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PAPERS: Alice McLeod Changing patterns of teenage pregnancy: population based study of small areas BMJ 2001; 323: 199-203 [Abstract] [Full text]

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Teenage pregnancies and family structure

Trevor Stammers   (29 July 2001)

Changing patterns of teenage pregnancy

Anne mh Williams   (17 September 2001)

Teenage pregnancies and family structure 29 July 2001
Trevor Stammers, Tutor in General Practice St. George's Hospital Medical School, London Send response to journal: Re: Teenage pregnancies and family structure	Since up to 80% of unintended pregnancies result from contraceptive failure (1), Alice McLeod wisely cautions that "differential access to contraceptive services may be only one component" affecting local variation in rates of teenage pregnancy (2). She mentions the well- established association between socio-economic deprivation and teenage pregnancies. She does not mention however the equally well established link between one-parent families and teenage pregnancy which is graphically illustrated by (though not highlighted in the text of) the 1999 Social Exclusion Report on teenage pregnancy. (3) 14-17 year olds who live in a two-parent family are less likely to have ever had sexual intercourse than young people living in any other family arrangement, even after adjusting for potentially confounding factors such as race, age and socio-economic deprivation. (4) This is hardly surprising, as children whose parents talk to them about sexual matters and provide sexuality education at home are more likely than others to postpone sexual activity. (4) There is likely to be an overall greater chance of good quality communication to both sons and daughters if there are two parents rather than one. Since cohabitations are four times more likely to break up than marriages and less than 4% of cohabitations last ten years or more (5), a child born outside of marriage stands very little chance in their teenage years of being in the optimal family structure associated with the lowest risk of unplanned pregnancy. Without better marriage education and support in the UK (6), our teenage pregnancy rates are likely to remain high even with increasing contraceptive availability. 1. Pearson VAH, Owen MR, Phillips DR, Pereira Gray DJ, Marshall MN. Pregnant teenagers knowledge and use of emergency contraception. BMJ 1995; 310:1644 2. McLeod A. Changing patterns of teenage pregnancy: population based study of small areas. BMJ 2001 323 199-203 3. Social Exclusion Unit Teenage pregnancy p33 Figure 19 London HMSO 1999 4. Blake SM, Simkin L, Ledsky R et al. Effects of parent-child communications intervention on young adolescents' risk for onset of early intercourse. Fam Plan Perspect 2001 33 52-61 5. Morgan P Marriage-lite: The rise of cohabitation and its consequences p13 Institute for the Study of Civil Society (CIVITAS) London 2000 6. www.celebratingmarriage.com (accessed 28.7.2001)
Changing patterns of teenage pregnancy 17 September 2001
Anne mh Williams, GP Glasgow Send response to journal: Re: Changing patterns of teenage pregnancy	As we now have such clear evidence that teenage pregnancy is related to deprivation, surely it becomes a priority to eradicate that deprivation, in our programmes to reduce teenage pregnancy. (1) This paper helps us to conclude that provision of more and more contraception may not be the answer. ‘variation …. may indicate different levels of provision of contraceptive services. However, eradicating the unexplained local variation would make little difference in terms of reducing numbers of pregnancies, compared with reducing the effects of deprivation.’ The evidence calls to question the millions of pounds funding such projects as the “Healthy Respect Project’ in Edinburgh, which seeks to promote the Morning After Pill. As the scientists involved in the project admit: “There has never been a placebo controlled trial of emergency contraception and its efficacy can only be estimated. Calculations used to arrive at estimates of efficacy are inevitably based on poor quality data.” (2) The MAP is certainly not the answer to health risks, as it does not, in any way, protect against diseases and can only serve to increase promiscuity. Sexually Transmitted Infections show an alarming rise amongst young people(3). There is evidence, as we have seen, that teenage pregnancy is associated with socio-economic deprivation so perhaps this problem would be the better one to tackle. 1. Mcleod,A Changing patterns of teenage pregnancy: population based study of small areas BMJ 2001;323:199-203 ( 28 July ) 2. Glasier A., The Science of Emergency Contraception, Abstract. Annual Symposium, Faculty Of Family Planning & Reproductive Health Care, Royal College Of Obstetricians & Gynaecologists 18th May 2001 3. ISD Scottish Statistics 2000 www.show.scot.nhs.uk