fell in England and Wales over
the time period 1980–1995 by 56%. Singh and Darroch suggest that this
trend can be seen as part of the overall decline in childbearing in all age
groups across industrialized
countries.5
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SECULAR COMPARISONS
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When considering changes in teenage birth rates over time, policy
documents
tend to be selective in the time period examined and,
more importantly, seldom
make comparisons with secular trends
in other age groups. Any changes (either
up or down) in teenage
rates may simply reflect overall patterns of fertility
among
all women of reproductive age.
Figure
2 shows the live birth
rates for women in England and Wales, by
age, from the beginning
of World War II to the late 1990s. For the entire time
period,
the highest birth rates are found among women in their 20s and
early
30s, with rates in the latter age group taking over those
among women in their
20s. Throughout the time period, birth
rates for women under the age of 20 are
relatively low. Moreover,
at any one time the birth rates for women aged under
20 tend
to reflect the overall pattern of changing birth rates for women
of
all ages in the country. Over the six decades, rates of births
to teenage
mothers followed patterns similar to those for the
general reproductive
population; there has been no explosion
in the rate of births to women under
the age of 20 in recent
years.
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DISCUSSION
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Health professionals and the general public should be wary of
claims that
the rate of teenage pregnancy in Britain is `high'
and increasing in an
alarming way. International comparisons
suggest that the rate is moderate and
that the past six decades
have seen a decline rather than a rise. Over the
same three
to six decades the number of adolescents having sex has increased
greatly
7 and the age
at menarche has
decreased.
8 The fact
that birth
rates have not risen in a time when the at-risk population rose
sharply,
suggests that (again contrary to popular opinion) teenagers
are
reasonably competent at preventing unwanted
pregnancies.
7 We
believe that the selective reporting of international and
time comparisons by
policy makers results in a `manufactured
risk'
9 and has more
to do with moral panic than with public
health.
10
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Acknowledgments
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DAL is funded by a Department of Health Career Scientist Award;
MS is
funded by the South West Public Health Observatory.
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REFERENCES
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- Department of Health. The Health of the Nation: a
Strategy for Health in England. London: Stationery Office,1992
- Felice ME, Feinstein RA, Fisher MM, et al. Adolescent
pregnancy— current trends and issues: 1998 American Academy of
Pediatrics Committee on Adolescence, 1998–1999.
Pediatrics1999; 103:516
–20[Abstract/Free Full Text]
- Social Exclusion Unit. Teenage Pregnancy.
London: Stationery Office, 1999
- Kane R, Wellings K, Free C, Goodrich J. Uses of routine data sets
in the evaluation of health promotion intervention: opportunities and
limitations. Health Education2000; 100:33
–41
- Singh S, Darroch J. Adolescent pregnancy and childbearing: levels
and trends in developing countries. Family Plann
Perspect 2000;32:14
–23
- Macfarlane A, Mugford M. Birth Counts: Statistics of
Pregnancy & Childbirth, Vol. I,
London: Stationery Office, 2000
- Wellings K, Kane R. Trends in teenage pregnancy in England and
Wales: how can we explain them? J R Soc Med1999; 92:277
–82[Abstract]
- Whincup PH, Gilg JA, Odoki K, Taylor SJC, Cook DC. Age of menarche
in contemporary Britain teenagers: survey of girls born between
1982–1986. BMJ2001; 322:1095
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- Bullen E, Kenway J, Hay V. New Labour, social exclusion and
educational risk management: the case of `gymslip' mums. Br Ed Res
J 2000;26:441
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- Lawlor DA, Shaw M. Too much too young? Teenage pregnancy is not a
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Teenage pregnancy rates: high compared with where and when?
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INTRODUCTION
GEOGRAPHICAL COMPARISONS
