Rise in teen conception rates signals a warning against complacency

Alison Hadley is Director of the Teenage Pregnancy Knowledge Exchange at the University of Bedfordshire and Chair of the Sex Education Forum. In this blog, she explains why the slight increase in teen conception rates shouldn’t be overlooked, and how we can ensure all young people are equipped to have agency over their sexual and reproductive health in both the short and longer term.

The recent ONS publication of the 2021 conception rates highlighted the remarkable 20-year decline in under-18 conceptions. Since 1998, the baseline year for the original Teenage Pregnancy Strategy, rates have fallen by 72% to 13.1/1000. The data shows a similar reduction in conceptions to under-16s.

This decline reflects a long term concerted and coordinated effort by local government, health partners and the voluntary sector to support young people to make informed decisions about their reproductive and sexual health and confirms once and for all that England’s historically high rates were not inevitable if the right actions are put in place.

If young people are equipped to make informed choices, they will take them.

Nevertheless, the small increase in the 2021 rate, the first rise in 14 years, sounded a note of caution. Although it may in part be due to the lower rates in 2020 caused by behavioural changes during pandemic lockdown periods, it is a warning against complacency and a timely prompt to redouble our efforts to ensure every new cohort of young people has the knowledge and confidence they need to navigate healthy relationships and prevent unplanned pregnancy. 

The international evidence which underpinned the Strategy remains unchanged and together with lessons from the Strategy implementation, informs the current government guidance for Local Authorities (LAs) and their partners. The guidance sets out the ten key factors for an effective whole system local strategy, and a self-assessment for LAs and health partners to review what’s working well and to identify and address gaps. Companion guidance also sets out a whole system approach to supporting young parents.

Addressing all ten factors is important to build a whole system approach, but as the small increase in the 2021 data was in abortions rather than births, there are three issues that would benefit from immediate attention.

1. Retaining a focus on contraception in RSE

The evidence for RSE is clear. Young people who receive effective RSE are more likely to delay first sex until they are ready, have first sex that is consensual, to use contraception and condoms, and are less likely to experience an STI or unplanned pregnancy before 18, or in later life. Although RSE is now mandatory in all schools, the Sex Education Forum 2022 Poll of 16- & 17-year-olds found 33% learnt nothing or not enough about condoms and contraception and 50% learnt nothing or not enough about pregnancy options.

RSE needs to not simply provide information about the methods of contraception available, it must also ensure all young people, whatever their gender, understand their bodies, their fertility and their reproductive choices. Crucially, it should equip young people with the skills to weigh up options to make a well-informed personal choice and give them agency over their reproductive health in both the short and longer term.

While restricted curriculum time inevitably limits what can be provided, signposting to reliable sources of advice, such as Brook, can supplement lessons and help counter the partial or misinformation circulating on social media. 

So too can discussions in sexual and reproductive health (SRH) and primary care consultations. In the NATSAL-3 study, young people cited health professionals as one of the three most preferred and trusted sources of information on sex and relationships. Asking young people what they learnt about fertility and contraception in their RSE and filling in any gaps in knowledge can help ensure their choices are well informed, even if that choice is for a less reliable method.

With a reported increase in young women turning away from hormonal methods, respecting personal choice is essential to prevent young people losing trust in health professionals.

2. Reviewing service publicity

While effective RSE lays the foundations of knowledge and skills, the impact on reducing unplanned pregnancies will only be realised if young people know about and have easy access to trusted youth-friendly contraceptive services. As services stabilise after the disruption of the pandemic, now is a good time for commissioners and providers to review whether service publicity is up to date and reaching all young people, including those in school and college.

In the Sex Education Forum Poll, 56% had learnt nothing or not enough about how to access local SRH services, despite this being a requirement of the RSHE statutory guidance.

Details of face to face and digital services should be provided within RSE, ideally with a visit from the local service provider, with educators clear about young people’s rights to confidentiality in SRH services. Information should also be easily visible outside the classroom for those who missed the lesson or for whom, at the time, the information didn’t seem relevant. Consulting young people about how best to do this and sharing effective practice needs to be a priority for local commissioners, providers and schools in 2023.

3. Reaching young people at risk

Critical to reducing inequalities is ensuring RSE provision and easy access to services for young people experiencing risk factors associated with early unplanned pregnancy; such as family poverty, low school attendance and attainment, and experience of the care system.

The pandemic may have also increased the vulnerability of some young people. For example those who missed out on RSE at school during lockdowns, and the increased number of teenagers who have not returned to education and may be starting sexual relationships with scant knowledge or skills to look after their sexual health.

These young people need to be reached quickly through both targeted outreach work and by liaising with the statutory and voluntary agencies who they are likely to be in contact with. A quick win would be for commissioners and providers to identify all relevant agencies and ensure all practitioners have details of local services. Using this Making Every Contact Count (MECC) template is a good start, or you can use Brook’s Find a Service tool.

Behind the 72% drop in the national rate, lie significant inequalities between and within LAs and between individual young people. Reversing the worrying rising trend in the wider determinants of early pregnancy and poor outcomes is critical for continuing reductions in unplanned pregnancy and reducing inequalities. This depends on choices made by national government, but local actions do make a difference. While the impact of a decade of funding cuts and limited workforce capacity pose real challenges, now is a good time to revisit the Framework, re-start local teenage pregnancy partnerships and work out how to maximise the benefits of joint working.

For more information, including the most recent data for your local area, visit the Teenage Pregnancy Knowledge Exchange.