In March 2016, teenage pregnancy data published by the Office for National Statistics (ONS, 2016a) marked a huge milestone. England's under-18 conception rate is now 22.8/1000 15–17-year-old young women, a fall of 51% since 1998, with the number of conceptions dropping from 41 089 to 21 282. This exceeds the goal of the original Teenage Pregnancy Strategy, and brings the under-18 and under-16 conception rates to the lowest level since records began in 1969.
The strategy, launched in 1999 by the then Labour government, was the first comprehensive, long-term effort to tackle England's historically high rates and reduce inequalities experienced by young parents and their children (Social Exclusion Unit, 1999). Informed by international evidence, it aimed to: provide all young people with high-quality sex and relationships education and easy access to effective contraception through youth-friendly services; offer more intensive prevention for young people most at risk; and provide dedicated, coordinated support for young parents. The strategy was anchored in the principle of joined-up action, nationally and locally, recognising that effective support for young people required multi-agency contributions.
During the course of the strategy, many people thought the goal was unattainable. Some believed it was too ambitious; others felt that high rates were an intractable part of English life and impervious to prevention programmes. But with sufficient time and the concerted effort of committed senior leaders and dedicated local practitioners, the strategy has proved that if the right actions are put in place, rates will come down, even in deprived areas.
The achievement in addressing such a complex health and social issue affecting the lives of young people and their children is certainly something to celebrate. However, there is no room for complacency. England's teenage birth rate is still higher than comparable western European countries (ONS, 2016b), progress varies between English regions and local areas, and teenagers continue to be at highest risk of unplanned pregnancy with over 50% of conceptions ending in abortion. So it is vital to keep a focus on teenage pregnancy to sustain the progress made and further narrow inequalities. Universal high-quality sex and relationships education, well-publicised, easy-to-use contraceptive and sexual health services, and a youth-friendly workforce all need to be in place so successive generations of young people have the knowledge, skills and confidence to make well-informed choices and delay pregnancy until they are ready.
Continuing the strategy's aim of providing good support for those who do choose early parenthood is also essential. Midwives have played a key role in the success so far, and their contribution will be vital in making further progress.
Like all parents, teenage mothers and young fathers want to do the best for their children. Some manage very well, but for many, their health, education and economic outcomes remain disproportionately poor (Teenage Pregnancy Knowledge Exchange (TPKE), 2016). Every young parent has their own individual story, but the risk factors for early pregnancy highlight the vulnerabilities with which some young people enter parenthood: family poverty, persistent school absence and slower-than-expected academic progress by age 14, and being looked after or a care leaver (TPKE, 2016). As a result, some young parents will have missed out on protective factors, lacked positive parenting role models and may never have had a trusted adult in their life. This is compounded by fears of judgemental attitudes from staff and mistrust of confidentiality, which contribute to the late booking figures, and concerns that if they ask for advice—the very thing we would like them to do—practitioners may think they cannot cope.
Evidence and lessons from local areas show that poor outcomes are not inevitable if early, coordinated and sustained support is put in place (TPKE, 2016). Midwives are the starting point of that journey and play a crucial role in early help assessments to identify and address any problems, and in building trust and confidence of teenage mothers and young fathers. Specialist teenage pregnancy midwives have led the way in developing empathetic antenatal care and excellent partnerships with other agencies, including embedding postnatal contraceptive choice into the antenatal pathway. The challenge now is for those qualities to be embedded in all maternity services. Getting maternity services right for pregnant teenagers and young fathers (Public Health England (PHE) et al, 2015) gives lots of practical tips and useful resources, such as the Baby Buddy phone app, that can make all the difference to young parents' experience. Many such factors, like kindness, come at no cost!
So how do we make the case for a continued focus? At an individual level, getting support right can transform the lives of teenage mothers, young fathers and their children, enabling them to fulfil their potential. At a strategic level, it makes a vital contribution to safeguarding, giving every child the best start in life, breaking intergenerational inequalities and reducing future demand on health and social services (Local Government Association and PHE, 2016). Just a glance at the starkly poor outcomes for teenage mothers (box 1) shows how improved support will contribute to improving a range of public health and NHS outcome indicators. Put simply, investment now saves money later.
Box 1.Poor outcomes for teenage mothers
| Children in poverty: 63% higher risk for children born to women under 20 |
| Incidence of low birth weight of term babies: 25% higher risk for babies born to women under 20 |
| Stillbirth rate: 26% higher risk of stillbirth in babies born to women under 20 |
| Smoking status at time of delivery: Mothers under 20 are three times more likely to smoke throughout pregnancy |
| Infant mortality rate: 61% higher risk for babies born to women under 20 |
| Breastfeeding prevalence at 6–8 weeks: Mothers under 20 are half as likely to be breastfeeding at 6–8 weeks |
| Maternal mental health: Mothers under 20 have higher rates of poor mental health for up to 3 years after birth |
| Child development at 2–2½ years: Parental depression is the most prevalent risk factor for negative impact on poor child development outcomes; children of teenage mothers are more likely to have developmental delays |
| Rates of adolescents not in education, employment or training (NEET): 21% of estimated number of female NEETs aged 16–18 are teenage mothers |