Teenage pregnancy and sexual health in the United Kingdom

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Teenage pregnancy in the United Kingdom is a long-standing social phenomenon. The only other OECD developed country with comparable teenage pregnancy rates is the United States. Teenage pregnancy is higher in more economically deprived areas. A report in 2002 found that around half of all conceptions to under 18s was concentrated among the 30% most deprived population, with only 14% occurring among the 30% least deprived. Also found was that the most deprived areas had higher proportions of conceptions leading to a maternity.[1] The 2008 underage conception rate in England and Wales is down 13% since 1998.[2] Over 60% of the conceptions led to a legal abortion,[3] the highest proportion since conception statistics began in 1969. Other studies have shown similar findings.[4]

Comparative pregnancy rate[edit]

The United Kingdom currently has the highest teenage birth rate in Western Europe. It is a long-standing social phenomenon that successive governments have attempted to tackle without major success. The Labour Governments of Tony Blair and Gordon Brown pledged to halve the number of conceptions to girls under 18 by 2010. In this they were unsuccessful, with only a 13% drop recorded in 2008, a level the then Secretary of State for Children Ed Balls admitted was 'disappointing',[5] although numbers continued to fall over the following two years, with a 9.5% drop in the figures in 2010 despite an overall increase in fertility.[6]

Change in pregnancy rate over time[edit]

Births to teenagers increased during the 1960s and peaked in 1971 at 50.6 per thousand of the population. Since 1971 they have gradually fallen to their lowest level since the mid Fifties. The proportion occurring outside marriage has increased from around one in six in the 1950s to nine in every ten in 2006. Teenage abortion rates are currently at their highest rate since legalisation in 1968. Although the number of conceptions are falling the proportion ending in abortion has increased over the last ten years.

Geographic variation in pregnancy rate[edit]

High teenage pregnancy rates are found in areas with low GCSE exam success such as Nottingham, Kingston upon Hull, Doncaster, Barnsley, Middlesbrough, Manchester (highest), Sandwell, Bristol, Stoke on Trent, Bradford, North East Lincolnshire, and Blackpool. In 1997, a study revealed that there was a north-south divide in England in the rate of conceptions to under 18s, with the highest rates and proportion leading to maternity being in the north, and the lowest rates with the highest proportion leading to abortion, being in the south, with the exception of London, which had both high rates of conception and abortion.[7]

Pregnancy rate by ethnicity[edit]

Among White British, 50 per cent of births are outside marriage. The highest levels of births outside marriage, more than 60 per cent, were among Black British mothers. Among British Asian mothers, the rates of birth outside marriage is only 2 per cent.[8]

Sexual health[edit]

Sexual activity and contraception use[edit]

1952: The Family Planning Association, which was set up in the 1930s, began to offer contraceptive advice to single women who were just about to wed.[9]

1954: A study in Manchester revealed that between the years 1937 and 1954, almost a quarter of under-age girls coming to the attention of one female police officer regarding underage sex were pregnant. It was also noted that the girls often came from particular backgrounds, either broken homes or of bad parental influence. It was also revealed that they also tended to have a lower than average IQ.[10]

1961: A study of Scottish women revealed that almost a quarter of single women were sexually experienced before their 20th birthday, the proportion haven risen from 6% during the late 1940s and 15% during the late 1950s. The findings of the study showed that there was a clear increase in sexual intercourse among young single women before the advent of the contraceptive pill in 1961.[11]

The combined oral contraceptive pill became available, though initially only to married women. The proportion of teenage women who were married rose from 5% in 1951 to 8%.

1964: The first comprehensive survey of sexual behaviour in United Kingdom amongst unmarried teenagers revealed that a third of boys and almost one in six girls were sexually experienced by the age of 18. Plus one in twenty girls under 16 were sexually active.[12] It also estimated that around one in three teenage girls who engaged in premarital sexual intercourse fell pregnant.[13] Also revealed in the survey was that one in five of sexually experienced girls and two fifths of sexually experienced boys always used birth control. The most common form of birth control being the condom used by around 80% of the sexually active teenagers.[14][15]

Percent Of Adolescents Who Have Had Sex, Before The Age Of Sixteen[16]
Year Boys Girls
1964 14% 5%
1974 31% 12%
1991 28% 19%
2001 30% 26%
2008 34% 38%

Helen Brook set-up the Brook Advisory Centres offering contraceptive advice to young single people under the age of 25.

1967: A change in the law allowed local health authorities to offer contraceptive services to unmarried people if they so wished; though by 1968 only one in six authorities were providing such a service.[17] Mr K Robinson answering a question in the House Of Commons regarding the new Family Planning Act in October 1967, stated that it would be unwise to exclude girls under 16 from receiving advice at family planning clinics (FPC). Though these girls would only be seen at FPCs in exceptional circumstances even with parental consent.[18]

1969: Brook Advisory Centres were now offering contraceptive advice to over ten thousand unmarried people under 25, the majority were aged between 19 and 21 with around one in six being under 19.[19]

1970: The Family Planning Association were now mandated to offer contraception to unmarried people.

1971: A doctor was reported for informing the parents of a 16 year-old girl that she had come to him seeking contraception. This prompted the British Medical Association to advise doctors to maintain young patients' confidentiality when seeking contraception. Three quarters of teenagers visiting Brook Advisory Centres during the early '70s were doing so without their parents' knowledge.[19]

A survey of Scottish single female students revealed that a third had had sexual intercourse by the age of 18 with over half not using any form of contraception. The survey also showed that one in seven girls who had recently been sexually active, their partner was a casual boyfriend.[20]

Controversy was sparked when a 12-year-old girl who had just recently undergone an abortion was put on the contraceptive pill with her parents' consent by gynecologist Dr Mary Wilson at Calthorpe nursing home in Birmingham. She said "so many girls come back pregnant again after three or four months, that is why I gave her a supply of the pill and contraceptive advice". Labour MP Leo Abse was concerned that the prescribing of the pill to a 12-year-old child was an offence under the sexual offences act.[21]

1975: Under the new National Health Service reorganisation act contraception was made available free of charge to everyone including single people and those aged under 16. Clarification was given to doctors that they could provide contraception to patients under 16 without parental consent in certain circumstances.

The average age of first sexual intercourse for girls had now dropped from 21 in the mid-1950s to 18. Over a quarter of boys under 16 and almost one in eight girls under 16 were now sexually experienced.[22]

1976 A report by the British Pregnancy Advisory Service found that 69 percent of girls under 16 who came to them for an abortion during the year had used no contraception. Most of them were experienced at sex.[23]

1978: Brook Advisory Centres were now government funded. 3% of Brook's clients were now under the age of 16.

1980: A review of the 1974 DHSS circular about parental consent and the issuing of contraception/abortion advice to girls under 16, concluded that a doctor or a professional worker should always seek to persuade the child to involve her parents or guardian at the earliest stage of consultation. Though it is accepted that occasionally contraception would be given without parental consent.[24]

1983: Cuts in health service expenditure forced the closure of many family planning clinics and a restriction in the services available to young people.[25]

1984: In a high court ruling in favour of Victoria Gillick it was deemed illegal for health professionals to advise or give girls under 16 contraceptives without parental consent except in exceptional circumstances.[26]

1985: The House of Lords overturned the high court ruling and confidential contraceptive advice to young people was restored.[27]

1986: The number of girls under 16 visiting family planning clinics in England reached over seventeen thousand, in 1983. In 1985 the number dropped to twelve thousand due to the high court ruling it illegal to provide under 16s contraception confidentially; the number rose again to sixteen thousand in 1986 following the decision by the house of lords to overturn the high court ruling.[28]

1991: In the first sex survey of its kind, the National Survey of Sexual Attitudes and Lifestyles (NATSAL) revealed that one in six girls under 16 and a quarter of boys under 16 were sexually experienced.[29]

A survey revealed that a fifth of sexually active 16–17 year olds and over half of 18-19 year olds were using at least one method of contraception.[30]

2001: The second NATSAL showed that the average age of first intercourse had dropped from 17 in the 1980s to 16. It also revealed that a quarter of girls and nearly a third of boys were sexually experienced before the age of 16.[31]

2005: The number of girls under 16 visiting family planning clinics had risen throughout the 1990s to peak at over ninety-one thousand in 2003, before falling to eighty-three thousand. The most popular choice was the condom with over half choosing this method of contraceptive.[32]

Sexually transmitted infections[edit]

1954: study in Manchester showed that there was an increase in the number of teenage men and women visiting sexual health clinics for treatment of venereal disease. 23% of women seen at these clinics were teenagers compared to 10% in 1939. In men it rose from 3.8% in 1939 to 4.8%.[33]

1963: 27% of all women attending sexual health clinics with the sexually transmitted infection Gonorrhoea was under the age of 20.[14] This percentage was an increase on 1957 when 23% of women visiting STI clinics were under 20.[34]

1971: The number of teenagers visiting sexual health clinics with gonorrhoea reached over ten thousand, 60% were girls and one in twenty were under 16.[35]

1976: The rate of new cases of gonorrhoea diagnosed at sexual health clinics amongst girls under 16 in England had increased more than threefold since 1966 from 2.76 per hundred thousand of the population to 9.38. Amongst boys under 16 the rate had gone up from 0.94 to 2.19.[36][37]

1981: A third of all women visiting sexual health clinics in England with gonorrhoea were under 20. The number of persons under 16 being diagnosed with Gonorrhoea in England fell from 637 in 1976 to 361.[38]

1996: There was over ten thousand new cases of gonorrhoea to teenagers reported in sexual health clinics up over 30% from 1995 and over seven thousand new cases of Chlamydia to teenagers up over 16% from 1995.[39]

2005: The number of new cases of gonorrhoea reported at sexual health clinics occurring to teenagers had fallen since the 1970s, from over ten thousand, to three thousand seven hundred. Levels of chlamydia had risen throughout the 1980s and 1990s and was now the most common sexually transmitted infection amongst teenagers with over thirty thousand new cases reported, almost 28% of all new cases.[40]

2006: A screening programme of young people by the Department of Health revealed that 12% of girls aged 16–19) and 13% of men aged 20–24) were infected with the STI Chlamydia.[41]

Pregnancies[edit]

Abortions[edit]

1967: Abortion was legalised in England, Wales and Scotland under the Abortion Act. The first legalised abortions were performed on April 27, 1968.

1969: Over nine and a half thousand teenage girls (over one thousand two hundred being under 16) opted for an abortion in England, Wales & Scotland in the first full year of legalisation, (almost one in five of all abortions) the majority of whom were single. A survey of women seeking an abortion by the British Pregnancy Advisory Service revealed that almost two fifths of parents of single pregnant teenage girls were unaware of their daughters pregnancy, the majority of these being to teenagers who were not living at home.[42]

1982: In a court ruling a pregnant fifteen-year-old girl, who had been pregnant once before was allowed to have an abortion against the wishes of her father - who did not want her to have one on religious and moral grounds. This is believed to be the first known case in Britain where an under-age girl has been able to obtain a legal abortion without the consent of her parent/s.[43]

2006: Mother of two teenage daughters, Sue Axon lost her battle in the high court to try and prevent under age girls from seeking an abortion without their parents permission.[44] Figures revealed that there was 4,352 abortions in England, Wales & Scotland to under 16s. Up five percent on 2005.[45][46]

2008: The number of girls under 16 having an abortion reached a record level of 4,376 girls (4.4 per thousand of the population) in England & Wales during 2007. The number and rate fell slightly in 2008. 2007 statistics showed that the younger the age of the women at abortion the more likely it was to be in the second trimester. Seventeen percent of abortion to girls aged under-14 were over twelve weeks gestation compared to almost nine percent for women over aged over 34.[47][48] Statistics from the Department Of Health for the three-year period 2006 to 2008 showed that the area with the highest rate of abortion in girls under 16 in England & Wales was in the Southwark Primary Care Organisation (PCO) at a rate of 9.2 per 1000 girls in the population aged 13–15. Seven out of ten of the areas with the highest rate were in London. Outside London the PCO's with the highest rates were Darlington (8.0), Manchester (7.3) and Hartlepool (7.2). The rate for the whole of England & Wales was 4.1.

Births[edit]

1951: Throughout the 1940s the teenage birth rate rose from 15.0 in every thousand in 1941 to 21.3. At the end of the second-world war the proportion of teenage births born outside marriage had almost doubled from the beginning of the decade to a third. By 1951, the proportion had dropped to 16% a proportion that remained largely unchanged throughout the decade. There was around one in six pregnant brides during the decade, the proportion being even higher for teenagers with one in four being pregnant on their wedding day.

During the 1950s illegitimate teenage births made up just a small proportion of all illegitimate births, at just under 15% with over half of all illegitimate births being to women over the age of 25.

1959: by the end of the 1950s the number of teenage births had risen nearly 50% from thirty-three thousand in 1955 to forty-six thousand, a rate of 31.6. The numbers of births to girls under 16 remained constant during the late 1940s and early half of the 1950s. From 1955 to the end of the Fifties, the numbers of under 16s giving birth more than doubled.

1964: The number of births to women of all ages had risen 11% since 1960 to a post-World War II high of almost nine hundred thousand. Compared with an increase of almost 49% to seventy-six thousand (43 per thousand) among teenagers in the same period. The number of teenage brides marrying for the first time topped one hundred thousand. The proportion of them pregnant on their wedding day had increased from 25% during the 1950s to almost 40%, more than double the proportion to that of women in their twenties. The proportion of teenage births outside marriage had risen to almost 25%, the most marked increase was in the number of girls under 16 giving birth, with an almost 50% increase between 1959 and 1960 alone. The number of births to girls under 16 had increased by 125% since 1959.

1966: A Home Office survey on adoption revealed that the natural mother in over half of all illegitimate non-parental adoptions during the year were under the age of 21. There was almost eighteen thousand illegitimate adoptions during the year with fourteen thousand being adopted to someone other than the parent(s) (non-parental).[49]

1969: Even though the birth rate to women of all ages was in decline having peaked in 1964, the teenage birth rate continued to rise to a rate of 49.6 per thousand girls.

1971: Research revealed that illegitimate teenage births were more likely to occur to women from a manual social class background than a non-manual social class background. Also that over half of women having an illegitimate birth before the age of 18, would go on to have a legitimate birth before the age of 25 compared to only a third for women who did not have an illegitimate birth in their teens.[50]

1973: Although the overall teenage birth rate for England & Wales had peaked in 1971, the number occurring to under 16s had continued to rise, to over one thousand seven hundred. This represented a 55% increase since 1964 and a 250% increase since 1959.

1974: The number of girls under 16 in Scotland giving birth reached 148, up 39% since 1967. The number of abortions occurring to the same age group reached over 200 per year.[51]

1975: With the legalisation of abortion and better availability of contraception, the number of pregnant teenage brides had declined by 37% since 1970. The teenage birth rate also declined to a rate of 36.4 in 1975. However, the proportion of teenage births occurring outside marriage continued to rise to almost one in three.

1976: The proportion of all illegitimate births occurring to teenagers had more than doubled since the 1950s from 15% to 37%, whilst the proportion occurring to women over the age of 25 had fallen from 56% to 32% in the same period. However, the proportion of births occurring outside marriage to women of all ages was still only 9%.

With the legalisation of abortion came a drop in the numbers of illegitimate children being adopted from a peak of over nineteen thousand in 1968 down to almost nine thousand. In addition, the number of mother and baby homes had declined by nearly 72% since 1966.[52] Much of it due to the decline in the stigma attached to having a baby outside marriage and an increase in cohabitation among unmarried couples. There was also an increase in the number of never married lone mothers, rising 44% since 1971. With half of all never married lone mothers being under the age of 25.[53]

1981: The numbers of under 16s giving birth under 16 fell to their lowest level since 1965.

1983: The numbers of births to teenagers had fallen by a third since 1971 to over fifty-four thousand, a rate of almost twenty-seven in every thousand. The proportion occurring outside marriage had risen to 56 percent.

1986: The proportion of teenage women who were married had fallen from a peak of 11% in 1973 to just over 3%. The numbers of births to teenager began to increase, with the proportion of teenage births occurring outside marriage continuing to increase to 69%, almost a third of which were living at the same address at the time of the birth.

1990: The number of under 16s giving birth had risen 10% since 1981.

1996: The number of births to all teenagers continued to fall from fifty-four thousand in 1983 to almost forty-five thousand, a rate of almost thirty in every thousand. The proportion occurring outside marriage was almost 89% compared to 36% for women of all ages. Though the number of births occurring to under 16s in England & Wales increased to over one thousand six hundred, their highest level since the early 70s. With another hundred and sixty occurring in Scotland.

Under 16 birth rates (per 1000 aged 13–15) in the 4 countries of the United Kingdom[54][55][56][57]
Year England Wales Scotland N. Ireland
1997 1.7 2.3 1.9 1.0
2002 1.3 1.7 1.2 0.9
2006 1.2 1.4 1.2 0.9
2007 1.1 1.3 1.2 1.0

2001: The Census showed that half of all teenagers with children were lone parents, 40% were cohabiting as a couple and 10% were married.[58]

2005: There were forty-five thousand teenage births with 92% being outside marriage. Almost 74% of the births outside marriage were jointly registered to both parents. Over half of these were residing at the same address at the time of the birth. The teenage birth rate of 26.3.

The numbers of teenage births in Scotland had fallen from five and a half thousand (28.3 per thousand) in 1991 to four thousand one hundred, a rate of 25.8 per thousand, with 97% occurring outside marriage.[59]

2008: The number of births to girls under 20 in England & Wales was 44,690, a provisional rate of 26.2 per thousand teenage women in the population. Despite much media attention and public anger over the UK's high amount of teenage mothers, the rate of births to teenagers is actually at its lowest level since the mid-1950s.

Trends in teenage pregnancy[edit]

The statistics presented here use the age of a girl at the outcome of her pregnancy (either birth or abortion), these differ from ones used by the UK Government to track the teenage pregnancy rate. Their statistics, which are widely quoted are calculated using the age of the girl at conception. They are unique as in no other country in the world compile their pregnancy statistics this way. Using pregnancy statistics by age of girl at outcome of her pregnancy thus enables comparison with other countries in the world.

Teenage births in England & Wales (numbers & rates)[60][61]
Year Under 20 Under 16
Numbers Rate per 1000 women aged 15–19) % Outside Marriage Numbers Rate per 1000 women aged 13–15)
1955 33,000 23.5 16.7 200 0.3
1959 46,000 31.6 17.2 500 0.5
1964 76,000 42.5 22.5 1,100 1.1
1969 82,000 49.6 26.3 1,500 1.6
1971 83,000 50.6 25.8 1,500 1.5
1973 73,000 43.9 28.0 1,700 1.6
1981 57,000 28.1 46.5 1,200 1.0
1983 54,000 26.9 56.1 1,300 1.1
1990 56,000 33.3 80.3 1,300 1.5
1996 45,000 29.7 88.0 1,600 1.8
2006 45,500 26.6 93.0 1,200 1.2
2007 44,800 26.0 93.1 1,100 1.2
2008 44,700 26.0 93.9 1,200 1.3
2009 43,200 25.3 94.6 1,000 1.1
Teenage abortions to residents of England & Wales (numbers & rates)[62][63][64][65]
Year Under 20 Under 16
Numbers Rate per 1000 women aged 15–19) Numbers Rate per 1000 women aged 13–15)
1969 9,200 5.6 1,200 1.2
1971 20,500 12.5 2,300 2.3
1976 27,400 15.2 3,400 3.0
1981 34,900 17.3 3,500 3.0
1984 37,500 19.0 4,200 3.7
1986 37,700 19.8 3,900 3.7
1990 38,900 23.4 3,400 4.0
1994 28,500 19.6 3,200 3.5
1998 37,000 23.7 3,800 4.0
2001 37,000 23.5 3,700 3.7
2006 41,300 24.1 4,000 3.9
2007 44,000 25.5 4,400 4.4
2008 42,700 25.0 4,100 4.3
2009 40,100 23.8 3,800 4.0

Chart showing trends in teenage pregnancy to underage girls in England & Wales

See also[edit]

References[edit]

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  2. ^ "Teen Pregnancy Rates Lowest For Over 20 Years" DCSF
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  33. ^ WATT L (September 1961). "Venereal disease in adolescents". Br Med J 2 (5256): 858–60. doi:10.1136/bmj.2.5256.858. PMC 1969895. PMID 13783458. 
  34. ^ "Age Group Of Patients With Venereal Disease” British Journal Of Venereal Disease 1960/36 pg225
  35. ^ "Legal aspects of V.D. in teenagers". Br Med J 1 (5847): 190. January 1973. doi:10.1136/bmj.1.5847.190. PMC 1588119. PMID 4686552. 
  36. ^ "Sexually transmitted diseases annual report 1970"
  37. ^ "Sexually Transmitted Diseases Annual Report 1981" British Journal Of Venereal Disease 1970 and 1981
  38. ^ "Sexually Transmitted Diseases" (11 December 1984) "House of Commons Debate"
  39. ^ "Sexual Risk to Britain's teenagers" BBC News
  40. ^ "Health Protection Agency"
  41. ^ "13% Of Young Men Have Chlamydia" BBC News
  42. ^ "Survey Of 3000 unwanted Pregnancies" Joan Lambert (16 October 1971) British Medical Journal
  43. ^ (2001)'Comparative Health Law' Peter Decruz
  44. ^ "Mother Loses Right To Know Case" (January 2006) BBC News
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  47. ^ "Abortions" (22 Jul 2008) Hansard Written Answer column 1071
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  49. ^ "Home Office survey on adoption" (1971)
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  54. ^ Office for National Statistics
  55. ^ General Register Office for Scotland
  56. ^ Northern Ireland Statistics and Research Agency
  57. ^ Welsh Assembly Government
  58. ^ "Census 2001 People aged 16-29" Office For National Statistics
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  60. ^ Alison MacFarlane & Miranda Mugford (2000) Birth Counts Statistics of Pregnancy & Childbirth-Tables
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External links[edit]