The rise and fall of teenage pregnancy
School sex and relationships education has very little impact on teenage pregnancy rates, according to new research.
In a paper published in the latest issue of the journal Education and Health, Professor David Paton, chair of industrial economics at the University of Nottingham, examined the statistics for teenage pregnancy between 1969 and 2009.
"Millions of pounds have been spent by policymakers on numerous initiatives aimed at cutting teenage pregnancy rates," Paton writes. "However, identifying the impact of policy interventions ... presents something of a challenge."
In fact, the rate of conceptions among girls aged between 13 and 15 has remained almost exactly the same over the 40-year period. In 1969, there were 6.9 pregnancies per 1,000 teenagers. By 1979, it had risen to 7.5 per 1,000, the same figure as in 2009.
While there have been ups and downs, Paton argues that it is hard to prove that this is in any way linked to policy interventions. For example, in 1996 the conception rate reached a peak of more than nine per 1,000 girls. But this occurred only four years after the launch of a major initiative, the Health of the Nation, intended to halve the rate of teenage conceptions.
The next significant initiative, the 1999 Teenage Pregnancy Strategy, began several years after this rate began to decline: by that year, there were 8.3 pregnancies per 1,000 girls. As spending on this strategy increased in the years afterwards, this downward trend levelled off. Meanwhile, the recent decrease has come at a time of public-spending cuts.
"Underlying socio-economic factors, such as poverty, educational achievement and family stability, have significant impacts on teenage birth rates, and an improvement in some of these measures appears likely to be at the root of reductions in underage births since 1996," Paton says.
He refutes conventional wisdom that school-based sex education lessons and teenage access to contraception have had an impact on pregnancy rates. Both the 1992 Health of the Nation report and the 1999 Teenage Pregnancy Strategy led to major initiatives to improve access to family planning for young people. But, he says, while contraceptive uptake increased among under-16s, there was no discernible reduction in the rates of teenage abortions.
And he argues that there is no correlation between local authorities judged to have the best sex-education provision and those with the biggest post-1996 decreases in teenage pregnancy rates.
"Unwanted pregnancy among minors in England and Wales has proved remarkably resilient to policy initiatives," he says.
"The time appears ripe for a shift in focus from policies aimed at reducing the risks associated with underage sexual activity to those which are aimed more directly at reducing the level of underage sexual activity."
OPEN ATTITUDES AND CONFIDENTIAL CONTRACEPTION
Confidential, easy access to contraception, and an open attitude to sex, are vital in order to reduce the rate of teenage pregnancy, say sex-education experts.
In an article published in Education and Health, staff at sexual health charity Brook argue that real progress has been made in reducing the rates of teenage pregnancy since 1969: "We've all seen the headlines, the teenagers using abortion 'as a form of contraception' ... but ... in 2010 the rates (7.0 per 1,000) are the lowest they have been for 40 years."
To understand the apparently static figures, they say, it is vital to read between the lines. Since the introduction of free NHS contraception in 1974, the overall trend has been one of decline. Occasional spikes, they argue, are attributable to tangible causes.
For example, in the early 1980s, many under-16s were confused about their right to contraception and concerned that their confidence would be broken. As a result, their attendance figures at family-planning clinics dropped. Government cuts also led to the closure of many services. Although the legal issues surrounding confidentiality were resolved in 1985, it was a further five years before attendance figures recovered.
Then, in the 1990s, an expansion of specialist health services led to a 16 per cent reduction in teenage-pregnancy rates. However, the writers add: "Sadly much of this good work was undermined by the 1995 pill scare." This scare meant that the number of Brook's teenage clients choosing to use the contraceptive pill dropped by a third.
The writers cite the Dutch system - regularly named as one of the best in the world - as an example to follow. The Netherlands has the lowest teenage-pregnancy rate in Europe, at a sixth of that in the UK. They also have one of the lowest abortion rates for teenagers. Importantly, the writers say, they have "an open and accepting attitude towards teenage sexuality, widely available information and sex education, and easy access to confidential contraceptive services".
This, they believe, should be the goal for the UK, as well. "When access to services and information is restricted, the rates go up," they said. "So it's incredibly important that, in these times of austerity, these figures are there to serve as a warning of what can happen as we head down this route again."
The writers argue that it is necessary to engage with young people: "All of us involved with ... sexual health talk about informed choices," they say. "But a choice is only a choice if you know you have it, and have the skills, confidence and opportunity to make it."
Paton, D. "Underage Conceptions and Abortions in England and Wales 1969-2009: the role of public policy" (2012). Education and Health 30 (2), 22-24.
Professor David Paton, University of Nottingham.
Brook, a sexual health charity for young people.