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Teenage Pregnancy: Who suffers?

16 February 2011

Dr. Shantini Paranjothy, Clinical Senior LecturerPublic Health Medicine

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Overview• Epidemiology of teenage pregnancy

• Impact on health and well-being of mother, baby, father

• Giving every child the best start in life– avoiding teenage pregnancy– supporting teenage parents

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Live birth rate to women aged 15–19. (1999 figures)[Source: Eurostat & Centre for Sexual Health Research, Southampton]

Lawlor et al. R Soc Med. 2004 March; 97(3): 121–123

Definitions

• Conceptions = pregnancies resulting in live births, stillbirths or legal terminations– Under 20 (13 – 19 years) – Under 18 (13 – 17 years)– Under 16 (13 – 15 years)

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Conception rates E & W

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Conception rates 2008 (<18)

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Per 1,000 women

Conceptions (<18) in Wales

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Per 1,000 women (2008 data)

Conceptions (<18) by WIMD

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1998-02 2000-04 2002-06 2004-08Ratio: Most deprived to

Middle deprived fifth 1.89 1.75 1.61 1.67

Source: STATSWALES

Conceptions 2008 (E & W)

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Who suffers?

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Evidence for risk factors (girls)

RIPPLE study (longitudinal data)1997 – 2001(Allen E JECH 2007;61:20-27)

Factor Univariate OR Adjusted OR

Lack of expectation of education at age 20

4.6 (1.8, 11.6) 8.4 (1.2, 56.7)

Expectation of being a parent at age 20

2.7 (1.2, 6.4) 1.9 (0.6, 6.0)

Drunk monthly or more 4.8 (3.1, 7.3) 2.1 (1.2, 4.0)

Peer pressure to have sex early 0.9 (0.6, 1.5) 2.1 (1.2, 3.7)

Easy communication with mother or female guardian

0.4 (0.2, 0.8) 0.3 (0.1, 0.7)

Main source of information includes school

0.4 (0.2, 0.9) 0.7 (0.3, 2.1)

Who suffers?

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• Mother

• Baby

• Father

Obstetric complications

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• Anaemia (Hb<10g/dl)

• Pregnancy induced hypertension

• Assisted births

Maternal mortality

• Overall rate 14 per 100,000• <20 9.9 per 100,000• 46% in most deprived compared

with least deprived• Unemployment

– RR 7.4 (95%CI 5.6, 9.0)

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Psycho-social outcomes

• More mental health difficulties• More emotional and behavioural

problems• Less likely to complete education

and training• More likely to be living in poverty

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Longer term mortality

Compared to mothers aged 20-24– 70% increased risk of premature death

in mothers <17 years– 50% increased risk in mothers aged

18 – 19 years– Causes of death:

• Cervical cancer, Ischaemic Heart disease, suicide, violence assault, homicide

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Source: Int J Obstet Gynaecol 2004; 111:793-9

Who suffers?

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• Mother

• Baby

• Father

Adverse baby outcomes

• Pre-term birth• Low birth weight• Small for gestational age• Neonatal mortality• Infant mortality

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Smoking during pregnancy

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Breastfeeding rates

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Early years outcomes

• Increased risk of – Harm, illness, accidents and injuries– Cognitive, behavioural and emotional

complications

• Attributable to mother’s mental state rather than young age

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Who suffers?

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• Mother

• Baby

• Father

Evidence for risk factors (boys)

RIPPLE study (longitudinal data)1997 – 2001(Allen E JECH 2007;61:20-27)Outcome: pregnancy initiated by teenage boys

Factor Univariate OR Adjusted OR

Expectation of being a parent at age 20

2.5 (1.1, 5.5) 0.7 (0.2, 2.5)

Drunk monthly or more 3.4 (2.1, 5.5) 3.9 (1.7, 8.6)

Peer pressure to have sex early 3.7 (1.9, 7.3) 2.8 (0.7, 10.7)

Intent to skip school 3.5 (2.0, 6.2) 1.9 (0.6, 6.2)

Ability to identify sexual health services

1.0 (0.7, 1.5) 0.3 (0.1, 0.7)

Main source of information includes school

0.4 (0.2, 0.8) 0.4 (0.2, 0.9)

Young fathers

• Feel excluded

• Low earning potential– Damaging confidence and sense of self

• Benchmark against their own fathers

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Paternal health outcomes

• Poorly studied!

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Give every child the best start in life

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Give every child the best start in life

• Target to halve the under-18 conception rate in England by 2010 from the 1998 rate of 46.6 per 1,000

• 13% reduction in 2008

• Beyond 2010

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• Increase sexual health and relationships literacy

• Improve access to good quality sexual health services

• Reduce the number of unintended pregnancies, particularly among teenage girls

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Reproductive and Early years pathfinderInstitute of Public Health

PRIMARY OUTCOMES

Birth outcomes:

Birth weight, gestational age, congenital malformations, stillbirth, perinatal mortality

Child health outcomes: nutrition, growth, development hospital admissions, infection, respiratory health, injuries, education, obesity deaths.

Women’s health

Preconception, physical and mental health, smoking, alcohol, nutrition,

recreational drug use

Vulnerable groups e.g. teenage mothers

Intrauterine exposures

Health & Social Care

(Service Design and Quality)

Provision of health services, access, standards and quality of care

Fertility- time to pregnancy

Environmental exposures: Housing, neighbourhood and workplace

Life course outcomes

Reproductive and Early years pathfinderInstitute of Public Health

– Monitor epidemiology of the life course up to age 5

– Relate to evidence for effectiveness and current programmes in Wales

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