In the past forty years over £250 million has been spent by policy makers on numerous initiatives aimed at cutting teenage pregnancy rates in the UK, yet with almost negligible effect.
Some would no doubt argue that this money is well spent, in preventing the rates from worsening.
However Britain still has the highest rate of teenage pregnancy in Western Europe and there are increasing rates of STI’s, even though a number of research studies have shown that teenagers often regret the age when they started having intercourse.
Economist, Prof David Paton, has spent years researching UK teen pregnancy rates and last week published an article in the Education and Health Journal showing (not for the first time) that, despite the vast amounts of money spent, the rate of conceptions to under-16s in England and Wales was almost exactly the same in 2009 as forty years previously.
There have been some ups and downs in the rates (between about 7 and 10 per 1,000 per year) but these do not correspond neatly to major Government spending and advertising initiatives to cut teen pregnancy. Despite small recent decreases in the underage conception rate (the most recent decrease in teen pregnancy, from 2008 to the present, has come at a time of spending cuts to policies!) Paton says that: ‘unwanted pregnancy has proved remarkably resilient to policy initiatives implemented by different Governments over the past 40 years’.
Government policy for the past forty or so years has primarily focused on school sex education and on providing easy access to contraception.
Yet previous research by Paton, published last year in the Journal of Health Economics, on the effect of promoting emergency contraception found that widely promoting it to youngsters did not lead to any reduction in pregnancy or abortion rates. Unfortunately however, it did increase STI rates amongst teenagers.
Not only has easy access to contraception been ineffective (at best), Paton also claims that the impact of sex education on pregnancy rates is weak. He points out that an evaluation of the Teenage Pregnancy Strategy in 1996 was unable to find a correlation between local authorities judged to have the best SRE provision and those with the biggest decreases in teenage pregnancy rates.
Why have these strategies had so little effect and why have rates not dropped?
Many factors impact on teen pregnancy rates – poverty, education, family stability, media messaging etc – and small improvements in these may be at the root of small reductions in underage births since 1996. Their impact cannot be ignored when considering teen pregnancy rates. However government policies directly aimed at reducing unwanted pregnancy rates also have an impact.
The focus of Government policy on school sex education and on providing easy access to contraception is based on the two assumptions that it will, on one hand, reduce pregnancy rates for those already having sex, while at the same time it will not cause others to begin sexual activity.
However Paton uses economic models to argue that the two are closely linked. So easier access to family planning reduces the effective cost of sexual activity and makes it more likely (at least for some teenagers) that they will engage in underage sexual activity.
This is known as ‘risk compensation’. This is a phenomenon where applying a prevention measure results in an increase in the very thing it is trying to prevent. So if a girl is on the pill then her sexual behavior will seem to her to be less risky or costly and so she will continue with it or even increase it, in the false belief that she will not suffer harm. The problem of risk compensation has been highlighted in a previous blog on emergency contraception by Peter Saunders here.
What could have a better effect on teen pregnancy rates?
Brook and other family planning groups continue to strongly advocate more of the same: more information for teenagers, more sex education, easier and free access to contraceptives, confidentiality for under 16s. Two employees of Brooks state in the same journal as Paton’s article that: ’We need to ensure a culture that is open and positive about sex and relationships’.
Because of the problem of risk compensation however, Paton recommends instead: ‘…a shift in focus from policies aimed at reducing the risks associated with underage sexual activity to those which are aimed more directly at reducing the level of underage sexual activity.’
Paton also advocates more involvement of parents in the sexual health education of their teenagers. He cites evidence from the US showing that states that have introduced mandatory parental involvement laws have seen decreases in abortion rates and teenage STIs.
The state has a legitimate interest in reducing teenage pregnancy and the spread of sexually transmitted diseases, but parents in the UK have been increasingly sidelined in the delivery of sex education. Parents can usually better determine the physical, mental and emotional stages of development of their child and, accordingly, can deliver the required education within a moral, ethical and spiritual framework – unlike the present value-free teaching in schools and wider society.
Neither of Paton’s recommendations are likely to receive support from family planning groups. It does seem ironic that approaches based on encouraging young people to exercise self-control or chastity, and encouraging parents to be involved, attract so little support, and indeed sometimes outright opposition, from official sources.
There are areas of agreement with charities such as Brook however. Their director, Simon Blake, has highlighted one of the biggest challenges facing any approach, which is that:
‘Young people live in a highly sexualised culture and are sexualised by companies wanting them to buy their products.
Sexual imagery plays a very strong part in our culture today and sexual images are used in nearly all areas of advertising and the media, in fashion and dress, in order to generate interest and make money.
Trevor Stammers has pointed out that all too often teenagers are the ones who are blamed as being solely responsible for embarking on sexual relationships and for becoming pregnant. This happens regardless of the fact that it is adults who have exposed children of all ages to a society which is obsessed by sex, thus putting them under enormous pressure to conform. Adults must take greater responsibility for the problem.
Paton’s message is simple – to reduce the amount of sexual activity amongst teenagers, not just the risks associated with it – but clearly the challenge is huge. However, Paton’s other recommendation – that parents be more involved – hits the ball right back into the court of every parent or guardian of teenagers. It all starts at home, in the family, the smallest of economic units.