Despite the significant decline in the under 18 deaths in the last decade, as Zhou, Puradiredja, and Abel (2016) note, the UK remains the nation with the highest teenage pregnancy in Western Europe. The problem has been present since the end of last century. According to Wellings et al. (2016), at the end of the 20th century, there were concerns about the high rates of teenage conception in the UK compared to the western neighbours. However, in 1999, the UK government launched a campaign against teenage pregnancy, named the 10-year nationwide Teenage Pregnancy Strategy, and aimed at reducing teenage conception by 50% by 2010. For this reason, teenage pregnancy has been a complex public health problem in England. Pregnancy among girls under the age of 18 has doubled across different regions in England; every year over 40,000 teenagers become pregnant, with 50% of these pregnancies ending up in abortion, which has become an unavoidable cost to the National Health Standard (NHS). Also data from Office of National Statistic (2013) show that the rate of teenage motherhood in England is higher among mothers of Black Caribbean. (Primarolo and Merron, 2010); Royal College of Nursing, 2014-17).
With the arrival of the 21st century, perceptions and beliefs considering teenage pregnancy as shameful have long passed but still England is condemned critically for its historical records regarding poverty, educational failure and social exclusion of the teenage mothers. Furthermore, critics in the past have argued that England was only focusing on rectifying the medical problems associated with teenage pregnancy i.e. controlling prenatal mortality rates, reducing teenage pregnancies and abortion rates while a very little effort is taken to avoid disrupted young lives (Hartney et al., 2015; Scally, 2002). For this reason, Public Health England, as Hartley et al. (2015) posit, identified teenage pregnancy as a public health issue, and through the Teenage Pregnancy Strategy, started contributing vitally to bring positive changes in the problem. In regarding teenage pregnancy as public health issue, England has extended its focus around the social, psychological and biological well-beings of the teenage pregnant girls beyond mere medical focus. The current national and international policies and developments in public health for teenage pregnancy in England critically exemplify these positive changes (Primarolo & Merron, 2010).
In line with this debate, the essay offers a critical analysis of the teenage pregnancy in England as a Public Health issue. It extends the discussion to investigate the epidemiological data and related performance of healthcare system. It further answers the following questions: How national and international policies for health improvement or promotion in England relate to the World Health Organisation (WHO) policy. How does the country address inequalities in health at different geographical levels and between various population groups? What is the current level of performance effectiveness of various health promotion, health protection, and health improvement interventions?
Before moving towards the evaluation and analysis of teenage pregnancy in England, it is necessary to conceptualise theoretical understanding of public health. Health care literature defines a public health problem as The science and art of preventing disease, prolonging life and promoting health through organised efforts of society (Bailey, 2005, p. 316). Literature has highlighted that the public health care approach stresses on the collective and shared responsibility of the state actors. According to Turnock & Turnock, (2009), public health problems require the state to concentrate on the in-depth socioeconomic aspects and extensive set of determinants of health and disease. In this approach, all possible sorts of partnerships with the states and international actor are recognised, which are essential for the improved health of the population. Additionally, when a health problem is realised as public health problem, the country tends to utilise all the quantitative and qualitative models and approaches for tackling the issue (Turnock & Turnock, 2009). Examination of all these elements could offer a critical examination of how England is tackling teenage pregnancy as a public health issue in line with the theories.
To understand the patterns of distribution of teenage pregnancy, a recently published report in 2016 by Office of National Statistics (ONS) can be used. The report exhibits how teenage pregnancy has doubled in different parts of England. The large region of England is reporting an average of 97 teenage pregnancies per every 1000 women under 15 to 17 years (9.7%). The data is presented in the Figure 1 below:
Figure 1: Patterns of Teenage Pregnancies in England (Office of National Statistics (ONS), 2016, p. 11)
England and Wales
Conception rate per thousand women aged 15 to 17
Rank Local Authority Number of Conceptions 2014 2014 2013 1998
1 Nuneaton and Bedworth 97 43.0 29.7 48.8
2 Stoke-on-Trent 176 42.4 43.9 68.5
3 Tamworth 60 42.0 44.0 55.7
4 North East Lincolnshire 117 40.8 43.3 69.8
5 Kingston upon Hull, City of 164 39.3 35.9 84.6
6 Preston 91 38.6 35.7 49.7
7 Sandwell 219 38.3 36.6 69.1
8 Norwich 68 38.1 31.4 53.7
9 Walsall 198 37.5 36.8 67.2
10 Blackpool 95 37.3 41.7 64.8
Source: Office for National Statistics
Additionally, the distribution of teenage pregnancies in England can be traced within the category of birth inside marriage (1067 in 2008) less than the rate of birth out of wedlock (14,189 in 2008). Similarly, the percentage of the teenage parents living at different addresses (16,120 in 2008) has been reported higher compared to the proportion of the parents living at same address (14,189 in 2008) (Ruddock & Davies, 2013).
Further, the Office for National Statistics has also reflected the declining trends of teenage pregnancy in the general population. In measuring conception rates for 2014, ONS reports that teenage pregnancy is declining since 2008 across England. The teenage pregnancy rates were categorised into following categories i.e. under 18 conceptions and 20 conceptions.
Figure 2: Age-wise Pregnancy Distribution (Office of National Statistics (ONS), 2016)
Figure SEQ Figure \* ARABIC \s 1 3: Teenage Pregnancy Trends for women under 18 (Office of National Statistics (ONS), 2016).
Figure 4: Conception, maternity, and abortion rates and events of possible relevance to trends in women younger than 18 years between 1994 and 2013 (per 1000 women aged 1517 years). Source: Wellings et al. (2016).
The overall statistics show that age-wise pregnancy distribution in England is critical. Teenage pregnancy for women under 20 has declined by 6.4% to 37.9 conceptions per 1000 women in 2014 from 40.5 conceptions/1000 women in this age category. The teenage pregnancy rates have also declined for the women under 18 years old. It can be determined that according to ONS report, 22,653 women aged under 18 years were pregnant comparative to the 24,306 women under 18 years old in 2013. These statistics can be compared with the first ever produced official statistics of England in 1969, in which 45,495 teenage pregnancies were investigated. Despite these declining trends, teenage pregnancy is still viewed as severe public health challenge across England due to the presence of various factors that influence population health outcomes.
The 10-year nationwide Teenage Pregnancy Strategy has had some challenges. According to the Teenage Pregnancy Independent Advisory Group (TPIAG) (2010), public spending cuts remain a challenge for local areas, which can hamper the success of the strategy. For this reason, this calls for the need to review existing provision, and thus, implement the cuts thoughtfully and strategically. Even so, the major risk is that without effective and explicit prioritization and leadership of teenage pregnancy from the government, local areas will subsequently reduce coordination and leadership of teenage pregnancies. In essence, the disinvestment into the strategy, closure of cash services, as well as the loss of projects and posts, may hinder the success of the strategy.
Another challenge as TPIAG (2010) posits is the cost of effective contraception. Offering contraception, such as long acting reversible methods, as well as condoms to protect teenagers against STIs can be helpful in eliminating the problem. However, they are often expensive for the teenagers. Besides, there is the problem of variation in quality and provision, which hampers the effectiveness of fighting the teenage pregnancy issue. Also, clinics are not always open at instances convenient for the young or in places where they can access public transportation, which makes accessibility of the contraceptives difficult.
Another challenge is improving sexual and relationship education (SRE), which serves to educate teenagers about these aspects, and thereby preventing pregnancy. According to TPIAG (2010), the government failed in one instance making SRE part of the curriculum even though the idea received consensus of support amongst health professionals, teachers, the young, parents, and school governors. It is important to note that good SRE taught by trained professionals provides the young with the appropriate life skills and knowledge required in resisting peer, media, and partner pressures, as well as understanding issues of sexual responsibility and consent. However, the unequal provision of SRE in England provides a challenge because the teenagers do not learn about the issue of pregnancy, and therefore, they miss out on their entitlement to good quality teaching. Also, exclusion of teenage parents, despite the improvements done over the last decade, remains another big challenge in combatting the issue. Fully including parents in the prevention of the teenage pregnancy problem and supporting them along with their children is vital for the success of the issue.
Other challenges include social and economical problems for the regulatory as well as for the teenage mothers. Teenage pregnancy has been observed to be as a result and course of inequality, exclusion, and poverty (Department for Children School and Families, 2009). Teenage mothers are three time higher chances of poor antenatal health, 21% higher risk of low birth weight babies and 60% higher newborn death in their first year. Consequently, teenage mothers babies in later life also have significantly high chances of achieving low education, 63% high risk of living in poverty. Becoming a teenage parent also obstruct the way of education and social development of teenage parents in England. With low educational qualifications, ultimately the opportunities to get a good job also decline. According to Public Health England (2016), the majority of teenage mothers are living in poverty leading to high risk of healthcare problems for both the parents and for the child, teenage mothers also have high chances of having poor mental health up to years after giving birth.
Socioeconomic deprivation is found to be strongly related to the teenage pregnancy in England. As Harden, Brunton and Fletcher (2009) assert, teen mothers are socially excluded from participating in many community activities, which ultimately have very low expectations for their futures. Teenagers who become teenage mothers are more likely to become vulnerable families, who require strong support for the accomplishment of a positive future. Due to parenting difficulties, teenage mothers often develop postnatal depression, poor maternal health, and smoking or drug habits (1 in 12 young women), reiterat...
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