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LETTERS: Debbie Lawlor, Mary Shaw, and Sarah Johns Teenage pregnancy is not a public health problem BMJ 2001; 323: 1428 [Full text]

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Early childbearing is sometimes rational

Lisa Arai   (19 December 2001)

Teenage Pregnancy is a Public Health Problem

Aliki Taylor, Sheena Stewart; Kim Tanner; Gillian Cooper   (17 January 2002)

Early childbearing is sometimes rational 19 December 2001
Lisa Arai, Research student Dept of Geography, Queen Mary, U. of London E1 4NS Send response to journal: Re: Early childbearing is sometimes rational	It is refreshing to hear an alternative perspective on the 'problem' of teenage pregnancy. Lawlor and colleagues are justified in pointing out that adolescent childbearing does not always have the dire health consequences that is commonly believed. The literature that is used to justify the idea of adolescent childbearing as disadvantageous for the adolescent mother and her children is highly selective. In the Social Exclusion Unit's (1) report on teenage pregnancy, there is no mention of the positive health benefits of having children young. Yet, the children of teenage mothers can fare as well as those born to older women (2) and early childbearing can protect women from breast cancer (3) and their children from diabetes (4). In the States, Arline Geronimus and colleagues (4) have demonstrated that early childbearing is a rational behaviour in poor and chronically ill populations. Should poor women in depressed environments (where there are, in addition, likely to be few educational or vocational opportunities to interfere with early childbearing) defer having children till their twenties or later, their health would have deteriorated to such a extent that childbearing might be jeopardised. Their much-needed kin support networks might also be diminished due to the ill health or early deaths of parents and siblings. By having their children whilst in their teens, some women are having children at the optimal time. British teenagers who become parents might also be behaving rationally, given the constraints of their environments (socio-economic inequality being the major one). If this is the case, we should resist the tendency to see adolescent pregnancy and childbearing as pathological; it will not help either teenage parents or their children. (1)Social Exclusion Unit. Teenage pregnancy. London: Stationery Office, 1999 (2)Wolkind SN, Kruk S.Teenage pregnancy and motherhood.J R Soc Med. 1985 Feb;78(2):112-6. (3)McPherson, C M Steel, J M Dixon. ABC of breast diseases Breast cancer epidemiology, risk factors, and genetics. BMJ BMJ 2000;321:624-628 ( 9 September ) (4)Bingley, P.J.Douek, I.F., Rogers, C.A, Gale, E.A.M. Influence of maternal age at delivery and birth order on risk of type 1 diabetes in childhood: prospective population based family study. BMJ 2000;321:420-424 ( 12 August ) (5)Geronimus AT, Bound J, Waidmann TA. Health inequality and population variation in fertility-timing. Soc Sci Med. 1999 Dec;49(12):1623-36
Teenage Pregnancy is a Public Health Problem 17 January 2002
Aliki Taylor, Specialist Registrar in Public Health Medicine University of Birmingham, Sheena Stewart; Kim Tanner; Gillian Cooper Send response to journal: Re: Teenage Pregnancy is a Public Health Problem	Editor – We agree with the authors Lawlor, Shaw and Johns (1) who feel that teenage pregnancy in itself is not biologically harmful, but feel strongly that teenage pregnancy is a public health problem. High teenage pregnancy rates are linked to high levels of social exclusion, and poor knowledge of contraception (2). Many teenage pregnancies are unplanned, and being a teenage parent can lead to an increase in relative poverty, unemployment, poorer educational achievements and poor health of the child born (2)(3). It is recommended that plans to reduce teenage pregnancies focus on unintended conceptions, otherwise higher abortion rates alone could lead to reduced teenage pregnancies. Effective ways of reducing unintended conceptions include improved access to services, better sex education and linking into plans to reduce sexually transmitted infections (STIs) (4). Rates of STIs in teenage girls and young men are high and an important public health problem (5). In Redditch a Multi-agency Task Group was set up in 1999 with representation from General Practice, Public Health Medicine, Sexual Health Education Services, Midwifery Services, Community Health Council, Local Authority, Redditch Youth Services, Genito-Urinary Medicine, School Nursing, and Voluntary Services. The aim of the group was to improve the sexual health of young people there, as part of locality Health Improvement Programme. A Young Persons' clinic was soon set up in a ward with the highest local rates of teenage conceptions, and its staff included a male youth worker and young volunteers. Over a recent three- month period, there were 120 visits for one-to-one advice including 92 by young boys, mostly aged 13-15 years. Groups of young people were involved in auditing primary care services for accessibility and confidentiality and they designed posters, leaflets and a sexual health website. There was increased access to free emergency contraception at selected pharmacies in a Worcestershire wide pilot. Plans are being developed to improve the sexual health of young men and ethnic minorities, and develop other Young Persons Clinics locally. It is clear that young people need more accessible sexual health services, and that teenage conceptions are not always planned or wanted. High teenage pregnancy rates are a reflection of poor sexual health practice, which is a public health issue. The improvement of sexual health services and improved sex education can result in fewer pregnancies and STIs and healthier sexual attitudes and behaviour. (1) Lawlor D, Shaw M, Johns S. Teenage Pregnancy in not a public health problem. British Medical Journal 2001; 323:1428. (2) Social Exclusion Unit. Teenage Pregnancy. London, HMSO, 1999. (3) Dickson R, Fullerton D, Eastwood A, Sheldon T, Sharp F, Information Staff of CRD. Preventing and reducing the adverse effects of unintended teenage pregnancies. Effective Health Care 1997; 3: 1-12. (4) Kane R, Wellings K. Reducing the rate of teenage conceptions. An international view of the evidence: data from Europe. Oxford: Health Education Authority, 1999. (5) Public Health Laboratory Service, Department of Health and Social Security & PS and the Scottish ISD (D) 5 Collaborative Group. Trends in sexually transmitted infections in the United Kingdom: 1990-1999: New Episodes seen at genito-urinary clinics. London: Public Health Laboratory Service,2000.