Changes in conceptions in women younger than 18 years and the circumstances of young mothers in England in 2000–12: an observational study
Summary Background In 2000, a 10-year Teenage Pregnancy Strategy was launched in England to reduce conceptions in women younger than 18 years and social exclusion in young parents. We used routinely collected data and data from Britain's National Surveys of Sexual Attitudes and Lifestyles (Nats...
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| Published in | The Lancet (British edition) Vol. 388; no. 10044; pp. 586 - 595 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
Elsevier Ltd
06.08.2016
Elsevier Limited Elsevier |
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| Online Access | Get full text |
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| Abstract | Summary Background In 2000, a 10-year Teenage Pregnancy Strategy was launched in England to reduce conceptions in women younger than 18 years and social exclusion in young parents. We used routinely collected data and data from Britain's National Surveys of Sexual Attitudes and Lifestyles (Natsal) to examine progress towards these goals. Methods In this observational study, we used random-effects meta-regression to analyse the change in conception rates from 1994–98 to 2009–13 by top-tier local authorities in England, in relation to Teenage Pregnancy Strategy-related expenditure per head, socioeconomic deprivation, and region. Data from similar probability sample surveys: Natsal-1 (1990–91), Natsal-2 (1999–2001), and Natsal-3 (2010–12) were used to assess the prevalence of risk factors and their association with conception in women younger than 18 years in women aged 18–24 years; and the prevalence of participation in education, work, and training in young mothers. Findings Conception rates in women younger than 18 years declined steadily from their peak in 1996–98 and more rapidly from 2007 onwards. More deprived areas and those receiving greater Teenage Pregnancy Strategy-related investment had higher rates of conception in 1994–98 and had greater declines to 2009–13. Regression analyses assessing the association between Teenage Pregnancy Strategy funding and decline in conception rates in women younger than 18 years showed an estimated reduction in the conception rate of 11·4 conceptions (95% CI 9·6–13·2; p<0·0001) per 1000 women aged 15–17 years for every £100 Teenage Pregnancy Strategy spend per head and a reduction of 8·2 conceptions (5·8–10·5; p<0·0001) after adjustment for socioeconomic deprivation and region. The association between conception in women younger than 18 years and lower socioeconomic status weakened slightly between Natsal-2 and Natsal-3. The prevalence of participation in education, work, or training among young women with a child conceived before age 18 years was low, but the odds of them doing so doubled between Natsal-2 and Natsal-3 (odds ratio 1·99, 95% CI 0·99–4·00). Interpretation A sustained, multifaceted policy intervention involving health and education agencies, alongside other social and educational changes, has probably contributed to a substantial and accelerating decline in conceptions in women younger than 18 years in England since the late 1990s. Funding Medical Research Council, Wellcome Trust, Economic and Social Research Council, and Department of Health. |
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| AbstractList | Summary Background In 2000, a 10-year Teenage Pregnancy Strategy was launched in England to reduce conceptions in women younger than 18 years and social exclusion in young parents. We used routinely collected data and data from Britain's National Surveys of Sexual Attitudes and Lifestyles (Natsal) to examine progress towards these goals. Methods In this observational study, we used random-effects meta-regression to analyse the change in conception rates from 1994–98 to 2009–13 by top-tier local authorities in England, in relation to Teenage Pregnancy Strategy-related expenditure per head, socioeconomic deprivation, and region. Data from similar probability sample surveys: Natsal-1 (1990–91), Natsal-2 (1999–2001), and Natsal-3 (2010–12) were used to assess the prevalence of risk factors and their association with conception in women younger than 18 years in women aged 18–24 years; and the prevalence of participation in education, work, and training in young mothers. Findings Conception rates in women younger than 18 years declined steadily from their peak in 1996–98 and more rapidly from 2007 onwards. More deprived areas and those receiving greater Teenage Pregnancy Strategy-related investment had higher rates of conception in 1994–98 and had greater declines to 2009–13. Regression analyses assessing the association between Teenage Pregnancy Strategy funding and decline in conception rates in women younger than 18 years showed an estimated reduction in the conception rate of 11·4 conceptions (95% CI 9·6–13·2; p<0·0001) per 1000 women aged 15–17 years for every £100 Teenage Pregnancy Strategy spend per head and a reduction of 8·2 conceptions (5·8–10·5; p<0·0001) after adjustment for socioeconomic deprivation and region. The association between conception in women younger than 18 years and lower socioeconomic status weakened slightly between Natsal-2 and Natsal-3. The prevalence of participation in education, work, or training among young women with a child conceived before age 18 years was low, but the odds of them doing so doubled between Natsal-2 and Natsal-3 (odds ratio 1·99, 95% CI 0·99–4·00). Interpretation A sustained, multifaceted policy intervention involving health and education agencies, alongside other social and educational changes, has probably contributed to a substantial and accelerating decline in conceptions in women younger than 18 years in England since the late 1990s. Funding Medical Research Council, Wellcome Trust, Economic and Social Research Council, and Department of Health. BACKGROUNDIn 2000, a 10-year Teenage Pregnancy Strategy was launched in England to reduce conceptions in women younger than 18 years and social exclusion in young parents. We used routinely collected data and data from Britain's National Surveys of Sexual Attitudes and Lifestyles (Natsal) to examine progress towards these goals. METHODSIn this observational study, we used random-effects meta-regression to analyse the change in conception rates from 1994-98 to 2009-13 by top-tier local authorities in England, in relation to Teenage Pregnancy Strategy-related expenditure per head, socioeconomic deprivation, and region. Data from similar probability sample surveys: Natsal-1 (1990-91), Natsal-2 (1999-2001), and Natsal-3 (2010-12) were used to assess the prevalence of risk factors and their association with conception in women younger than 18 years in women aged 18-24 years; and the prevalence of participation in education, work, and training in young mothers. FINDINGSConception rates in women younger than 18 years declined steadily from their peak in 1996-98 and more rapidly from 2007 onwards. More deprived areas and those receiving greater Teenage Pregnancy Strategy-related investment had higher rates of conception in 1994-98 and had greater declines to 2009-13. Regression analyses assessing the association between Teenage Pregnancy Strategy funding and decline in conception rates in women younger than 18 years showed an estimated reduction in the conception rate of 11.4 conceptions (95% CI 9.6-13.2; p<0.0001) per 1000 women aged 15-17 years for every £100 Teenage Pregnancy Strategy spend per head and a reduction of 8.2 conceptions (5.8-10.5; p<0.0001) after adjustment for socioeconomic deprivation and region. The association between conception in women younger than 18 years and lower socioeconomic status weakened slightly between Natsal-2 and Natsal-3. The prevalence of participation in education, work, or training among young women with a child conceived before age 18 years was low, but the odds of them doing so doubled between Natsal-2 and Natsal-3 (odds ratio 1.99, 95% CI 0.99-4.00). INTERPRETATIONA sustained, multifaceted policy intervention involving health and education agencies, alongside other social and educational changes, has probably contributed to a substantial and accelerating decline in conceptions in women younger than 18 years in England since the late 1990s. FUNDINGMedical Research Council, Wellcome Trust, Economic and Social Research Council, and Department of Health. In 2000, a 10-year Teenage Pregnancy Strategy was launched in England to reduce conceptions in women younger than 18 years and social exclusion in young parents. We used routinely collected data and data from Britain's National Surveys of Sexual Attitudes and Lifestyles (Natsal) to examine progress towards these goals. In this observational study, we used random-effects meta-regression to analyse the change in conception rates from 1994–98 to 2009–13 by top-tier local authorities in England, in relation to Teenage Pregnancy Strategy-related expenditure per head, socioeconomic deprivation, and region. Data from similar probability sample surveys: Natsal-1 (1990–91), Natsal-2 (1999–2001), and Natsal-3 (2010–12) were used to assess the prevalence of risk factors and their association with conception in women younger than 18 years in women aged 18–24 years; and the prevalence of participation in education, work, and training in young mothers. Conception rates in women younger than 18 years declined steadily from their peak in 1996–98 and more rapidly from 2007 onwards. More deprived areas and those receiving greater Teenage Pregnancy Strategy-related investment had higher rates of conception in 1994–98 and had greater declines to 2009–13. Regression analyses assessing the association between Teenage Pregnancy Strategy funding and decline in conception rates in women younger than 18 years showed an estimated reduction in the conception rate of 11·4 conceptions (95% CI 9·6–13·2; p<0·0001) per 1000 women aged 15–17 years for every £100 Teenage Pregnancy Strategy spend per head and a reduction of 8·2 conceptions (5·8–10·5; p<0·0001) after adjustment for socioeconomic deprivation and region. The association between conception in women younger than 18 years and lower socioeconomic status weakened slightly between Natsal-2 and Natsal-3. The prevalence of participation in education, work, or training among young women with a child conceived before age 18 years was low, but the odds of them doing so doubled between Natsal-2 and Natsal-3 (odds ratio 1·99, 95% CI 0·99–4·00). A sustained, multifaceted policy intervention involving health and education agencies, alongside other social and educational changes, has probably contributed to a substantial and accelerating decline in conceptions in women younger than 18 years in England since the late 1990s. Medical Research Council, Wellcome Trust, Economic and Social Research Council, and Department of Health. In 2000, a 10-year Teenage Pregnancy Strategy was launched in England to reduce conceptions in women younger than 18 years and social exclusion in young parents. We used routinely collected data and data from Britain's National Surveys of Sexual Attitudes and Lifestyles (Natsal) to examine progress towards these goals. Methods In this observational study, we used random-effects meta-regression to analyse the change in conception rates from 1994-98 to 2009-13 by top-tier local authorities in England, in relation to Teenage Pregnancy Strategy-related expenditure per head, socioeconomic deprivation, and region. Data from similar probability sample surveys: Natsal-1 (1990-91), Natsal-2 (1999-2001), and Natsal-3 (2010-12) were used to assess the prevalence of risk factors and their association with conception in women younger than 18 years in women aged 18-24 years; and the prevalence of participation in education, work, and training in young mothers. Findings Conception rates in women younger than 18 years declined steadily from their peak in 1996-98 and more rapidly from 2007 onwards. More deprived areas and those receiving greater Teenage Pregnancy Strategy-related investment had higher rates of conception in 1994-98 and had greater declines to 2009-13. Regression analyses assessing the association between Teenage Pregnancy Strategy funding and decline in conception rates in women younger than 18 years showed an estimated reduction in the conception rate of 11·4 conceptions (95% CI 9·6-13·2; p<0·0001) per 1000 women aged 15-17 years for every £100 Teenage Pregnancy Strategy spend per head and a reduction of 8·2 conceptions (5·8-10·5; p<0·0001) after adjustment for socioeconomic deprivation and region. The association between conception in women younger than 18 years and lower socioeconomic status weakened slightly between Natsal-2 and Natsal-3. The prevalence of participation in education, work, or training among young women with a child conceived before age 18 years was low, but the odds of them doing so doubled between Natsal-2 and Natsal-3 (odds ratio 1·99, 95% CI 0·99-4·00). Interpretation A sustained, multifaceted policy intervention involving health and education agencies, alongside other social and educational changes, has probably contributed to a substantial and accelerating decline in conceptions in women younger than 18 years in England since the late 1990s. Funding Medical Research Council, Wellcome Trust, Economic and Social Research Council, and Department of Health. In 2000, a 10-year Teenage Pregnancy Strategy was launched in England to reduce conceptions in women younger than 18 years and social exclusion in young parents. We used routinely collected data and data from Britain's National Surveys of Sexual Attitudes and Lifestyles (Natsal) to examine progress towards these goals. In this observational study, we used random-effects meta-regression to analyse the change in conception rates from 1994-98 to 2009-13 by top-tier local authorities in England, in relation to Teenage Pregnancy Strategy-related expenditure per head, socioeconomic deprivation, and region. Data from similar probability sample surveys: Natsal-1 (1990-91), Natsal-2 (1999-2001), and Natsal-3 (2010-12) were used to assess the prevalence of risk factors and their association with conception in women younger than 18 years in women aged 18-24 years; and the prevalence of participation in education, work, and training in young mothers. Conception rates in women younger than 18 years declined steadily from their peak in 1996-98 and more rapidly from 2007 onwards. More deprived areas and those receiving greater Teenage Pregnancy Strategy-related investment had higher rates of conception in 1994-98 and had greater declines to 2009-13. Regression analyses assessing the association between Teenage Pregnancy Strategy funding and decline in conception rates in women younger than 18 years showed an estimated reduction in the conception rate of 11.4 conceptions (95% CI 9.6-13.2; p<0.0001) per 1000 women aged 15-17 years for every £100 Teenage Pregnancy Strategy spend per head and a reduction of 8.2 conceptions (5.8-10.5; p<0.0001) after adjustment for socioeconomic deprivation and region. The association between conception in women younger than 18 years and lower socioeconomic status weakened slightly between Natsal-2 and Natsal-3. The prevalence of participation in education, work, or training among young women with a child conceived before age 18 years was low, but the odds of them doing so doubled between Natsal-2 and Natsal-3 (odds ratio 1.99, 95% CI 0.99-4.00). A sustained, multifaceted policy intervention involving health and education agencies, alongside other social and educational changes, has probably contributed to a substantial and accelerating decline in conceptions in women younger than 18 years in England since the late 1990s. Medical Research Council, Wellcome Trust, Economic and Social Research Council, and Department of Health. |
| Author | Mercer, Catherine H, PhD Wilkinson, Paul, Prof Datta, Jessica, MSc Copas, Andrew, PhD Johnson, Anne M, Prof Erens, Bob, MSc Glasier, Anna, FRCOG Wellings, Kaye, Prof Jones, Kyle, MSc Gibson, Lorna J, MSc Macdowall, Wendy, MSc Palmer, Melissa J, PhD Scott, Rachel H, MSc Geary, Rebecca S, PhD Tanton, Clare, PhD French, Rebecca S, PhD |
| AuthorAffiliation | d Research Department of Infection and Population Health, University College London, London, UK b Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK c Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK a Centre for Sexual and Reproductive Health Research, London School of Hygiene & Tropical Medicine, London, UK |
| AuthorAffiliation_xml | – name: b Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK – name: c Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK – name: a Centre for Sexual and Reproductive Health Research, London School of Hygiene & Tropical Medicine, London, UK – name: d Research Department of Infection and Population Health, University College London, London, UK |
| Author_xml | – sequence: 1 fullname: Wellings, Kaye, Prof – sequence: 2 fullname: Palmer, Melissa J, PhD – sequence: 3 fullname: Geary, Rebecca S, PhD – sequence: 4 fullname: Gibson, Lorna J, MSc – sequence: 5 fullname: Copas, Andrew, PhD – sequence: 6 fullname: Datta, Jessica, MSc – sequence: 7 fullname: Glasier, Anna, FRCOG – sequence: 8 fullname: Scott, Rachel H, MSc – sequence: 9 fullname: Mercer, Catherine H, PhD – sequence: 10 fullname: Erens, Bob, MSc – sequence: 11 fullname: Macdowall, Wendy, MSc – sequence: 12 fullname: French, Rebecca S, PhD – sequence: 13 fullname: Jones, Kyle, MSc – sequence: 14 fullname: Johnson, Anne M, Prof – sequence: 15 fullname: Tanton, Clare, PhD – sequence: 16 fullname: Wilkinson, Paul, Prof |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/27229190$$D View this record in MEDLINE/PubMed |
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| ContentType | Journal Article |
| Copyright | Wellings et al. Open Access article distributed under the terms of CC BY 2016 Wellings et al. Open Access article distributed under the terms of CC BY Copyright © 2016 Wellings et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved. Copyright Elsevier Limited Aug 6, 2016 2016 Wellings et al. Open Access article distributed under the terms of CC BY 2016 |
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| DOI | 10.1016/S0140-6736(16)30449-4 |
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| References | Oringanje, Meremikwu, Eko, Esu, Meremikwu, Ehiri (bib21) 2016; 2 (bib29) Feb 25, 2010 Johnson, Copas, Erens (bib9) 2001; 15 Nanchahal, Wellings, Barrett (bib16) 2005; 59 Gigante, Victora, Gonçalves, Lima, Barros, Rasmussen (bib22) 2004; 16 Johnson, Mercer, Erens (bib10) 2001; 358 McLeod (bib14) 2001; 323 Santelli, Duberstein, Lindberg, Finer, Singh (bib18) 2007; 97 Uren, Sheers, Dattani (bib15) 2007; 33 Hobcraft, Kiernan (bib3) 2001; 52 Olausson, Haglund, Weitoft, Cnattingius (bib4) 2001; 33 (bib1) 1999 Payne, Abel (bib12) 2012; 53 Pietri, Connolly, Yu, Humphreys (bib27) 2014; 6 Wilkinson, French, Kane (bib30) 2006; 368 Hadley, Chandra-Mouli, Ingham (bib2) 2016 Yang, Gaydos (bib19) 2010; 46 bib25 bib23 Wellings, Brima, Sadler (bib26) 2015; 91 (bib28) Feb 25, 2010 Connolly, Pietri, Jingbo, Humphreys (bib17) 2014; 6 Wellings, Wadsworth, Johnson, Field, Macdowall (bib6) 1999; 4 Erens, Phelps, Clifton (bib11) 2014; 90 bib7 Sedgh, Finer, Bankole, Eilers, Singh (bib13) 2015; 56 (bib8) 2015 Conrad (bib24) 2012; 34 Penman-Aguilar, Carter, Snead, Kourtis (bib5) 2013; 128 Girma, Paton (bib20) 2015; 131 BJOG. 2016 Dec;123(13):2071-2075 27229191 - Lancet. 2016 Aug 6;388(10044):538-40 27229189 - Lancet. 2016 Aug 6;388(10044):560 27894660 - Lancet. 2016 Nov 26;388(10060):2604-2605 27891802 - BJOG. 2016 Dec;123(13):2071-2075 27894659 - Lancet. 2016 Nov 26;388(10060):2604 Erens (10.1016/S0140-6736(16)30449-4_bib11) 2014; 90 Olausson (10.1016/S0140-6736(16)30449-4_bib4) 2001; 33 Johnson (10.1016/S0140-6736(16)30449-4_bib10) 2001; 358 Payne (10.1016/S0140-6736(16)30449-4_bib12) 2012; 53 McLeod (10.1016/S0140-6736(16)30449-4_bib14) 2001; 323 Yang (10.1016/S0140-6736(16)30449-4_bib19) 2010; 46 Wellings (10.1016/S0140-6736(16)30449-4_bib26) 2015; 91 Pietri (10.1016/S0140-6736(16)30449-4_bib27) 2014; 6 Johnson (10.1016/S0140-6736(16)30449-4_bib9) 2001; 15 Nanchahal (10.1016/S0140-6736(16)30449-4_bib16) 2005; 59 Connolly (10.1016/S0140-6736(16)30449-4_bib17) 2014; 6 Hadley (10.1016/S0140-6736(16)30449-4_bib2) 2016 Santelli (10.1016/S0140-6736(16)30449-4_bib18) 2007; 97 (10.1016/S0140-6736(16)30449-4_bib1) 1999 Gigante (10.1016/S0140-6736(16)30449-4_bib22) 2004; 16 Girma (10.1016/S0140-6736(16)30449-4_bib20) 2015; 131 Hobcraft (10.1016/S0140-6736(16)30449-4_bib3) 2001; 52 Uren (10.1016/S0140-6736(16)30449-4_bib15) 2007; 33 Wellings (10.1016/S0140-6736(16)30449-4_bib6) 1999; 4 Penman-Aguilar (10.1016/S0140-6736(16)30449-4_bib5) 2013; 128 Conrad (10.1016/S0140-6736(16)30449-4_bib24) 2012; 34 Oringanje (10.1016/S0140-6736(16)30449-4_bib21) 2016; 2 Sedgh (10.1016/S0140-6736(16)30449-4_bib13) 2015; 56 Wilkinson (10.1016/S0140-6736(16)30449-4_bib30) 2006; 368 |
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| Snippet | Summary Background In 2000, a 10-year Teenage Pregnancy Strategy was launched in England to reduce conceptions in women younger than 18 years and social... In 2000, a 10-year Teenage Pregnancy Strategy was launched in England to reduce conceptions in women younger than 18 years and social exclusion in young... BACKGROUNDIn 2000, a 10-year Teenage Pregnancy Strategy was launched in England to reduce conceptions in women younger than 18 years and social exclusion in... |
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| SubjectTerms | Abortion Adolescent Birth control Education England Female Health Surveys Humans Internal Medicine Intervention Life Style Medical research Mothers - statistics & numerical data Observational studies Pregnancy Pregnancy in Adolescence - statistics & numerical data Pregnancy Rate - trends Prevalence Regression Analysis Risk factors Sex education Sexual Behavior - statistics & numerical data Social conditions & trends Socioeconomics Teenage pregnancy Training Womens health |
| Title | Changes in conceptions in women younger than 18 years and the circumstances of young mothers in England in 2000–12: an observational study |
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