Teenage pregnancy is not a public health problem
BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7326.1428 (Published 15 December 2001) Cite this as: BMJ 2001;323:1428
- Debbie Lawlor, lecturer in epidemiology and public health medicine (D.A.Lawlor{at}bristol.ac.uk),
- Mary Shaw, senior research fellow,
- Sarah Johns, PhD student
- Department of Social Medicine, University of Bristol, Bristol BS8 2PR
- School of Geographical Sciences, University of Bristol, Bristol BS8 1SS
EDITOR—We agree with Smith and Pell's interpretation of their own and others' results that first teenage pregnancies are not associated with adverse outcomes, but we disagree with their conclusion that the associations they found between second teenage pregnancy and risk of preterm delivery and stillbirth indicate causation.1 The most likely explanation is a combination of inadequate control for socioeconomic position, which the authors concede, and differences in the interval between pregnancies among teenage compared with older mothers.
Differences in pregnancy spacing cannot be rejected as an explanation, as the authors attempt to do, without its impact in this study being assessed. Furthermore, the authors do not consider the possible impact of differences in antenatal care between pregnant teenagers and older women in any of their analyses.
Health professionals should not accept without challenge the myth that teenage pregnancy is an important public health problem in the way that these authors do. There is no biological reason to suggest that having a baby before the age of 20 is associated with ill health. It is increasingly common for women to delay their first birth until they are in their 30s; the mean age at first birth for married women in England and Wales was 29.3 in 1999. This is despite the increased risk of chromosomal abnormalities and complications of pregnancy in this age group.
Women having babies in their 30s and 40s are not labelled a public health problem, and neither are women who have problems conceiving, even though their babies have an increased risk of perinatal death.2 This so called public health problem of teenage pregnancy is really a reflection of what is considered to be socially, culturally, and economically acceptable in the United Kingdom.
Current policy in the United Kingdom aims, firstly, to halve the conception rate of the under 18s and set a downward trend in the rate for under 16s by 2010 and, secondly, to achieve a reduction in the risk of long term social exclusion of teenage parents and their children.3 We would argue that the second of these goals is the appropriate public health aim, and yet most action is likely to be geared towards the first. A primary care group in Bristol received funds from the local health authority's inequalities budget to undertake work towards achieving the first of these targets only.4
Teenage pregnancy is not a public health problem; the cumulative effect of social and economic exclusion on the health of mothers and their babies, whatever their age, is.