England's Teenage Pregnancy Strategy: a hard-won success

538 www.thelancet.com Vol 388 August 6, 2016 Teenage pregnancy is considered a key indicator of adolescent health for good reason. The associations between teenage births and mortality, morbidity, and social and economic hardship for the mother and child are well established. Research over many decades has provided us with a good understanding of the underlying factors for the complex issue of teenage pregnancy and reasonable evidence for what strategies work to limit it. In The Lancet, Kaye Wellings and colleagues present the impact of the UK Teenage Pregnancy Strategy on rates of teenage abortions and births in England over the 13 years after its introduction in 2000. The Teenage Pregnancy Strategy was a complex, intersectoral, and multicomponent intervention, informed by available evidence on likely eff ective strategies to reduce pregnancies, from inception throughout its funding period. There were three main components of the strategy. The fi rst element was a whole-government approach to administration, headed by a cross-departmental ministerial task force (spanning the departments of health, education, and employment), monitored by an independent national advisory group and implemented by funded regional and local service coordinators and partnership boards. The second element was improved prevention eff orts, including: high quality education about sex and relationships in schools; better access to eff ective contraception; enhanced eff orts targeting the most at-risk groups, and young males; a media campaign with separate components for young people and parents; and a print and broadcast media campaign. The third element was better support for pregnant teenagers and teenage parents to ensure completion of education and access to secure housing with in-home support for mothers and their children. At the mid-course review in 2005, the UK’s national conception rate had dropped 11% for those younger than 18 years and 15% for those younger than 16 years, but with variability, including reductions as substantial as 43% in one local authority. From this point, a more intensive approach to lower-performing authorities was adopted. In the study by Wellings and colleagues, investigators combined routinely collected area-level data on abortions and births, deprivation, and Local Implementation Grant expenditures with individuallevel risk factor information from the three waves of the National Surveys of Sexual Attitudes and Lifestyle (Natsal) to describe changes in conception, abortions, and maternities in individuals younger than 18 years in England from 2000 to 2013. The maternity rate of individuals younger than 18 years in England has decreased slowly but steadily from its peak in 1996–98, but much more rapidly from 2007 to 2013, along with a decline in the abortion rate, halving the conception rate overall. The most substantial reductions were in the most deprived areas, where rates were originally highest. Participation in work, education, or training by young women who became mothers before age 18 years doubled over the period of the Teenage Pregnancy Strategy. The authors also estimated an absolute decrease in conception rate of between 8·2 conceptions England’s Teenage Pregnancy Strategy: a hard-won success