How effective was England’s teenage pregnancy strategy? A comparative analysis of high-income countries

Baxter, A. J. , Dundas, R. , Popham, F. and Craig, P. (2021) How effective was England’s teenage pregnancy strategy? A comparative analysis of high-income countries. Social Science and Medicine, 270, 113685. (doi: 10.1016/j.socscimed.2021.113685) (PMID:33434717)

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Abstract

Teenage pregnancy is associated with numerous health risks, both to mothers and infants, and may contribute to entrenched social inequalities. In countries with high rates of teenage pregnancy there is disagreement on effective action to reduce rates. England’s Teenage Pregnancy Strategy, which cost £280 million over its ten year implementation period, has been highlighted as an effective way of reducing pregnancies after rates fell by more than 50% from 1998 to 2014 and widely advocated as a replicable model for other countries. However, it is not clear whether the fall is attributable to the strategy or to background trends and other events. We aimed to evaluate the impact of the Teenage Pregnancy Strategy on pregnancy and birth rates using comparators. We compared under-18 pregnancy rates in England with Scotland and Wales using interrupted time series methods. We compared under-18 birth rates and under-20 pregnancy rates in England with European and English-speaking high-income countries using synthetic control methods. In the controlled interrupted time series analyses, trends in rates of teenage pregnancy in England closely followed those in Scotland (0.08 fewer pregnancies per 1,000 women per year in England; -0.74 to 0.59) and Wales (0.14 more pregnancies per 1,000 women per year in England; -0.48 to 0.76). In synthetic control analyses, under-18 birth rates were very similar in England and the synthetic control. Under-20 pregnancy rates were marginally higher in England than control. Although teenage pregnancies and births in England fell following implementation of the Teenage Pregnancy Strategy, comparisons with other countries suggest the strategy had little, if any, effect on pregnancy rates. This raises doubts about whether the strategy should be used as a model for future public health interventions in countries aiming to reduce teenage pregnancy.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Craig, Professor Peter and Baxter, Andrew and Popham, Dr Frank and Dundas, Ms Ruth
Creator Roles:
Baxter, A. J.Conceptualization, Methodology, Software, Formal analysis, Investigation, Resources, Data curation, Writing – original draft, Writing – review and editing, Visualization, Project administration
Dundas, R.Conceptualization, Writing – review and editing, Supervision, Funding acquisition
Popham, F.Conceptualization, Writing – review and editing, Supervision, Funding acquisition
Craig, P.Conceptualization, Writing – review and editing, Supervision, Funding acquisition
Authors: Baxter, A. J., Dundas, R., Popham, F., and Craig, P.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > MRC/CSO SPHSU
Journal Name:Social Science and Medicine
Publisher:Elsevier
ISSN:0277-9536
ISSN (Online):1873-5347
Published Online:06 January 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in Social Science and Medicine 270:113685
Publisher Policy:Reproduced under a Creative Commons license

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
727651SPHSU Core Renewal: Measuring and Analysing Socioeconomic Inequalities in Health Research ProgrammeAlastair LeylandMedical Research Council (MRC)MC_UU_12017/13IHW - MRC/CSO SPHU
727671SPHSU Core Renewal: Informing Healthy Public Policy Research ProgrammePeter CraigMedical Research Council (MRC)MC_UU_12017/15IHW - MRC/CSO SPHU
Chief Scientist Office (CSO)SPHSU13
Chief Scientist Office (CSO)SPHSU15