1. Professor David Paton Nottingham University Business School 25 th March 2010 Reducing teenage pregnancy & sexual activity: what works and what doesn’t

2. Law Reform Commission Proposals Provide confidential access to contraception for: 16-17: consent presumed 14-15: child encouraged to inform parents 12-13: parents informed (but consent not necessary) WHY? Commission argues that: access to contraception is essential in reducing teenage pregnancy & STI rates confidentiality is crucial in increasing take-up of services (cf. Gillick ruling in England)

3. Sexual Health in Ireland

8. U16 birth, pregnancy & abortion rates Ireland 1995-2008

9. Sexual Health in Ireland

10. Be careful before changing anything !!

11. Tell parents & use clinic Don’t use clinic Family planning clinic? Don’t have sex Have sex anyway Get contraception elsewhere Parental consent & contraception

12. Access to family planning (schools, clinics, pharmacies) is not associated with lower pregnancy rates amongst minors (Paton, 2002, 2006; DiCenso, 2002; Clements et al, 1998; Wilkinson, 2006 etc.) Access may increase abortions/lower births (Wilkinson, 2006) Evidence overwhelming that emergency birth control (morning after pill) has no impact on unwanted pregnancy rates (Raymond et al, 2007; Girma & Paton, 2006 etc.) EBC may lead to increase in unprotected sex/STIs (Paton, 2006; Raymond & Weaver, 2008) Research Evidence 1: access to family planning

13. Experiment 1. Gillick Ruling in England & Wales ( Journal of Health Economics, 2002) Evidence 2: Confidentiality and Family Planning

14. Family Planning & U16 Conception Rates, Eng & Wales: 1980-1989 Gillick Ruling 5 10 15 20 rates 198019851989 year U16 Family Planning rateU16 conception rate

15. Family Planning, U16 & 16-19 Conception Rates, Eng & Wales:1980-1989 Gillick Ruling 50 70 90 110 5 10 15 20 rates 198019851989 year U16 Family Planning rateU16 conception rate 16-19 conception rate

16. Experiment 2. McHenry County, Illinois ( American Jnl of Public Health, 2004, 2005). Introduction of parental consent led no significant change in pregnancies Experiment 1. Gillick Ruling in England & Wales ( Journal of Health Economics, 2002) Imposition of parental consent did not increase underage conceptions relative to older teenagers or to Scotland. Evidence 2: Confidentiality and Family Planning

17. Over 30 US States have imposed parental involvement laws for abortion since 1984 Evidence 3: Confidentiality and abortion  Teenage abortion rates down  Teenage births don’t change or go down  Overall teenage pregnancy rates down.  Teenage STIs down (see e.g. Levine, 2003; Klick & Stratmann, 2008)

18. Evidence 4: What else affects teenage pregnancy/sexual activity?  Poverty  Religious affiliation  Family stability  Educational achievement (see, e.g., Paton, 2001; Wilkinson, 2006; Evans et al, 2002 etc.

19. 1. More sexual activity ? 2. High failure rates, especially for adolescents Why doesn’t access to family planning work? Examples: England: 50% of minors having abortions had been prescribed the pill in previous year (Churchill et al, 2001) Netherlands: two thirds of those having abortions were using contraception (Rutgers, 2008) Condom users: 17% of condom users can expect to experience pregnancy over 12 months (Kost et al 2008)

20. Confidential access to family planning since mid-70s (interrupted by Gillick ruling in 1985) Teenage pregnancy strategies launched in 1992 and 1997 Massive investment in and promotion of EBC, school clinics, “signposting” of services etc. The English experience:

21. Progress of English Teenage Pregnancy Strategy 2004 target 2010 target Teenage Pregnancy Strategy starts 0 10 20 30 40 50 60 Rates 1995200020052010 U18 conception rateU16 conception rate

22. Progress of English Teenage Pregnancy Strategy

24. Pregnancy rates no change Early sexual activity up More pressure for abortion Likely effects of Law Commission Reforms

25. Are you sure you want to copy the English?

26. References Colman S., T. Joyce and R. Kaestner (2008), ‘Misclassification Bias and the Estimated Effect of Parental Involvement Laws on Adolescents’ Reproductive Outcomes’ American Journal of Public Health, 98(10): 1881-5. DiCenso A., G. Gordon, W. Andrew and L. Griffith (2002), ‘Interventions to reduce unintended pregnancies among adolescents: systematic review of randomised controlled trials’, British Medical Journal, 324(15, June): 1426-34. Evans W.N, W.E Oates and R.M. Schwab (1992), ‘Measuring peer group effects: a study of teenage behavior’, Journal of Political Economy, 100(5, Oct): 966-91. Girma, S and D Paton (2006), ‘Matching Estimates of the Impact of Over-the-Counter Emergency Birth Control on Teenage Pregnancy’, Health Economics, 15 (Sept): 1021- 32. Glasier, A, K Fairhurst, S Wyke, S Zirebland, P Seaman, J Walker & F Lakha (2004), ‘Advanced Provision of Emergency Contraception Does not Reduce Abortion Rates’, Contraception, 69: 361-6. Joyce T., R. Kaestner and S. Colman (2006), ‘Changes in Abortions and Births and the Texas Parental Notification Law’, New England Journal of Medicine, 354(10, March): 1031-8. Klick J. and T. Stratmann (2008), ‘Abortion access and risky sex among teens: parental involvement laws and sexually transmitted diseases’, Journal of Law, Economics and Organization, 24(1, May): 2-21. Kost K., S. Singh, B. Vaughan, J. Trussell and A. Bankole (2008), ‘Estimates of contraceptive failure from the 2002 National Survey of Family Growth’, Contraception, 77: 10-21. Levine, PB (2003), ‘Parental involvement laws and fertility behavior’, Journal of Health Economics, 22 (5, Sept), 861-78. Paton, D (2002), ‘The Economics of Abortion, Family Planning and Underage Conceptions’, Journal of Health Economics, 21 (2, March): 27-45 Paton, D (2006), ‘‘Random Behaviour or Rational Choice? Family Planning, Teenage Pregnancy and STIs’, Sex Education, 6 (3, August): 281- 308. Raymond, EG, J Trussell & CB Polis (2007), ‘Population Effect of Increased Access to Emergency Contraceptive Pills: a systematic review’, Obstetrics & Gynecology, 109 (1, Jan): 181-8. Raymond E.G. and M.A. Weaver (2008), ‘Effect of an emergency contraceptive pill intervention on pregnancy risk behavior’, Contraception, 77: 333-6. Stanford J.B. (2008), ‘Emergency Contraception: overestimated effectiveness and questionable expectations’, Clinical Pharmacology and Therapeutics, 83(1, Jan): 19-21. Trussell, J., E.B. Schwarz, K. Guthrie and E. Raymond (2008), ‘No such thing as an easy (or EC) fix’, Contraception, 78: 351-4. Wilkinson P., R. French, R. Kane, K. Lachowycz, J. Stephenson, C. Grundy et al (2006), ‘Teenage conceptions, abortions and births in England: 19894-2003, and the national teenage pregnancy strategy’ Lancet, 368(Nov): 1879-86. Zavodny, M (2004), ‘Fertility and parental consent for minors to receive contraceptives’, American Journal of Public Health, 94(8): 1347-1351. Zavodny, M (2005), ‘Erratum In: Fertility and Parental Consent for Minors to Receive Contraceptives’, American Journal of Public Health, 95(1): 194.