Deprivation and variations in teenage conceptions and abortions in England

There are substantial variations between local authorities in the conception rate of teenagers and the proportion of these that end in abortion. This study builds two deprivation models that explain part of the variation in conceptions and abortions. It then identifies outliers, local authorities with teenage conception and abortion rates that are above or below those predicted by the model. It is suggested that the local authorities with lower than expected conceptions are the ones to look to when seeking to discover how to prevent teenage conceptions and those with higher than expected abortion rates may have abortion services that are more accessible. In general, spatial comparisons of conceptions and abortion should take into account variations in deprivation.     

Trends in Family Planning in Russia, 1994–2003

CONTEXT: Although Russian women have adequate knowledge of modern contraceptives, their level of use of these methods has been low, and abortion rates remain relatively high.
METHODS: In 1994–2003, sexually active women aged 18–49 were interviewed about their contraceptive use as part of the Russia Longitudinal Monitoring Survey. Trends in contraceptive use were examined. Multivariate analyses were conducted to identify characteristics associated with reliable contraceptive use (IUD use or consistent oral contraceptive use) in 1994 and 2003.
RESULTS: In each year, about 25% of sexually active women had used no contraceptive method in the past month, and 20% had used traditional methods. Prevalence of barrier method use increased from 9% to 21% between 1994 and 2003, while that of IUD use declined from 34% to 21%. These changes were especially pronounced in Moscow and St. Petersburg, and among younger women. Common reasons for nonuse were irregular sexual relations (cited by 29% of nonusers in 2003), desire for pregnancy (22%), perceived inability to get pregnant (15%), feeling that contraceptives are uncomfortable or unpleasant (15%), health problems (11%) and the availability of abortion (6%). In 1994 and 2003, the odds of reliable contraceptive use were elevated among women with at least a secondary education (odds ratios, 1.5–1.7), and were reduced among smokers (0.6–0.7).
CONCLUSIONS: Modern, effective contraceptive use has not increased among sexually active Russian women. Growing use of barrier contraceptives may reflect HIV awareness. Obstacles to effective contraceptive use, such as attitudes and health service factors, need further clarification.     

Teenage fathers and the fathers of infants of urban, teenage mothers.

Data from Certificates of Live Birth, for recorded resident births in Baltimore in 1983, were used to describe fathers whose child was born to a teenage mother. Four groups were identified: 1) both father and mother were teenagers (12 per cent); 2) only the mother was a teenager (14 per cent); 3) only the father was a teenager (2 per cent); 4) both parents were aged 20 years of above (72 per cent). The fathers in the first three groups appeared at serious educational and financial disadvantage as compared with those where neither parent was a teenager. Within the teenage parent groups, White fathers had lower educational attainment than Black; one in four White fathers was married vs less than 5 per cent of Black. Although limited in scope, the data indicate that disadvantages associated with being a teenage father or the father of an infant born by a teenage mother are clear cut.     

Trends in teenage pregnancy in England and Wales: how can we explain them?

Teenage pregnancy is associated with adverse social and physical outcomes for both mother and child. We drew on various sources--birth and abortion statistics from the Office for National Statistics, data from the National Survey of Sexual Attitudes and Lifestyles, and routinely collected data from family planning clinics--to identify trends in England and Wales and their possible determinants. The rate of teenage sexual activity has increased steadily and consistently over the past four decades, whilst the rate of teenage fertility has shown greater variation. When the teenage fertility rate is calculated against the denominator of sexually active women, rather than the total sample of teenage women, the underlying trend in teenage fertility over the past four decades has been downwards, though not consistently so. Fluctuations in the teenage fertility rate seem to track intervention-related factors such as access to, and use of, contraceptive services and the general climate surrounding the sexual health of young people.     

Perinatal mortality in single and multiple births in Japan, 1980–1991

Summary. Perinatal mortality rates (PMR) decreased significantly per year in single, twin, triplet, quadruplet and quintuplet births during the period 1980–1991. The PMRs were 7.7 per 1000 livebirths for singletons, 45.6 for twins, 89.0 for triplets, 116.8 for quadruplets, and 476.2 for quintuplets during the 12 years. The relative risks of perinatal death in multiplets vs. singletons were 6 for twins, 12 for triplets, 15 for quadruplets and 62 for quintuplets. The PMR was significantly higher in males than females for singletons and twins, but there was no sex differential in PMRs for higher order of multiple births. The PMR increased with birth order in twins and triplets, whereas there was no birth order effect on the PMR for quadruplets. An increasing proportion of multiple births among perinatal deaths may be related to the increasing multiple birth rate in Japan.     

Induced abortions and births. Trends in seven counties, Norway, 1972-1983

This paper discusses the changes in the frequencies of induced abortions and births according to changes in the abortion legislation in Norway during the 1970s. The study material consists of women aged 15-44 years having undergone induced abortion or giving birth in seven Norwegian counties during the period 1972-83. Since the liberalization of the abortion legislation in 1976 and later when the law on abortion on women's request came into force in January 1979, the number of induced abortions per 1000 women 15-44 years of age has decreased by 20%, until December 31, 1983. For no age group has the number of induced abortions per 1000 women increased since the liberalization of the abortion legislation. While the number of terminations of pregnancy per 1000 women below the age of 25 has remained unchanged since 1975, the number of abortions per 1000 women aged 25-29 has decreased by nearly 18% and for women aged 30-44, by 34%. The number of terminated pregnancies per 1000 women of fertile age has shown a decrease corresponding to the reduction in births per 1000 women. Thus the liberalization of the abortion law cannot account for the decreased number of births after 1975.     

Tuberculosis and ethnicity in England and Wales, 1950–70

This article seeks to contribute to recent debates about ethnicity and health by exploring the history of migration and tuberculosis in England and Wales between 1950 and 1970. It concludes that the story was more complex than recent writing, with its emphasis on 'port health' concerns, has implied. The fear that tuberculosis was being imported by migrants was certainly a central concern of both early researchers and the medical establishment. However, some researchers did show some interest in material explanations and in the roles of housing and work patterns in the transmission of the disease. A system of medical examinations at the ports of entry was not in fact implemented and it was at the local level that a system of surveillance was set up. Finally, despite much debate about the susceptibility of migrants, racial concerns were less evident than recent writers have suggested.     

Seasonal variation in adolescent conceptions, induced abortions, and late initiation of prenatal care.

The monthly distribution of conceptions among adolescents and the proportion of adolescent pregnancies that are voluntarily terminated by induced abortion by month of conception are the objects of this study. Additionally, seasonal variations in the timing of initiation of prenatal care services by adolescents are investigated. Vital records files of single live births, fetal deaths, and induced terminations of pregnancy to residents in the State of South Carolina, 1979-86, were aggregated to estimate conceptions. There was a significant difference between adolescents and adults in the monthly distribution of conceptions. The peak month of adolescent conceptions coincided with the end of the school year. Pregnancies of adolescents occurring at this time further demonstrated later access of prenatal care services than conceptions occurring at other times of the year, most notably during the school term. These findings suggest that there is considerable opportunity for improving the availability of reproductive health care services for adolescents. The results specifically suggest the potential benefit of increasing adolescent pregnancy prevention efforts prior to high-risk events and increasing the availability of and access to health care and counseling services to adolescents during the school recess months of the summer.     

Adolescent pregnancy, infant mortality, and source of payment for birth: Alabama residential live births, 1991-1994.

PURPOSE: To assess potential impact of programs to prevent adolescent pregnancy on infant mortality. METHODS: Infants (n = 247,503) born alive to Alabama residents from 1991 to 1994 were identified from birth cohort files and linked to infant death records. Deliveries funded by Medicaid, private insurance, and self-payers were studied separately. Relative risks (RR) and population attributable risks were calculated. The latter provided estimated percentages by which infant (<1 year) death risks would have decreased if adolescent (< or =19 years) pregnancies had been prevented. RESULTS: Infants of mothers <16 years of age were at higher risk of death than were infants of mothers aged 20 to 34 years (adults): the RRs were 4.1, 3.4, and 1.4 for self-payers, private insurance, and Medicaid groups, respectively. In the self-payer and private insurance groups, but not the Medicaid group, infants of mothers aged 17 to 19 years were more likely to die than were infants of adults. Infants from repeat adolescent pregnancies comprised nearly one-third of all infants born to adolescents, and in each payer-group were more likely to die than were infants of adults: The RRs were 4.9, 2.5, and 1.3 for self-payers, private-insurance, and Medicaid groups, respectively. Theoretically, preventing all adolescent pregnancies and preventing only repeat adolescent pregnancies would have reduced infant mortality in the total population by 8% and 4%, respectively. CONCLUSIONS: Programs to prevent first and subsequent adolescent pregnancies probably have little effect on infant mortality. Efforts to prevent adolescent pregnancies should not have a short-term goal of notably reducing infant mortality.     

Comparison of cancer deaths in England and Wales and the Developed World by age and gender 1973–92, and, new malignancies in England and Wales 1971–88

Cancer deaths in England and Wales and the developed world were examined by age and gender between1973–1992. Whilst over-all mortality levels increased, this was mainly linked to extended longevity, as the rate fell substantially for people under 55 in the majority of countries, possibly as a result of improved treatment and prevention outcomes.Whilst England and Wales had above average reductions in cancer deaths, especially for children, there wereconsiderable rises in new malignancies, 1971–88, particularly amongst women under 35 years, and in certain selected sites.These over-all changes do not appear to be the result of improved diagnosis, thus, despite evidence of moreeffective therapeutic and preventative measures the incidence of new malignancies is increasing. The possible implications are briefly discussed, in the context of ‘medical audit’, which increasing uses mortatlity rates as ‘indicators of effectiveness’.     

Are our data on teenage pregnancy across ethnic groups in England fit for the purpose of policy formulation,implementation, and monitoring?

The Teenage Pregnancy Strategy for England has a Public Service Agreement target to substantially reduce the level of teenage pregnancies by 2010. It argues that all the main risk factors need to be incorporated into risk assessments undertaken by agencies and professionals. These include deprivation, poor educational attainment and disengagement from school, and ethnicity, the last's association with high teenage pregnancy rates being independent of deprivation. The strategy adds, too, that local areas should target delivery of their local strategy more intensively on these groups most at risk. An attempt is made to systematically review the evidence on the availability and quality of ethnicity data on maternities and abortions, based on extensive structured searches of a wide range of abstracted and full-text literature and statistical sources published 1997–2008. This reveals that, in practice, local teenage pregnancy strategies have little, if any, ethnically coded data to draw upon and it is not surprising that they have had difficulties in targeting these groups. The experience of other countries demonstrates that data of quality can be collected on teenage pregnancy if this is prioritised. The Race Relations (Amendment) Act 2000 should be used to catalyse statutory agencies to set up the necessary systems to ensure that collection of teenage pregnancy data by ethnic group is routine and robust.     

Contraceptive medicalisation, fear of infertility and teenage pregnancy in Brazil

In Brazil, as in many other countries, teenage pregnancy is widely recognised as a public health problem. Buttressed by a public health science of the economics of teenage pregnancy that emphasises the postponement of parenthood as key to poverty reduction, young people's lack of appreciation for medical knowledge of contraceptives is most often credited for failed attempts to reduce teenage pregnancy. Based on a longitudinal ethnographic study conducted in Pelotas, Brazil, with young people over the course of 10 years, our study found that young women who became teenage parents did not lack medical knowledge but were, rather, highly medicalised. Not only were they intensely concerned with the ill-effects of oral contraceptives on possible future fertility, they also engaged in intricate routines of contraceptive-use as a way of testing and safeguarding their fecundity. Our analysis attends to the way these practices are shaped by the problematisation of the economics of teenage pregnancy, as well as by the gendering of cultural norms relating to the transition to adulthood. We theorise the results by considering how contraceptive medicalisation enabled some women to engage with the authority of normative society, while developing a potent off-stage critique of this authority and of what they considered to be discriminatory messages imbedded in scientific discourses on teenage pregnancy.     

Domestic violence,single parenthood,and fathers in the setting of teenage pregnancy

PurposeTo explore the relative impact of demographic and early interpersonal family relationships as associations of fatherhood where the mother is a teenager, compared to where the mother is over 20 years of age.MethodA prospective cross-sectional cohort study was undertaken. Institutional ethics committee approval and informed consent were obtained. Data were analyzed from interviews with consecutive males about to become fathers where the mother was aged less than 20 years (teenage) and compared to information from males about to become fathers where the mother was aged 20 years or more (control). Subjects were interviewed to obtain information covering their early life experiences, demographic information, drug use, opinion of the pregnancy, and future planning.ResultsIn multivariate analysis, and after controlling for family income and education, the following factors had a significant independent association with fatherhood in the setting of teenage pregnancy: a history of parental separation/divorce in early childhood, exposure to family violence in early childhood, and illicit drug use (ever or in pregnancy).ConclusionsFathers, in the setting of teenage pregnancy, are more likely to report adverse early family relationships, such as exposure to domestic violence or parental separation or divorce. As such, these fathers may lack a positive role model for parenting and fatherhood.     

Trends and disparities among diabetes-complicated births in Minnesota, 1993-2003

We used Minnesota birth certificate data from 1993-2003 to test 2 hypotheses: rates of diabetes-complicated pregnancy are increasing, and disparities between more and less socially advantaged groups are widening. Significant increases occurred in rates (per 1000 live births) of prepregnancy and gestational diabetes mellitus (from 2.6 to 4.9 and 25.6 to 34.8, respectively). Increases were significant in all demographic groups except gestational diabetes among American Indian mothers, and disparities worsened among all groups. Targeted interventions and surveillance improvements are needed.     

Contraceptive medicalisation,fear of infertility and teenage pregnancy in Brazil

In Brazil, as in many other countries, teenage pregnancy is widely recognised as a public health problem. Buttressed by a public health science of the economics of teenage pregnancy that emphasises the postponement of parenthood as key to poverty reduction, young people's lack of appreciation for medical knowledge of contraceptives is most often credited for failed attempts to reduce teenage pregnancy. Based on a longitudinal ethnographic study conducted in Pelotas, Brazil, with young people over the course of 10 years, our study found that young women who became teenage parents did not lack medical knowledge but were, rather, highly medicalised. Not only were they intensely concerned with the ill-effects of oral contraceptives on possible future fertility, they also engaged in intricate routines of contraceptive-use as a way of testing and safeguarding their fecundity. Our analysis attends to the way these practices are shaped by the problematisation of the economics of teenage pregnancy, as well as by the gendering of cultural norms relating to the transition to adulthood. We theorise the results by considering how contraceptive medicalisation enabled some women to engage with the authority of normative society, while developing a potent off-stage critique of this authority and of what they considered to be discriminatory messages imbedded in scientific discourses on teenage pregnancy.