0036-9330/91/02091/172 $2.00 in USA © 1991 Scottish Medical Journal
Scot Med J1991; 36: 172-174
TEENAGE PREGNANCY IN SCOTLAND: TRENDS AND RISKS K. Rosenberg, * H.P. McEwan Glasgow Royal Maternity Hospital
Abstract: Teenag~ pregnanc~, consid,ered to be associ~ted with social and medical risks, is seen as a growing probl~m. Populatw~ based mform,atwn from the Registrar General (Scotland) and Notification of Abortion permiued an analysis of the trends tn the numbers, rates and outcomes ofpregnancies among women aged less than 20 years. In addition, clinical information is available on all deliveries in Scottish hospitals from the standard hospital discharge ~ocument per"!itting an~lysis of the association of defined complications with age. Contrary to current perceptions, pregnancies and births among teenagers are not more frequent in 1988 when compared to 1975. The~e h~s been, however, a large increase in births to single women, a group with particular problems. The. obstetric r~ks wh~n compared to older w?men, are small and probably socially, not age related. ,!h~se include a slightly higher rate ?f pre-term dellv~ry and low birth weight and a later presentation for ~peclall~t antenatal care. The proportion of pregnanctes affected by neural tube defects which are terminated 1S lower among women under 20. These medical risks are small, however, compared to the well-documented social and economic problems which will have long term and indirect effects on health.
Introduction N DEVELOPED countries, pregnancy in adolescence is considered a problem replete with social and obstetric disadvantages. A recent paper! highlighted these concerns including those at governmental level for the long-term social and financial consequences of teenage motherhood. Current perceptions are that the problem is worsening; we summarise here the risks and trends. Jones? gave pregnancy rates for 15-19-year-olds in 1980 in several Western countries as varying from 96 per 1000 in the United States to 14 per 1000 in The Netherlands. England and Wales (4511000) and Scotland (43/1000)3 have rates midway between these extremes. As clinical information on all pregnancies is routinely available in Scotland, as well as information on births from civil registration, the following discussion is based on Scottish data.
I
Methods Data on live and stillbirths by age and marital status for 1975-1988 was extracted from Annual Reports of the Registrar General (Scotland)." Information on terminations of pregnancy by maternal age was obtained for 1975-1987 from Notifications of Abortion." Clinical data was ?btai':!ed by ad hoc analysis of the standard maternity hospital discharge document, the SMR2,s Statistical significance was calculated using the test of proportions. Results and Discussion Rates of Pregnancy, Abortion and Births in Women aged 15-19. The number of pregnancies per 1000 women aged 15-19 from 1975 to 1987 was lowest in 1983 at 40 per thousand. Although there was some increase from 1984 to 1987, the rate remained lower in 1987 (46/1000) than in 1975. (50/lO?O). A larger proportion of pregnancies was term1Oate~ 10 1987 than in 1975 but the major change has ~een. an 1Oc~ease from 11.4 to 22.2 per thousand of hveblft~s to single women. In 1987, a lower proportion of conceptions occurred among married women and there was a lower rate of marriage during pregnancy itself. These changes have also been reported for England and Wales? and Australia." Number of births The total number of livebirths to women under 20 decreased from 8267 in 1975 to 6158 in 1988. Livebirths to single women, however, increased from 2297 to 4558 during * Dr Rosenberg sadly died in November 1990.
172
this perio~ (from 28% to 74% of the total). The ongoing concern WIth teenage pregnancy does not follow from an increase in the rate or numbers of births but from the growth in numbers of births to unmarried teenage mothers, a group seen to be at particular disadvantage. Age distribution of teenage pregnancies From 1975 to 1988,3 the proportion of teenage pregnancies to girls under 16 years was small (1-2%); the numbers varied from 294 to 446 per annum with no consistent trend, Most of these pregnancies were terminated; 59% in 1975 increasing to 70% in 1987. The number of livebirths to girls under 16 was 147 in 1988 compared to 145 in 1975. Ab~rtion statistics are given collectively for females aged 16.-1910 Scotland and show that 29% of pregnancies among this age group were terminated in 1987; an increase from 18% in 1975. The age distribution of births has changed little in the years under discussion; 40% of teenage births were to 19-year-olds, 30% to those 18 and 20% to those aged 17 years. The majority of births thus occurred in females who were physically mature and no longer schoolgirls. Social aspects The Scottish Maternity Hospital Discharge Document' includes personal as well as clinical information on Scottish mothers and permits a more detailed look at marital status. In 1988, 85% of women under 20 giving birth were having their first baby and of these 70% were single. The proportion of primiparous women who were married increased from 15% in women under 18 to 68% in women aged 20-24 (Table I). This data is cross-sectional so does not allow one to follow a woman through successive pregnancies to see whether marriage occurred after the birth of the first baby. The proportion of married women, however, was higher among multiparous women indicating that marriage occurred before the birth of a second child or that it is married teenagers who have more than one child." There is evidence from England and Wales 9 that a large proportion (77%) of illegitimate births are co-registered which implies that the father is involved in some level of support for the mother. Data collected on 911 nulliparous women including 283 teenagers in a poor area of Glasgow, however, indicated that single girls were alone and living in difficult financial circurnstances.!" Seventy per cent of the unmarried 17-19-year~0Ids described themselves as single i.e. neither living in a stable relationship nor planning to marry.
Teenage pregnancy in Scotland: Trends and risks
Rosenberg and McEwan
Table I Women less than 25 years delivering in Scottish hospitals, 1988
Scot Med J1991; 36: 172-174
TEENAGE PREGNANCY IN SCOTLAND: TRENDS AND RISKS K. Rosenberg, * H.P. McEwan Glasgow Royal Maternity Hospital
Abstract: Teenag~ pregnanc~, consid,ered to be associ~ted with social and medical risks, is seen as a growing probl~m. Populatw~ based mform,atwn from the Registrar General (Scotland) and Notification of Abortion permiued an analysis of the trends tn the numbers, rates and outcomes ofpregnancies among women aged less than 20 years. In addition, clinical information is available on all deliveries in Scottish hospitals from the standard hospital discharge ~ocument per"!itting an~lysis of the association of defined complications with age. Contrary to current perceptions, pregnancies and births among teenagers are not more frequent in 1988 when compared to 1975. The~e h~s been, however, a large increase in births to single women, a group with particular problems. The. obstetric r~ks wh~n compared to older w?men, are small and probably socially, not age related. ,!h~se include a slightly higher rate ?f pre-term dellv~ry and low birth weight and a later presentation for ~peclall~t antenatal care. The proportion of pregnanctes affected by neural tube defects which are terminated 1S lower among women under 20. These medical risks are small, however, compared to the well-documented social and economic problems which will have long term and indirect effects on health.
Introduction N DEVELOPED countries, pregnancy in adolescence is considered a problem replete with social and obstetric disadvantages. A recent paper! highlighted these concerns including those at governmental level for the long-term social and financial consequences of teenage motherhood. Current perceptions are that the problem is worsening; we summarise here the risks and trends. Jones? gave pregnancy rates for 15-19-year-olds in 1980 in several Western countries as varying from 96 per 1000 in the United States to 14 per 1000 in The Netherlands. England and Wales (4511000) and Scotland (43/1000)3 have rates midway between these extremes. As clinical information on all pregnancies is routinely available in Scotland, as well as information on births from civil registration, the following discussion is based on Scottish data.
I
Methods Data on live and stillbirths by age and marital status for 1975-1988 was extracted from Annual Reports of the Registrar General (Scotland)." Information on terminations of pregnancy by maternal age was obtained for 1975-1987 from Notifications of Abortion." Clinical data was ?btai':!ed by ad hoc analysis of the standard maternity hospital discharge document, the SMR2,s Statistical significance was calculated using the test of proportions. Results and Discussion Rates of Pregnancy, Abortion and Births in Women aged 15-19. The number of pregnancies per 1000 women aged 15-19 from 1975 to 1987 was lowest in 1983 at 40 per thousand. Although there was some increase from 1984 to 1987, the rate remained lower in 1987 (46/1000) than in 1975. (50/lO?O). A larger proportion of pregnancies was term1Oate~ 10 1987 than in 1975 but the major change has ~een. an 1Oc~ease from 11.4 to 22.2 per thousand of hveblft~s to single women. In 1987, a lower proportion of conceptions occurred among married women and there was a lower rate of marriage during pregnancy itself. These changes have also been reported for England and Wales? and Australia." Number of births The total number of livebirths to women under 20 decreased from 8267 in 1975 to 6158 in 1988. Livebirths to single women, however, increased from 2297 to 4558 during * Dr Rosenberg sadly died in November 1990.
172
this perio~ (from 28% to 74% of the total). The ongoing concern WIth teenage pregnancy does not follow from an increase in the rate or numbers of births but from the growth in numbers of births to unmarried teenage mothers, a group seen to be at particular disadvantage. Age distribution of teenage pregnancies From 1975 to 1988,3 the proportion of teenage pregnancies to girls under 16 years was small (1-2%); the numbers varied from 294 to 446 per annum with no consistent trend, Most of these pregnancies were terminated; 59% in 1975 increasing to 70% in 1987. The number of livebirths to girls under 16 was 147 in 1988 compared to 145 in 1975. Ab~rtion statistics are given collectively for females aged 16.-1910 Scotland and show that 29% of pregnancies among this age group were terminated in 1987; an increase from 18% in 1975. The age distribution of births has changed little in the years under discussion; 40% of teenage births were to 19-year-olds, 30% to those 18 and 20% to those aged 17 years. The majority of births thus occurred in females who were physically mature and no longer schoolgirls. Social aspects The Scottish Maternity Hospital Discharge Document' includes personal as well as clinical information on Scottish mothers and permits a more detailed look at marital status. In 1988, 85% of women under 20 giving birth were having their first baby and of these 70% were single. The proportion of primiparous women who were married increased from 15% in women under 18 to 68% in women aged 20-24 (Table I). This data is cross-sectional so does not allow one to follow a woman through successive pregnancies to see whether marriage occurred after the birth of the first baby. The proportion of married women, however, was higher among multiparous women indicating that marriage occurred before the birth of a second child or that it is married teenagers who have more than one child." There is evidence from England and Wales 9 that a large proportion (77%) of illegitimate births are co-registered which implies that the father is involved in some level of support for the mother. Data collected on 911 nulliparous women including 283 teenagers in a poor area of Glasgow, however, indicated that single girls were alone and living in difficult financial circurnstances.!" Seventy per cent of the unmarried 17-19-year~0Ids described themselves as single i.e. neither living in a stable relationship nor planning to marry.
Teenage pregnancy in Scotland: Trends and risks
Rosenberg and McEwan
Table I Women less than 25 years delivering in Scottish hospitals, 1988
