Preventing unintended teenage pregnancies and reducing their adverse effects.

Introduction This paper summarises the results of a systematic review of the research evidence on approaches to preventing teenage pregnancy and alleviating the direct negative health and social effects of teenage pregnancy. It is based on an issue of Effective Health Care, Vol 3, No 1,1 and full details of the systematic review are available elsewhere.2 The United Kingdom has the highest teenage pregnancy rate among 15-19 year olds in Western Europe. However, the rate of conceptions in the 16-19 year old age group has been decreasing since 1990 and the rate is currently 56.8 per 1000. In the under 16 year olds the rate has been steady over the past 20 years3 despite evidence that young people are starting intercourse at an earlier age.4 In England and Wales, the Health of the Nation strategy has identified the prevention of pregnancy in under 16 year olds as a priority area, with a target to reduce the rate of conceptions from 9.6 per 1000 in 1989 to 4.8 per 1000 by the year 2000.5 The most recent figures show that the rate of conceptions in under 16 year olds is currently at 8.3 per 1000.' This rate varies across districts, ranging from 4.2 to 19.3 per 1000 in 1993.6 For many young women pregnancy and motherhood are positive and welcomed experiences without long term negative outcomes.7-9 However, compared with women aged 20 to 35, teenagers are at higher risk of experiencing adverse health, and more importantly, educational, social, and economic outcomes (table 1). 10 17 Teenage pregnancies may also result in significant public costs."8 19 About half of the pregnancies among under 16 year olds and a third of the pregnancies among 16-19 year olds are terminated.' These terminations can have an adverse effect on the health of teenagers. Pregnant teenagers who have a miscarriage may also suffer due to inadequate support. Several factors are associated with early sexual initiation, non-use of contraception, and teenage pregnancy. These include social influences, health service, and socioeconomic factors, as well as individual characteristics. Pregnancy rates are higher in more socially deprived areas and in areas with less public welfare services, and the proportion of pregnancies terminated are lower.2"" The associated burden of unintended pregnancy may therefore be greater in poorer localities. Particular groups at increased risk of pregnancy during the teenage years include daughters of teenage mothers, young people "looked after" by the local authority and leaving care, school non-attendees due to truancy or exclusion, and homeless or runaway teenagers.