Executive summary

   The United Kingdom has the highest rates of teenage
pregnancies in Western Europe. 1 Although the
United States and most of Western Europe have seen
a fall in teenage conception rates in recent years, the
problem has continued to escalate in this country. Although
for many young women pregnancy and motherhood are
welcomed experiences, this group is more at risk of
experiencing negative outcomes associated with pregnancy
than women aged 20 to 35. Teenage pregnancy is an
important public health issue which may lead to serious
health and social consequences for teenage mothers, their
babies and their families and result in considerable public
cost. 2 These problems have led to considerable political
interest and the Government has produced an action plan
aimed at reducing rates of teenage pregnancy and getting
more teenage parents into education or employment, to
reduce their risk of long term social exclusion. 1

  The South West region has a favourable teenage
conception profile compared to other regions across the
country. However, in recent years the teenage pregnancy
problem in the region has worsened and rates have
increased steadily alongside national figures. There is
marked variation in the numbers and rates of conceptions
between different health authorities, local authorities and
electoral wards. The majority of teenage conceptions
continue to occur in the large urban areas; however high
rates are also seen in some rural areas. In particular,
Cornwall, which has notable problems of rural deprivation
and social isolation, has seen a marked rise in teenage
conceptions. These trends highlight socio-economic
deprivation, whether in urban or rural areas, as a key factor
associated with teenage pregnancy.

  There has been a falling trend in the number and rate of
abortions in all age groups across the country. However, in
the South West there has been a steady increase in the
numbers of teenage abortions and in the overall abortion
rates. Although there is considerable variation across the
region in the proportion of all teenage conceptions
terminated, in most areas this proportion is above the
national average of 41%. Areas with high rates of
conception also tend to have a lower percentage of these
pregnancies terminated. National research has revealed a
trend to a lower ratio of abortions to births in more
deprived areas. 1 This trend is reflected across the region,
with the lowest ratios occurring in areas with high levels of
deprivation.
  
  Research has found that increasing the availability of
contraceptive services for young people is associated with
reduced pregnancy rates. 2 Most centres offering abortion in
the South West are situated in urban areas; however these
areas also have the lowest proportions of conceptions
leading to termination. Indeed, the teenage pregnancy
profiles are generally worse in the urban areas where the
provision of contraceptive services is concentrated. The
factors behind the uptake of services are complex and it is
likely that the problems of deprivation and social exclusion
may have as large a part to play in influencing teenage
pregnancy as the provision of the services themselves. This
suggests that provision of services should be based on a
needs assessment of the local community, considering the
local demography, teenage pregnancy profile and the
location and utilisation of existing services targeted at young
people.

  In general the factors accounting for the variation in
teenage pregnancy across the region are complex and multifactorial.
3 Multi-factorial problems usually require multidimensional
approaches involving education, health, local
people and social services. 2 General anti-poverty strategies
may have a considerable impact on the problem and may
help reduce the adverse outcomes associated with teenage
pregnancy. It is important that there is a consistent public
health response towards tackling the teenage pregnancy
problem in the South West, which is coupled with strategies
from other partner agencies and the commitment of key
individuals at local level.