1. Teenage Pregnancy 1 Teenage Pregnancy: Who suffers? 16 February 2011 Dr. Shantini Paranjothy, Clinical Senior Lecturer Public Health Medicine

2. Teenage Pregnancy 2 Overview Epidemiology of teenage pregnancy Impact on health and well-being of mother, baby, father Giving every child the best start in life –avoiding teenage pregnancy –supporting teenage parents

3. Teenage Pregnancy 3 Live birth rate to women aged 15–19. (1999 figures) [Source: Eurostat & Centre for Sexual Health Research, Southampton] Lawlor et al. R Soc Med. 2004 March; 97(3): 121–123

4. Definitions Conceptions = pregnancies resulting in live births, stillbirths or legal terminations –Under 20 (13 – 19 years) –Under 18 (13 – 17 years) –Under 16 (13 – 15 years) Teenage Pregnancy 4

5. Conception rates E & W Teenage Pregnancy 5

6. Conception rates 2008 (<18) Teenage Pregnancy 6 Per 1,000 women

7. Conceptions (<18) in Wales Teenage Pregnancy 7 Per 1,000 women (2008 data)

8. Conceptions (<18) by WIMD Teenage Pregnancy 8 1998-022000-042002-062004-08 Ratio: Most deprived to Middle deprived fifth1.891.751.611.67 Source: STATSWALES

9. Conceptions 2008 (E & W) Teenage Pregnancy 9

10. Teenage Pregnancy 10

11. Who suffers? Teenage Pregnancy 11

12. Teenage Pregnancy 12

13. Evidence for risk factors (girls) RIPPLE study (longitudinal data) 1997 – 2001 (Allen E JECH 2007;61:20-27) FactorUnivariate OR Adjusted OR Lack of expectation of education at age 20 4.6 (1.8, 11.6)8.4 (1.2, 56.7) Expectation of being a parent at age 20 2.7 (1.2, 6.4)1.9 (0.6, 6.0) Drunk monthly or more4.8 (3.1, 7.3)2.1 (1.2, 4.0) Peer pressure to have sex early0.9 (0.6, 1.5)2.1 (1.2, 3.7) Easy communication with mother or female guardian 0.4 (0.2, 0.8)0.3 (0.1, 0.7) Main source of information includes school 0.4 (0.2, 0.9)0.7 (0.3, 2.1)

14. Who suffers? Teenage Pregnancy 14 Mother Baby Father

15. Obstetric complications Teenage Pregnancy 15 Anaemia (Hb<10g/dl) Pregnancy induced hypertension Assisted births

16. Maternal mortality Overall rate 14 per 100,000 <20 9.9 per 100,000 46% in most deprived compared with least deprived Unemployment –RR 7.4 (95%CI 5.6, 9.0) Teenage Pregnancy 16

17. Psycho-social outcomes More mental health difficulties More emotional and behavioural problems Less likely to complete education and training More likely to be living in poverty Teenage Pregnancy 17

18. Longer term mortality Compared to mothers aged 20-24 –70% increased risk of premature death in mothers <17 years –50% increased risk in mothers aged 18 – 19 years –Causes of death: Cervical cancer, Ischaemic Heart disease, suicide, violence assault, homicide Teenage Pregnancy 18 Source: Int J Obstet Gynaecol 2004; 111:793-9

19. Who suffers? Teenage Pregnancy 19 Mother Baby Father

20. Adverse baby outcomes Pre-term birth Low birth weight Small for gestational age Neonatal mortality Infant mortality Teenage Pregnancy 20

21. Smoking during pregnancy Teenage Pregnancy 21

22. Breastfeeding rates Teenage Pregnancy 22

23. Early years outcomes Increased risk of –Harm, illness, accidents and injuries –Cognitive, behavioural and emotional complications Attributable to mother’s mental state rather than young age Teenage Pregnancy 23

24. Teenage Pregnancy 24

25. Who suffers? Teenage Pregnancy 25 Mother Baby Father

26. Evidence for risk factors (boys) RIPPLE study (longitudinal data) 1997 – 2001 (Allen E JECH 2007;61:20-27) Outcome: pregnancy initiated by teenage boys FactorUnivariate OR Adjusted OR Expectation of being a parent at age 20 2.5 (1.1, 5.5)0.7 (0.2, 2.5) Drunk monthly or more3.4 (2.1, 5.5)3.9 (1.7, 8.6) Peer pressure to have sex early3.7 (1.9, 7.3)2.8 (0.7, 10.7) Intent to skip school3.5 (2.0, 6.2)1.9 (0.6, 6.2) Ability to identify sexual health services 1.0 (0.7, 1.5)0.3 (0.1, 0.7) Main source of information includes school 0.4 (0.2, 0.8)0.4 (0.2, 0.9)

27. Young fathers Feel excluded Low earning potential –Damaging confidence and sense of self Benchmark against their own fathers Teenage Pregnancy 27

28. Paternal health outcomes Poorly studied! Teenage Pregnancy 28

29. Give every child the best start in life Teenage Pregnancy 29

30. Give every child the best start in life Target to halve the under-18 conception rate in England by 2010 from the 1998 rate of 46.6 per 1,000 13% reduction in 2008 Beyond 2010 Teenage Pregnancy 30

31. Teenage Pregnancy 31 Increase sexual health and relationships literacy Improve access to good quality sexual health services Reduce the number of unintended pregnancies, particularly among teenage girls

32. Teenage Pregnancy 32

33. Teenage Pregnancy 33 Reproductive and Early years pathfinder Institute of Public Health PRIMARY OUTCOMES Birth outcomes: Birth weight, gestational age, congenital malformations, stillbirth, perinatal mortality Child health outcomes: nutrition, growth, development hospital admissions, infection, respiratory health, injuries, education, obesity deaths. Women’s health Preconception, physical and mental health, smoking, alcohol, nutrition, recreational drug use Vulnerable groups e.g. teenage mothers Intrauterine exposures Health & Social Care (Service Design and Quality) Provision of health services, access, standards and quality of care Fertility- time to pregnancy Environmental exposures: Housing, neighbourhood and workplace Life course outcomes

34. Reproductive and Early years pathfinder Institute of Public Health –Monitor epidemiology of the life course up to age 5 –Relate to evidence for effectiveness and current programmes in Wales Teenage Pregnancy 34