99 33 | |
AA uu t t uum
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TTrr ee nn dd ss
Teenage mothers and the
health of their children
Beverley Botting, Michael Rosato and Rebecca Wood
Demography and Health
ONS
Teenage mothers continue to present challenges
to social policy and remain of topical interest to
the media. This article discusses trends in teenage
conception rates, their outcomes and long term
consequences. In 1996, 7 per cent of all births were
to girls aged under 20. On average children born to
teenage girls have lower birthweights, increased
risk of infant mortality and an increased risk of
some congenital anomalies. They are less likely to
be breastfed and more likely to live in deprived
INTRODUCTION
‘Teenage conceptions tend to be both a symptom and
a cause of social inequality. They can become a cycle
of deprivation’1
circumstances. These factors in turn influence
their health and long term opportunities.
The seriousness of teenage pregnancy as a health issue was
reflected in the previous Government’s Health of the Nation
initiative.2 The target was to reduce the conception rate for girls
aged under 16 in England by at least 50 per cent from its 1989 base
of 9.5 per 1,000 to 4.8 by the year 2000. The current Government
is similarly concerned and has set up four Task Groups to address
the problems of unwanted pregnancies, particularly among those
aged under 16. The Green Paper ‘Our Healthier Nation’3 does not
set national targets for reducing the conception rate, but recognises
the need for local targets where this is a matter of local concern.
Of course some teenage pregnancies are planned, and others, although
not planned, result in wanted babies. It is in this age group, however,
that there is the largest proportion of unplanned and unwanted
pregnancies. These pregnancies can have long term implications on
the health and socio-economic future of both the mother and child.
RECENT DEMOGRAPHIC TRENDS
Conceptions
In official statistics, conceptions are defined as pregnancies
resulting in live births, stillbirths or legal terminations. These data
are available for the total population of England and Wales. Data
on other pregnancy outcomes, mainly miscarriages, are excluded
from this definition as they are only available for samples of the
population and are known to be incomplete.
O f f i c e
f o r
N a t i o n a l
S t a t i s t i c s
19
P o p u l a t i o n
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A u t u m n
Using this definition of ‘conception’, conception rates (per
thousand girls aged 15–19) fell for all teenage girls from 69 in
1990 to 59 in 1995 and then rose again to 63 in 1996 (Figure 1).
Nevertheless, these rates are still all below the teenage conception
rates seen in the early 1970s.
Figure 1
Conception rates by age of woman, England and
Wales 1969-1996
140
Rate per 1,000 women in age group
120
100
19
18
80
17
<20
60
16
40
20
15
1 9 9 8
Births and abortions
Since the introduction of the Abortion Act in April 1968, there has
been an increase in the proportion of teenage conceptions
terminated by abortion. The patterns of increase differed for
different ages of teenagers. Figure 2 shows that, for girls aged 16
and under, during the 1970s there was a sharp increase in the
proportions of conceptions ending in a termination. Since 1980
there has been only slight fluctuation in these proportions. For girls
aged 17, 18 and 19, however, there was a sharp increase until 1972,
followed by gradual but sustained increases thereafter. In 1996, 37
per cent of all teenage conceptions ended in an abortion, compared
with 50 per cent of conceptions to girls aged under 16.
Based on age at conception, in 1990-95 consistently 4 or 5 girls in
every 1000 aged under 16 conceived and went on to have a
registrable birth. For all teenagers the ‘conception leading to
maternity’ rate was 44 in 1990, falling to 38 in 1994 and 1995, and
then increasing to 40 in 1996. The teenage birth rate for England
and Wales was 30 per 1000 girls aged 15–19 in 1996. This is lower
than the ‘conception leading to maternity’ rate, because it is based
on the girl’s age at the birth of the child rather than at conception:
many girls who conceive when aged 19 are 20 when they give
birth. In 1996, 7 per cent of all births were to girls aged under 20.
<16
14
0
1969 1972 1975 1978 1981 1984 1987 1990 1993 1996
Marital status and number of children
Year
Source: ONS Series FM1
For girls aged under 16 there has been little variation in conception
rates since 1969. Approximately 8 girls in every thousand become
pregnant before their 16th birthday. The number of girls aged under
16 becoming pregnant rose slightly for the third year running in
1996. There were 8,800 conceptions to girls aged under 16 in 1996
compared with 8,000 in 1995. The underage conception rate in
1996 was 9.4 per thousand girls aged 13–15, 11 per cent higher
than in 1995 (8.5). Therefore these rates have not yet fallen
sufficiently to reach the Health of the Nation targets.2 A similar
pattern was seen in Scotland, with rates falling until 1995 and then
increasing again in 1996.4
Figure 2
Another major demographic change has been in the marital status
of teenage mothers. Figure 3 shows the dramatic decrease in the
number of teenage births taking place inside marriage. In 1981, 55
per cent of live births to teenagers took place inside marriage,
compared with 17 per cent in 1991. In 1996, only 12 per cent of
teenage live births took place inside marriage compared with 64
per cent of all births. Over the same 15 year period there has been a
corresponding increase in the number of live births outside
marriage registered by both parents. This reflects the rise in
cohabitation since the 1980s.
The number of births outside marriage to teenage girls who
registered the birth alone remained fairly constant through the 1980s.
The number fell between 1990 and 1995 and then rose slightly in
Conceptions terminated by abortion by age of
woman, England and Wales 1969-1996
Figure 3
Livebirths to teenagers by marital status and
registration, England and Wales 1978-1996
40000
70
35000
60
14
50
<16
15
40
16
<20
18
19
17
30
Registered jointly outside marriage
25000
Number
Percentage
30000
20
20000
Registered by the
mother alone
15000
10000
10
5000
0
Registered inside marriage
0
1969 1972 1975 1978 1981 1984 1987 1990 1993 1996
1978
1981
Year
O f f i c e
Source: ONS Series FM1
f o r
N a t i o n a l
1987
Year
Source: ONS Series FM1
20
1984
S t a t i s t i c s
1990
1993
1996
9 3
1996. These are the girls most likely to be bringing up their child as a
single parent. It is estimated that in Great Britain in 1996 there were
approximately 44 thousand lone parents aged under 20.5 In February
1997 there were 38 thousand lone parents aged between 16 and 19
receiving income support. Therefore the majority of lone teenage
mothers would appear to claim income support. It is not possible to
identify the additional number of lone parents under this age who are
receiving assistance from income support on their parents’ claim.6
In 1994-95, of girls who gave birth in NHS hospitals when aged
16, 4 per cent were recorded as having had a previous child.
Corresponding proportions for older teenagers were 9 per cent of
17 year olds, 15 per cent of 18 year olds, and 25 per cent of those
aged 19 who delivered in an NHS hospital.7
|
A u t um n
Table 1
1 9 9 8
Po p u l a t i o n
T r e n d s
Risk of teenage motherhood by indicators of socioeconomic status
and family circumstances as determined at the 1981 Census
Indicators of risk
Hazard
ratio
Confidence
intervals
Family
social class
I
II
IIIN
IIIM
IV
V
Other
1.32+
1.00
2.36
3.59
6.41
7.10
9.96
9.16
Housing tenure
owner occupier
rent: private
rent: local authority
1.88+
1.00
1.64
3.54
(1.81 - 1.96)
Absence of father
of LS teenager in
1.77
(1.61 - 1.94)
1.39+
1.00
0.69
1.15
1.81
(1.34 - 2.45)
(1.29 - 1.35)
(1.64 - 3.39)
(2.51 - 5.17)
(4.51 - 9.12)
(4.96 - 10.15)
(6.83 - 14.53)
(6.41 - 13.11)
(1.38 - 1.94)
(3.27 - 3.82)
S O C I A L A N D G E O G R A P H I C VA R I AT I O N
Family background
Research has shown that certain social factors are associated with
increasing chances of teenage pregnancy. The National Survey of
Health and Development is a longitudinal study of a group of
people born in March 1946. Analyses of these data found that
teenage mothers were more likely to come from a lower socioeconomic background.8 They were also likely to have more
siblings than their peers, and to have parents who showed little
interest in their education.
Similar results were found from the British National Child
Development Study. This is another longitudinal study of a sample
of the population born in 1958. Analyses of these data showed that
living in a family with lower socio-economic status, living in a lone
parent family, and coming from a larger family were associated with
an increased risk of a birth through the teens and early 20s.9
These findings, however, are from groups of people who were in
their late teens during the early 1960s and mid 1970s
respectively. The demography of Britain is very different two and
three decades later. Nevertheless, these research findings have
been confirmed by recent analyses using the ONS Longitudinal
Study. This is a follow-up study of 1 per cent of the population
enumerated at the 1971 Census.
Table 1 presents some results from these analyses. This shows that
girls living in local authority rented accommodation were over three
times more likely to become a teenage mother compared with girls
living in owner occupied accommodation. If the girls’ fathers were
absent from their households, or if the girls had three or more
siblings, they were also at greater risk of becoming teenage mothers.
household
Number of siblings
none (lone child)
one
two
three or more
Note: + result shows results for the main effects model.
Source: ONS Longitudinal Study (LS).
Fewer teenage births than average are born within marriage. In
1994-96 58 per cent of births to teenage mothers were outside
marriage but registered by both parents (Table 2). If the teenage
mother is married, or if her partner is present at their child’s birth
registration, social class is available for the child’s father. Social
class (based on the Registrar General’s classification) is derived
from occupation information for 10 per cent of all live births.
Based on the occupation of the baby’s father, only 6 per cent of
births to teenage girls were in social classes I and II. This compares
with 14 per cent of births in 1994-96 to women aged 20–24, and 36
per cent of women aged 25 and over. Therefore, a smaller
proportion of babies born to teenage mothers have a father in
higher social classes, compared with children of older mothers.
Table 2
Percentage distribution of live births by social class, marital
status, and mother’s age, England and Wales 1994-1996
Percentages
(combined)
Marital status
Age of mother
<20
All ages
20-24
25+
13.3
58.1
46.6
41.2
76.0
19.6
65.9
26.5
28.6
12.2
4.4
7.5
Social class of father*
All
I, II
IIIN
IIIM
IV
V
Other
71.4
6.0
5.2
25.5
16.7
9.1
9.5
87.8
14.2
7.9
33.4
17.8
7.7
6.6
95.6
36.3
10.3
29.0
12.2
4.1
3.8
92.5
29.8
9.5
29.7
13.6
5.2
4.8
Total
100
100
100
100
128,600
396,549
1,436,597
1,961,746
Using data from the 1958 Birth Cohort, it was found that girls who
had experienced the divorce of their parents between the ages of 7
and 16 (the ages at which they were re-interviewed) were almost
twice as likely to become teenage mothers compared to those
whose parents remained married.10 Twenty five per cent of women
whose parents had separated became teenage mothers, compared
with 14 per cent of those whose parents stayed together. Also, girls
from lone parent families where the mother did not work outside
the home were much more likely to become teenage mothers than
those with single mothers who worked outside the home.
Inside marriage
Outside marriage/
joint registration
Sole Registration
Social class
Table 1 shows that the risk of becoming a teenage mother was
almost ten times higher for girls whose family was in social class V
compared with those in social class I.
(0.61 - 0.79)
(1.01 - 1.31)
(1.59 - 2.06)
Base numbers
Source: ONS Series DH3.
* Father’s social class is not available for sole registrations.
O f f i c e
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N a t i o n a l
S t a t i s t i c s
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Country of birth
In 1996, 7 per cent of all births were to girls aged under 20. This
varied, however, by the mother’s country of birth. As shown in
Table 3, only women born in Bangladesh had a higher proportion
of live births to girls aged under 20 (9 per cent). Less than 3 per
cent of mothers from India, East Africa, Australia, Canada and
New Zealand were aged under 20. These results will be
confounded by differences in the age-structure of the population at
risk. The Bangladeshi born population in England and Wales is still
relatively young since they are more recent immigrants than other
New Commonwealth immigrants.
Table 3
Mother’s country of birth by mother’s age at childbirth,
England and Wales 1996
Numbers, percentages and rates
<20
All ages
Percentage of
Age-specific rates*
births to
by mother‘s country
teenage mothers of birth
<20
All ages
44,668
649,489
6.9
30
60
United Kingdom
41,757
Irish Republic
217
Rest of European Union
453
Australia, Canada,
62
New Zealand
1,618
New Commonwealth
India
78
Pakistan
516
Bangladesh
637
East Africa
70
Caribbean
84
Other
561
566,356
4,968
8,604
3,182
7.4
4.4
5.3
1.9
30
..
..
..
58
..
..
..
47,104
6,608
12,319
6,930
5,114
2,754
19,275
3.4
1.2
4.2
9.2
1.4
3.1
2.9
47
23
86
90
18
62
..
97
68
164
178
68
61
..
All
1 9 9 8
While 29 per cent of lone mothers aged 18 or 19 live in someone
else’s household, this proportion rises to 80 per cent for lone
mothers aged under 18. Thus the youngest lone mothers are mostly
living in someone else’s household.
Teenage lone mothers who head their own household are more
likely to live in areas of social housing than the population as a
whole. From the 1991 Census, lone teenage mothers were six
times more likely than the general population to live in areas
where more than 75 per cent of the housing was social housing.
Almost one in four lone teenage mothers who are head of their
household live in Local Authority areas with more than 50 per
cent social housing, compared with only 8 per cent of heads of
household in England as a whole.
E d u c a t i o n l e ve l
Despite the availability of home education to teenage girls, the
effect of a teenage pregnancy in the UK has been that a girl is
less likely to complete her education and training, thus
restricting her job opportunities.11 Results from the 1958 birth
cohort study 9 showed that staying in school past the minimum
school leaving age, even after controlling for educational
performance, was associated with postponing childbearing past
the teenage years. Teenage mothers from the 1946 birth cohort
study were, on average, the least able academically,
unambitious and had left school at the minimal age.8 As a result
they had fewer academic qualifications and on average these
were of a lower level than their contemporaries.
* Rates per 1,000 live births
.. Not available
Source: ONS Series DH3 and FM1.
Geographical area
Age-specific live birth rates help overcome the problems caused by
differences in the age-structure of different populations. Women
born in the UK had proportionately 6 times more births to teenage
girls, yet their teenage birth rate was only 30 per cent higher than
that of girls born in India. Women born in Pakistan, Bangladesh
and the Caribbean Commonwealth all have teenage birth rates
more than twice that of teenage mothers who were born in the
United Kingdom. Women born in Pakistan and Bangladesh,
however, also have much higher birth rates for all women.
Teenage conception and live birth rates vary across England and
Wales. In 1996 in England and Wales 63 girls in every 1,000 aged
15–19 became pregnant. This varied across England from 70 in the
West Midlands and North West Regional Offices areas to 51 in
Anglia and Oxford Regional Office area.13 Rates tended to be
higher in the north of England and lower in the south. The rate in
Wales was 70 per 1,000 girls aged 15–19. The same pattern in rates
was seen for girls aged under 16. In 1994-96 the lowest conception
leading to maternity rate for girls aged under 16 was for the Anglia
and Oxford, and the South and West Regional Office areas (3.0 per
1,000 girls aged 13–15). The highest rate was for the Northern and
Yorkshire Regional Office area (5.6). This variation in local rates
was recognised in the Health Green Paper ‘Our Healthier Nation’.3
It was stated that ‘although nationally we are concerned that
teenage conceptions are damaging the health and social well-being
of young mothers and their babies, the incidence is not spread
evenly across the country, so setting a national target in this area
might be less relevant for some localities. For others it will be a
high priority and they will want to target this problem locally.’
L i v i n g a rr a n g e m e n t s
Table 4 shows the proportions of lone mothers who head their own
household by the mother’s age. Overall 9 per cent of all lone
mothers live in someone else’s household, but this proportion is
much larger for teenage lone mothers. Lone mothers who remain
unmarried do not become local authority or housing association
tenants straight away; two fifths of those aged under 20 live as
members of another household, most often with their parents.12
Table 4
Percentage of lone parents by age and residence,
England 1996-1997
Age of lone parent
< 18
20
Head of household
20 +
71
All lone parents
93
80
29
7
9
100
100
100
10,000
35,000
740,000
785,000
All
Source: DETR unpublished data.
22
91
100
In someone else’s household
Base numbers
18 or 19
O f f i c e
f o r
N a t i o n a l
The geographical variation in teenage pregnancy rates is due, in
part, to the different socio-economic characteristics of different
parts of the country. ONS derived an area classification using
characteristics from the 1991 Census. Using this classification,
the teenage birth rate in 1994 varied between 11 per thousand
girls aged 15–19 in Local Authority areas described as ‘most
prosperous areas’ to 43 in ‘ports and industries’(Figure 4). Other
types of areas with above average birth rates were areas
characterised by ‘mixed economies’, ‘manufacturing’, ‘coalfields’
and ‘inner London’.14 The same pattern was seen for the under16s birth rates in 1994-96.
S t a t i s t i c s
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A u t um n
1 9 9 8
Po p u l a t i o n
T r e n d s
Teenage birth rates for groups of local authorities in England and Wales, 1994
Figure 4
45
40
Rate per 1,000 women
35
30
25
20
15
10
5
0
England
and
Wales
Coast Mixed urban Growth
and
and rural
areas
country
Most
Services Resort and
Mixed
prosperous
and
retirement economies
areas
education
areas
ManuPorts and
facturing industry
Coalfields
Inner
London
Group
Source: Population Trends 87
Other research in Tayside, Scotland in 1980-90 found similar
results.15 There was a higher teenage pregnancy rate in more
deprived areas. Also, in Scotland in 1990-92, it was found that
teenage pregnancy rates increased with deprivation of the area.16
Figure 5 shows teenage births as a proportion of all births by
level of deprivation. This Figure has used the Carstairs index
to allocate a deprivation score to each enumeration district. It
also shows that in 1994-96 the most deprived areas of England
and Wales had high proportions of teenage births compared
with the least deprived areas. In the most deprived areas 12
per cent of births were to teenage girls, compared with 2 per
cent of births in the least deprived areas.
reducing teenage pregnancy.19 A sample of students in Exeter
in 1995 were asked about their sex education.20 Only a small
amount of information had been derived from schools.
Thirteen per cent of girls aged 15 gave school lessons or
teachers as their main source of information about sex, yet 31
per cent of the same girls thought that school should be their
main source of information.
The number of teenagers visiting community family planning
clinics in England increased by 59 per cent between 1990-91 and
1996-97.21 In 1996-97, 10 per cent of girls aged under 16 and 20
per cent of girls aged 16–19 visited these clinics.
Teenage births as a proportion of all births by level of
deprivation, England and Wales, 1994-1996
Figure 5
H E A LT H O F T H E W O M A N
C o n t r a c e p t i o n u s a ge
14
The proportion of teenagers in Great Britain first having sex before
age 16 has increased. Nearly one in five (19 per cent) of young
women interviewed in 1990-91 reported having sex before the age
of 16.18 Most teenage pregnancies are unplanned, yet around half of
those first having sex before age 16 reported using no
contraception compared with about one-third of those aged 16 and
over at first intercourse.
A review concluded that providing sex education in school
before young people become sexually active, and increasing
availability to family planning services, can be effective in
12
Teenage births as % of all births
Britain has one of the highest rates of teenage pregnancy in Europe.
There are wide variations in teenage fertility rates between countries
in the European Union. In 1996 these varied between 4 per thousand
girls aged 15–19 in the Netherlands, to 16 in Ireland.17 The only
higher rate was for teenagers in England and Wales (30). These
differences cannot be explained by differences in sexual activity or
greater recourse to abortion. One difference could be the
effectiveness with which teenagers use contraception.
10
8
6
4
2
0
Least
deprived
2
3
4
Most
deprived
Level of deprivation (Carstairs index)
Source: ONS birth statistics
O f f i c e
f o r
N a t i o n a l
S t a t i s t i c s
23
P o p u l a t i o n
Figure 6a
Tr e n d s
9 3
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A u t u m n
1 9 9 8
Prevalence of drinking before and during pregnancy,
United Kingdom 1995
Before pregnancy
Prevalence of smoking before and during pregnancy,
England 1995
Figure 6b
Before pregnancy
During pregnancy
During pregnancy
70
90
80
60
70
50
Percentage
Percentage
60
50
40
40
30
30
20
20
10
10
0
0
< 20
20-24
25-29
30-34
35+
< 20
All mothers
20-24
Age of mother
25-29
30-34
35+
All mothers
Age of mother
Source: Infant feeding survey 1995
Source: Infant feeding survey 1995
Drinking alcohol and smoking
Deliver y method
In 1995, over 80 per cent of women in all age groups who had
recently given birth drank alcohol before pregnancy.22 During
pregnancy, however, far fewer of these women drank alcohol
(Figure 6a). This proportion was lowest for teenage mothers,
with 56 per cent drinking alcohol during pregnancy. Average
levels of alcohol consumption during pregnancy was low, with
over 70 per cent of the drinkers consuming less than one unit of
alcohol per week on average.
The rate of caesarean delivery is strongly associated with the age
and parity of the woman. Teenage mothers experience a much
lower proportion of elective caesarean deliveries compared with all
women. In 1994-95, 7 per cent of teenage mothers had an
emergency caesarean and 3 per cent an elective caesarean,
compared with 9 per cent and 7 per cent respectively of all
mothers7 (Table 5). As a result, 79 per cent of teenage mothers had
a spontaneous delivery compared with 73 per cent of all women.
In contrast, of all the recent mothers surveyed, two thirds of
teenage mothers had smoked before pregnancy, and almost half
of all teenage mothers smoked during pregnancy. As shown in
Figure 6b, these proportions of women smoking were higher than
for any other age group.
H e a l t h d u r i n g p re g n a n c y
A pregnant teenager is considered a high risk obstetric
patient because she has a higher risk than normal of
developing anaemia and pre-eclampsia.23 She also has a
higher risk of maternal mortality. Her baby has an increased
risk of infant mortality and of being low birthweight. There
is some evidence that insufficient and inadequate prenatal
care is related to complications in pregnancy. A study of
teenage mothers in 1979 24 showed that more than one quarter
had first consulted their GPs when they were more than three
months pregnant. Nearly one fifth had not had their first
ante-natal visit until after the 20th week of pregnancy. Nearly
half the women who had delayed their first visit had done so
because they had not realised that they were pregnant.
Long term outcomes for the women
Forty per cent of teenage mothers have episodes of depression
within one year of childbirth.25 This is higher than for teenage girls
in general. A study of young people living at home in 1993 showed
that 19 per cent of girls aged 16–19 had a neurotic disorder.26
Teenage mothers are often socially isolated.27 They may not receive
adequate help and support to enable them to cope with the
responsibilities and adjustments to parenthood. Social support is
associated in turn with the health and well-being of the mothers.
Table 5
Percentage distribution of delivery method by
mother’s age, England 1994-1996(combined)
< 20
Spontaneous
Forceps & Ventouse
All Breech
Elective caesarian
Emergency caesarian
Other
Total
Base numbers
Source: DH HES Maternity Statistics.
24
O f f i c e
f o r
N a t i o n a l
S t a t i s t i c s
All ages
79
10
1
3
7
0
73
11
1
7
9
0
100
100
23,977
604,300
9 3
H E A LT H O F T H E C H I L D R E N
Birthweight
In 1994-96 the average birthweight of all live births was 3,321
grams. For children of teenage mothers, however, the average
birthweight was 3,145 grams for births within marriage, and
3,224 grams for those babies born outside marriage whose
parents were living together.
Table 6
Birthweight (grams)
<20
1
8
1
7
1
7
1
1
2
6
21
38
24
7
1
0
1
1
5
19
37
26
8
1
0
1
1
4
15
35
30
12
1
0
1
1
5
17
36
29
11
1
100
100
100
100
128,600
396,549
1,436,597
1,961,746
<1000
1000-1499
1500-1999
2000-2499
2500-2999
3000-3499
3500-3999
4000+
Not stated
All
Base numbers
(Live births)
25+
1
9
<1500
<2500
1 9 9 8
Po p u l a t i o n
An interesting finding is for teenage girls who were lone mothers,
both characteristics considered to be at risk. Despite both these risk
factors, a smaller proportion of their babies are of low birthweight.
Of teenage girls who register their babies alone, 8.5 per cent have a
low birthweight baby compared with 9 per cent of all teenage
mothers or 9.5 per cent of all lone mothers (Figure 7). As discussed
earlier, however, many teenage lone parents (especially those aged
under 18) live in someone else’s household, usually their parents. It
is likely, therefore, that these women receive care and support
during their pregnancy, resulting in fewer low birthweight babies.
Mortality
Source: ONS Series DH3.
Table 6 shows the percentage distribution by birthweight for babies
born in England and Wales in 1994-96 by different mother’s age
groups. Overall, 7 per cent of all live births were of low
birthweight (less than 2,500 grams). For teenage mothers this
proportion was 9 per cent.
Children of teenage mothers experience higher infant mortality
rates. Figure 9 shows that infant mortality rates have been
consistently higher for babies of teenage mothers since 1975. In
1996, 9 babies in every thousand born to teenage mothers died in
the first year of life, compared with 6 babies in every thousand
total births. Nevertheless, there have been similar improvements in
rates for babies of teenage mothers as for all babies over the period.
There are differences in infant mortality rates by the parents’
marital status, social class and the babies’ birthweights. In
Figure 8
Incidence of breastfeeding by mother’s age for first
babies only, Great Britain 1985, 1990 and 1995
Proportion of low birthweight babies, England and
Wales 1996
Figure 7
1985
12
9.1
1995
90
9.5
80
8.5
70
7.3
Percentage
Percentage
1990
100
10
8
T r e n d s
There is a strong association between a mother’s age and whether
she breastfeeds her child. This pattern has not changed during the
last decade, as shown in Figure 8. Only 44 per cent of women aged
under 20 breastfeed their first child at birth, compared to 64 per
cent of those aged 20–24 and over 80 per cent of older women.
Since breastfeeding is known to have a protective effect, these low
levels of breastfeeding mitigate against these children having the
best start in life. There are differences in levels of breastfeeding
between the different countries of the United Kingdom. In England
46 per cent of teenage mothers breastfeed their first child,
compared with only 25 per cent of teenage mothers in Scotland and
24 per cent in Northern Ireland.
All ages
20-24
A u t um n
Breastfeeding
Percentage distribution of live births by birthweight and
mother’s age, England and Wales 1994-1996 (combined)
Mother’s age
|
6
60
50
40
4
30
20
2
10
0
0
All live
births
Teenage
mothers
Sole
registrations
Teenage and
sole registrations
<20
20-24
25-29
30 and over
Mother's age
Source: Infant feeding survey 1995
Source: ONS birth statistics
O f f i c e
f o r
N a t i o n a l
S t a t i s t i c s
25
P o p u l a t i o n
Figure 9
Tr e n d s
9 3
|
A u t u m n
Infant mortality rates by age of mother, England and
Wales 1975-1996
1 9 9 8
teenagers more likely to be of low birthweight: these low
birthweight babies have a poorer chance of survival compared with
similar weight babies who have older mothers.
25
Table 8
Infant mortality by birthweight and mother’s age, England
and Wales 1994-1996(combined)
Rates per 1,000 live births
20
Age of mother
All ages
Rate per 1,000 live births
<20
<20
15
20-24
25+
9.6
7.1
5.4
6.0
<1500
<2500
262.0
59.1
235.3
50.3
215.0
47.0
223.2
48.8
<1000
1000-1499
1500-1999
2000-2499
2500-2999
3000-3499
3500-3999
4000+
Not stated
514.0
96.3
35.3
14.9
6.2
3.9
3.4
3.4
43.5
464.3
92.9
28.8
12.6
5.5
2.8
2.1
3.1
27.1
426.2
79.4
24.8
10.1
3.7
2.0
1.5
2.1
24.5
441.5
83.7
26.5
11.1
4.3
2.3
1.7
2.3
26.0
All
10
All ages
5
0
1975
1978
1981
1984
1987
1990
1993
1996
Year
Source: ONS Linked infant mortality data
Source: ONS Series DH3.
Health
1994-96 there was little difference in infant mortality rates by
the parents’ marital status for children of teenage mothers,
whereas being married conferred some protection for babies
overall (Table 7). For women aged 25 and over there is a clear
social class gradient of increasing rates with lower social
classes. This same pattern is seen for the children of teenage
mothers, but they have higher rates in each social class. Thus
teenage mothers have more births in the lower social classes, and
these babies experience higher mortality than their counterparts
with older mothers.
Table 7
Infant mortality by social class and mother’s age, England and
Wales 1994-1996 (combined)
Rates per 1,000 live births
Age of mother
<20
All ages
20-24
25+
9.6
7.1
5.4
6.0
Inside marriage
Outside marriage/
joint registration
9.6
9.8
6.8
7.4
5.0
6.6
5.3
7.3
Sole Registration
9.1
7.4
7.5
7.9
9.8
6.1
9.2
8.9
8.9
10.3
12.2
7.1
5.9
6.3
6.3
7.6
8.6
10.0
5.3
4.5
5.1
5.5
5.9
7.4
7.3
5.9
4.6
5.4
5.9
6.6
8.1
8.7
Total
Children of teenage mothers are more likely to have more accidents,
especially poisoning and burns. In the first five years of life children
of teenage mothers are twice as likely to be admitted to hospital as a
result of an accident or gastro-enteritis.28 Research suggests that
these increased risks are associated with factors such as poverty.
Children of young mothers are also at an increased risk of some
congenital anomalies. Table 9 shows numbers and rates of selected
congenital anomalies notified by Health Authorities to the National
Congenital Anomaly System. Although it is known that notifications
are incomplete, there is no reason to assume differential reporting by
the mother’s age. It is therefore likely that the variations shown in
this table, if not the absolute measures, are a reflection of real
differences. The risk of chromosomal anomalies is known to
increase with advancing maternal age. It is not surprising, therefore,
that Table 9 shows that young mothers have a lower risk of
chromosomal anomalies.
Source: ONS Series DH3.
Births to teenage mothers have an increased risk, however, of
central nervous system anomalies, alimentary anomalies, and
anomalies of the musculoskeletal system. Research has shown that
increasing the intake of folic acid can reduce the prevalence of
neural tube defects. Results from the 1995 Infant Feeding Study
showed that only 53 per cent of recent mothers aged under 20
knew that increasing intake of folic acid was good for them in early
pregnancy.22 This compares with 67 per cent of those aged 20–24,
76 per cent of those aged 25–29 and over 80 per cent of recent
mothers aged over 30. Most women who knew about the benefits
of folic acid also said they had increased their intake of folic acid.
Therefore if fewer teenagers are aware of the benefits of folic acid,
their intake is likely to be lower than for older women. This lower
intake of folic acid in teenage girls may account for some of the
excess in central nervous system anomalies seen in this age group.
Table 8 shows the usual gradient in infant mortality rates for
birthweight, with decreasing mortality rates with increasing
birthweight. For babies of teenage mothers, however, the rates are
higher than those for all babies in each birthweight category. The
biggest proportional excesses in rates are for babies weighing
2,500 grams or over at birth. Therefore, not only are the children of
As seen in Table 9, gastroschisis (an abdominal wall defect) has a
higher prevalence in young mothers. In 1995-96 the notification rate
of gastroschisis was 5 times higher for teenage mothers compared
with all mothers. These findings confirmed a study of earlier data
from the ONS National Congenital Anomaly System. This study of
notified cases of gastroschisis in 1987-93 found a notification rate of 5
Marital status
Social class
All
I, II
IIIN
IIIM
IV
V
Other
26
O f f i c e
f o r
N a t i o n a l
S t a t i s t i c s
9 3
per 10,000 live births for teenage mothers. This was 3 times higher
than the rate for mothers aged 20–24 and over 4 times higher than the
rate for all women.29 A raised risk for teenage mothers was also found
in a study of abdominal wall defects in Australia.30 In this study girls
aged under 20 were 8 times more likely to have a baby with abdominal
wall defects than mothers aged 25–29.
Table 9
|
A u t um n
Table 10
Numbers and rates per 10,000 total births
Rate
Number
Rate
11,017
84.5
847
97.2
Central nervous system anomalies 492
Anencephalus
59
All spina bifida
135
Eye
134
Cleft lip and palate
1,128
Other face, ear and neck
397
Heart and circulatory
940
Respiratory
125
Alimentary
613
Genital organs
1,208
Urinary system
776
Musculoskeletal
4,141
Gastroschisis
182
Skin and integument
403
Chromosomal anomalies
863
Down’s syndrome
634
Congenital metabolic disorders
159
3.8
0.5
1.0
1.0
8.7
3.0
7.2
1.0
4.7
9.3
6.0
31.8
1.4
3.1
6.6
4.9
1.2
49
10
10
10
76
24
68
9
50
84
55
364
65
22
46
32
16
5.6
1.1
1.1
1.1
8.7
2.8
7.8
1.0
5.7
9.6
6.3
41.8
7.5
2.5
5.3
3.7
1.8
All babies notified
Total live and still births
1,303,910
Hazard
ratio
Confidence
intervals
Age of LS teenager’s mother at birth of
eldest sibling in household
Mother’s age at birth of the LS teenager
to 19
20-24
25-29
30-34
35-39
40 plus
< 20
T r e n d s
Risk of teenage motherhood by indicators of family
structure as determined at the 1981 census
20+ v to 19
Age of mother
Number
Po p u l a t i o n
Indicators of risk
Congenital anomalies - all babies notified, age of mother by
condition, England and Wales 1995-1996 combined
All ages
1 9 9 8
2.31
(2.12 - 2.52)
0.82+
1.00
0.55
0.38
0.35
0.45
0.49
(0.79 - 0.85)
(0.48 - 0.61)
(0.33 - 0.43)
(0.30 - 0.41)
(0.37 - 0.53)
(0.38 - 0.63)
Note: + result shows results for the main effects model.
Source: ONS Longitudinal Study (LS).
CONCLUSIONS
Teenage conception rates, although lower than in the 1970s, still
cause concern. There are social inequalities in teenage conception
rates and in the proportions that are terminated by abortion.
Teenage girls who continue with the pregnancy are more likely to
give birth to a low birthweight baby and have raised risks of some
congenital anomalies and of infant death. Teenage mothers are
more likely to live in deprived conditions, and their lack of
education and training reduces their long term potential to improve
their socio-economic conditions. Therefore all initiatives to reduce
the incidence of unwanted and unplanned teenage conceptions
could potentially improve the socio-economic conditions for these
girls and their future children.
87,158
Source: Series MB3 no.11 Congenital anomaly statistics 1995 and 1996.
Long term outcomes for the children
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