London School of Hygiene & Tropical Medicine

Rates of teenage pregnancy in England have halved since the implementation of the Government's Teenage Pregnancy Strategy (TPS) in 1999, and the greatest effect is seen in areas of high deprivation and areas that received the most TPS funding, according to research published in The Lancet.

Led by the London School of Hygiene & Tropical Medicine with UCL (University College London), the study is the first to show the long-term effect of a nationwide strategy launched by the Labour government in 1999, aimed at reducing under-18 conception rates by 50% by 2010 and limiting social exclusion among young parents.

The TPS had several components including providing high-quality sex and relationships education, youth friendly contraceptive services, support for young parents to take part in education, employment, training and coordinated action, at government and local level. Local implementation grants were allocated according to teenage pregnancy rates in each area.

The observational study reports the long-term independent evaluation of TPS. The team used data from 148 local authority areas in England to model changes in under-18 conceptions, abortions, and birth rates in relation to TPS funding, deprivation, and region between the five-year periods, immediately before (1994-1998) and after (2009-2013) implementation of the strategy.

Their findings show that, from its peak in 1998, the under-18 conception rate showed a moderate decline until 2006, when it fell more sharply. Between 1998 and 2013 the conception rate dropped from approximately 47 to fewer than 25 conceptions per 1,000 young women aged 15-17 years. The most deprived areas, and those where more strategy-related resources were targeted had higher under-18 conception rates before the TPS was implemented, experienced greater declines.

Between 1998 and 2013, the conception rate dropped by 34 conceptions per 1,000 young women aged 15-17 (from 65 to 31 per 1,000) in areas receiving the highest TPS funding, compared with just 16 per 1,000 in areas with the lowest level of funding (from 36 to 20 per 1,000).

Professor Kaye Wellings at the London School of Hygiene & Tropical Medicine led the study. She said: "England's under-18 conception rate has fallen to its lowest level since the 1970s. What's more, progress has been made towards halting the cycle of inequality that has long been associated with teenage pregnancy."

The team used data from the National Surveys of Sexual Attitudes and Lifestyles (Natsal) to assess changes in factors associated with under-18 conception between the periods of fieldwork for Natsal-2 (1999-2001) and Natsal-3 (2010-12). The researchers also assessed changes in young mothers' participation in education, work, and training over the period.

The study shows that participation in education and work has improved for women who conceive under the age of 18, but rates of participation still remain lower than their non-pregnant peers. A decline in teenage pregnancy rates has been seen in other countries though the evidence suggests it has been less marked.

Professor Wellings said: "As young people globally spend longer in education and settle with a partner later we're now seeing a near universal trend towards fewer early pregnancies. But the more striking decline in under-18 maternities in England compared with other European countries, and its close link with government investment in reducing teenage pregnancy rates, appears to reflect the intensive and sustained efforts of the strategy to address the problem by changing social norms and increasing access to education and reliable contraception."

The proportion of young women who conceived before age 18 who were engaged in work, education or training nearly doubled between 1999 and 2013 (from 20% to 36%) despite the less favourable economic climate. Furthermore, the authors estimate that the conception rate dropped by 11.4 conceptions per 1,000 young women for every £100 spent per head, or 8.2 fewer conceptions after taking into account deprivation and region

Despite the achievements in reducing under-18 conception rates, further reductions are still needed to bring them in line with other high-income countries. England's teenage pregnancy rates are still high by comparison with countries in Scandinavia or the Netherlands.

Professor Wellings said: "Our findings suggest that shifts in the educational aspirations of young women and the increasing use of highly effective contraception are both driving the trend towards fewer early conceptions. One provides the motivation not to get pregnant, the other the means."

A separate study also published today in the Journal of Adolescent Health by the University of Bedfordshire identifies lessons from the Teenage Pregnancy Strategy that may apply to other countries.

Publication

• Kaye Wellings, Melissa J Palmer, Rebecca S Geary, Lorna J Gibson, Andrew Copas, Jessica Datta, Anna Glasier, Rachel H Scott, Catherine H Mercer, Bob Erens, Wendy Macdowall, Rebecca S French, Kyle Jones, Anne M Johnson, Clare Tanton, Paul Wilkinson. Changes in conceptions in women younger than 18 years and the circumstances of young mothers in England in 2000-12: an observational study. The Lancet. DOI:10.1016/S0140-6736(16)30449-4