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Better intervention needed to tackle repeat teen pregnancies

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More effort should be made to find the most appropriate contraception method for teenagers who have previously given birth or had a termination, according to UK researchers.

A study based on more than 20 years’ worth of data has found that teenagers in England and Wales who become pregnant are at higher risk of further teen pregnancies.

Nearly one in four teenagers presenting for an abortion have already been in contact with health services for a previous birth or termination, according to the study, which analysed national data from 1992 to 2013.

“We need to recognise that the circumstances of each pregnancy may be very different”

Lisa McDaid

Terminations among women who had previously been pregnant rose from 17.2% in 1992 to 22.9% in 2013, a percentage that has remained “fairly stable” since 2004, said the researchers from the University of East Anglia. A minority – less than 5% – had two or more previous pregnancies.

While the teenage conception rate in England and Wales was now at a record low, further reductions were still needed to bring it in line with other European countries, said the study authors in the Journal of Adolescent Health.

Efforts needed to focus not just on preventing first-time pregnancies but also to support pregnant and parenting teenagers to better manage their reproductive lives, they said.

These should focus on “ensuring that young women had an effective contraceptive method in place that best meets their needs and are aware of their fertility after pregnancy”, they said.

The authors highlighted some successful examples involving the introduction of outreach nurses. Contraception outreach nurses visiting young mothers at home within four weeks postpartum led to teenage conception rates in Hull falling from 17.7% in 2008 to 13.8% in 2011.

“All organisations will need to work together so that teenagers have an effective contraceptive plan in place that meets their needs after a pregnancy”

Lisa McDaid

The researchers said that, for the first time, their study had revealed the number of young women aged 15-19 undergoing a termination who had either previously been pregnant, given birth or had an abortion.

Lead researcher Lisa McDaid said: “This information will help to guide more targeted interventions to continue the downward trend in pregnancy and to monitor the effectiveness of current sexual health priorities on reducing conceptions and unwanted pregnancies among this age group.

“The continuing high proportion of teenagers who have an abortion following one or more previous pregnancies highlights the complexity of these young women’s lives and we need to recognise that the circumstances of each pregnancy may be very different,” she said.

The researchers highlighted that in 2013 responsibility for commissioning community contraceptive services had moved from the NHS to local authorities, while maternity and abortion services remained the responsibility of clinical commissioning groups.

Ms McDaid suggested the separation could make it harder for teenagers to access support and contraception when they most need it.

“All organisations will need to work together so that teenagers have an effective contraceptive plan in place that meets their needs after a pregnancy, along with receiving ongoing support to encourage up-take and continuation, and improved access to emergency contraception,” she said.

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