Teenage pregnancy: a problem or what?
In England and Wales, the average age of childbearing is 29.1 years and the average woman has her first baby at 27.1 Over the past 30 years, these ages have risen but the rate of teenage pregnancy has hardly changed.2 There is a widening gap in the UK between the majority of women and the minority who start their families in their teens. Does this represent the increasing isolation of an underclass?
Britain's rate of teenage pregnancy is the highest in the EU. Elsewhere in Europe, levels of teenage childbearing have been falling since the 1970s,3 but high rates have persisted in Britain, in Iceland4 and, further afield, in Canada, Australia and New Zealand.5 The USA has by far the highest rate of teenage pregnancy in the developed world, despite a steady fall since the 1950s.6
Persistent high rates in the English-speaking countries have been attributed to their ambivalent attitudes to contraception, sex education and mass communication about sexuality, their welfare provision for unmarried mothers and their social inequalities.3 It is widely believed that teenage motherhood is a self-perpetuating cycle,7 but in a recent study, mother–daughter repetition accounted for only a minor part of the difference in teenage childbearing between Britain and France.3
Is teenage pregnancy a bad thing?
The UK government is trying to tackle this issue,8 but some doctors feel it is not a problem. Recently, in the Lancet, a general practitioner argued that prejudice against teenage pregnancy is misplaced, and that teenagers are better suited, physically and mentally, for pregnancy than older, more materialistic couples. ‘Fertility problems are minimal, risks of congenital abnormality are low, there are fewer pregnancy complications, and later risks of breast cancer for women are reduced’.9
A similar view was expressed in the International Journal of Epidemiology by Lawlor and Shaw, from a department of social medicine: ‘We do not believe that labelling a woman who chooses to have a baby under the age of twenty as a public health problem actually helps the mother or her child’.10 Other contributors countered that teenage pregnancy is associated with increased risk of poor social, economic and health outcomes for mother and child,7,11 but Lawlor and Shaw concluded that ‘there are no inherent health or medical problems associated with…having a child before the age of 20’.12
The teenage mothers themselves do not feel they have a problem. In a Texan study, pregnant adolescent girls (mean age 16) rated their quality of life as reasonably satisfactory: 92% belonged to a racial-ethnic minority and all qualified for Medicaid.13 In England, a study by Barrell14 of adolescent mothers found that they had mature attitudes but none had planned their pregnancy and for most of them, pregnancy had been preceded by chronic truancy.
What happens afterwards?
Teenagers generally do well in pregnancy. Their caesarean section rate is 13.4% compared with 33.4% among women aged over 40.15 Their maternal mortality rate is 8.2/100,000, slightly higher than the maternal mortality rate of 7.2 for women aged 20–24 but much lower than the maternal mortality rate of 35.5 for women over 40.16
Their babies do not do so well, however. In the USA, infant mortality is 8.1/1000 for mothers aged 15 or under, compared with 5.4/1000 for 18–19 year olds. This is partly because of higher risks of preterm delivery and low birthweight.17 Healthy term babies are also at increased risk. Postneonatal mortality for infants of mothers aged 15 or under is 3.2/1000 compared with 0.8/1000 for mothers aged 23–29, with older teenagers in between.18
Teenage mothers face long term health risks. On pp. 793–799 Olausson et al.19 report an increased risk of premature death among women who had babies as teenagers. The relative risk was 1.6 and causes of death included cervical and lung cancer, heart disease, violence and alcohol-related diseases. Olausson concludes that the increased death rates were not due to the pregnancy itself but to lifestyle factors that accompany teenage pregnancy.
This study was performed in Sweden, where teenage pregnancy rates are relatively low, so the subjects may have been a group at higher risk than their UK counterparts. In all developed countries, however, teenage pregnancy is a marker of deprivation. In England and Wales, between one-third and one-half of conceptions are terminated in this age group.2 In Greece, 57% of pregnancies among women aged 15–19 are terminated.20 Social factors associated with teenage pregnancy include substance abuse, violence and poor scholastic performance, and rates of depression among teenage mothers may be as high as 44%.6
What should be done?
One of the UK government's priorities is to help teenage girls avoid unwanted pregnancy.8 Given the complexity of their social difficulties, however, it is not surprising that this is proving difficult. A sex education programme developed in Scotland for 13–15 year olds failed to reduce sexual risk-taking behaviour21 and a systematic review of strategies for preventing teenage pregnancy concluded that none of them is effective.22
Those who decide to keep their babies should be treated with respect23 and require support during and after pregnancy. Increasing numbers of hospitals are setting up specific antenatal clinics for teenage mothers.24 Barrell describes a Pupil Referral Unit where adolescent mothers can receive the support which they clearly need.14 In Dundee, a clinic aimed at changing dietary habits among pregnant teenagers was helpful to those who used it but the difficulty was persuading girls to attend.25
In an Australian study, 20% of teenagers attending an antenatal clinic used marijuana and some used multiple drugs. Of the remainder, about 50% were ex-users who had given up when they became pregnant. With good antenatal care, however, pregnancy outcomes were almost as good as for other women.26 The same researchers carried out a randomised controlled trial of a programme of postnatal visits to teenage mothers. Visits were associated with a reduction in adverse neonatal outcomes and a significant increase in contraceptive knowledge, but did not affect breastfeeding or infant vaccination knowledge or compliance.27
Opinions on teenage pregnancy are sometimes polarised and often reflect prejudice of one kind or another. There should be no conflict between a strategy of trying to reduce unwanted pregnancies and one of supporting teenagers who decide to have babies. Both policies aim to reduce the frighteningly short cycle of deprivation that can harm teenage mothers and their children.