Teenage pregnancy analysis

1. Recent trends

1.1 Under 16 conceptions

Since 2000 there has been a small increase in the under 16 conception rate in whilst the overall rate in has continued to fall (see table 1). The overall number of under 16s conceptions has also increased during this period.

Table 1: Bolton under 16 conceptions

Year No of U16 Conception NW England conceptions rate/1000 conception conception rate/1000 rate/1000 1998 43 8.6 - 8.9 1999 70 13.6 - 8.2 2000 42 8.0 - 8.3 2001-03 136 8.2 8.1 7.9 2002-04 146 8.7 8.1 7.8 2003-05 159 9.4 8.3 7.7 Sources: Office for National Statistics & Teenage Pregnancy Unit

1.2 Under 18 conceptions and abortion

Year on year rates of under 18s conceptions in Bolton continue to fluctuate. Just simply comparing the 2005 rate to the baseline rate of 1998 shows that the rate has changed very little during the period (see table 2). The 50% reduction target for 2010 looks unlikely.

Abortion rates have also fluctuated slightly but remain fairly constant during the period.

Table 2: Bolton under 18 conceptions and abortions

Year No of U18 % of Conception % increase/ conceptions conceptions rate/1000 decrease in rate leading to since 1998 abortion 1998 (Baseline) 249 36.9 50.3 N/A 1999 272 40.4 54.8 +9.1 2000 272 41.9 55.2 +9.8 2001 252 35.3 48.5 -3.5 2002 286 30.4 53.4 +6.2 2003 276 40.4 49.9 -0.4 2004 298 32.1 53.5 6.5 2005 291 38.1 51.8 3.2 Trajectory to meet target 2006 - - 46.5 -7.4 2007 - - 41.2 -18.1 2008 - - 35.8 -28.7 2009 - - 30.5 -39.4 2010 - - 25.1 -50.0 Sources: Office for National Statistics & Teenage Pregnancy Unit

Figure 1 shows the trend for the under 18 conception rates graphically for Bolton, the NW and England. Whilst Bolton has fluctuated but has remained fairly stable overall, the trend both regionally and nationally has been a small decrease. However, the last few years has seen a small incline in rates in the NW.

Figure 1: Comparative trends in under 18 conceptions rates

60

Bol ton MCD 50 Engl and 000

r 1 40 North West pe

LA 2004 target ate

n r 30

o i

cept 20 n co

8 10 r 1 de

n

U 0 1997 1998 1999 2000 2001 2002 2003 2004 2005p 2006 2007 2008 2009 2010

Year

However, figure 2 shows that comparing rates between different years needs to be done with caution as the percentage change at the Bolton LA level is not statistically significant when compared to the regional and national average. The percentage change in the under 18 conception rate is given as +3.2% between 1998 and 2005. However, the confidence limits are between –13.1 and +22.8.

Figure 2: Change in under 18 conception rate 1998-05

25

20

15 rval) e 10

idence int 5

0

h 95% conf -5 (wit % change in rates 98-05 -10

-15 Bolton MCD

By looking at 3 year aggregate rates, this uncertainty is lessened to a degree. The percentage change in the rates of teenage conceptions (U18) for Bolton between 1997-99 and 2003-05 is actually a 2.1% decrease, compared to a 9% decrease for England as a whole.

It should be noted that table 5 (Characteristics of mothers giving birth aged under 19) in the teenage conception analysis produced in 2004 has not been updated by the Teenage Pregnancy Unit and so has not been included in this report

3. Ward level information

It should be noted that analysing teenage conception rates at ward level should be done with caution as the rates are often based on very small numbers. However, this has hopefully been lessened somewhat by using aggregated years in this analysis.

It should also be noted that ONS is still providing data at the pre-2004 ward level as the data refers to conceptions up to 2004. For this reason this report has used the names of pre-2004 wards when displaying other associated datasets and pointing to areas needing priority attention for teenage conception work. Table 3 Recent conception and associated data by electoral ward

Conceptions 2000-02 CONCEPTIONS 2002-04 ETHNICITY DEPRIVATION GCSE ATTAINMENT BY PUPIL WARD OF RESIDENCE 2002 Under 18 General conception direction rate 2002-04 change in Deprivation % of girls % of girls % of boys % of boys Under 18 No. of u18 Under 18 95% CI conception % BME pop Estimated quintile achieving 5+ achieving 5+ achieving 5+ achieving 5+ conception conceptions conception 95% CI Upper rate 00/02 15-17 girls deprivation (5=most GCSEs at GCSEs at GCSEs at GCSEs at WARD NAME rate 2000-02 2002-04 rate 2002-04 Lower Limit Limit –02/04* (2001) score 2004 deprived) A* to C A* to G A* to C A* to G 28.5 24 30.5 20.5 45.2 ↑ 10.0 18.29 4 64.7 95.3 59.3 96.3 Blackrod 33.5 28 32.7 22.7 47.0 ↓ 1.3 18.35 4 52.3 95.3 53.8 91.3 Bradshaw 39.7 31 42.3 29.9 59.6 ↑ 1.3 18.19 4 66.2 .. 44.8 .. 77.1 85 92.3 75.2 112.8 ↑ 8.6 37.80 5 36.8 90.6 26.5 86.7 Bromley Cross 41.8 23 26.0 17.3 38.8 ↓ 0.0 13.72 3 71.3 .. 51.1 .. Burnden 53.0 50 55.9 42.6 73.0 ↑ 48.1 37.77 5 41.9 94.2 35.1 88.3 Central 46.8 40 51.9 38.3 70.0 ↑ 70.1 58.40 5 31.7 88.3 27.8 82.3 Daubhill 59.0 40 54.6 40.3 73.6 ↓ 35.8 34.92 5 46.1 90.8 30.4 89.9 Deane-Cum- Heaton 42.8 41 38.9 28.8 52.5 ↓ 13.7 22.54 4 55.1 .. 51.8 .. Derby 50.5 52 62.6 48.0 81.2 ↑ 63.6 51.60 5 36.7 93.7 28.0 79.4 Farnworth 88.1 79 82.8 66.9 102.1 ↓ 9.6 47.81 5 31.6 92.4 30.6 82.7 Halliwell 78.9 57 81.9 63.7 104.7 ↑ 36.2 37.37 5 59.2 94.7 44.6 90.5 Harper Green 60.9 68 65.1 51.7 81.8 ↑ 14.3 39.80 5 31.1 89.3 38.7 88.3 Horwich 45.3 28 35.5 24.6 50.9 ↓ 3.3 19.60 4 61.8 94.7 49.4 90.6 Hulton Park 23.6 27 28.0 19.3 40.6 ↑ 5.1 14.65 3 71.4 96.2 66.7 100.0 Kearsley 47.0 33 42.3 30.2 58.9 ↓ 2.6 26.22 4 51.2 .. 35.0 .. Little Lever 52.9 31 48.5 34.3 68.2 ↓ 5.8 21.48 4 51.5 .. 43.0 .. 30.2 16 24.9 15.3 40.3 ↓ 8.6 20.68 4 54.5 93.5 40.7 87.0 Tonge 127.5 59 96.4 75.4 122.5 ↓ 3.3 39.72 5 44.0 92.0 25.0 83.3 Westhoughton 51.1 48 56.5 42.9 74.2 ↑ 2.4 21.19 4 58.5 91.5 38.6 86.4 Bolton 52.3 860 52.3 - - 18.0 29.40 50.7 94.0 40.8 88.9

Sources: Office for National Statistics, Census 2001, DFES & Teenage Pregnancy Unit

Table 3 highlights those wards that have displayed higher than Bolton average conceptions rates for the periods 2000-02 and 2002-04. It also provides a general direction change indicator for each ward. It also provides the confidence limits for the most recent rate and displays how wide these limits are and thereby reinforces the need for caution when using rates at a small area level. Very few of the wards show statistically significant, higher than the Bolton average, rates (only Breightmet, Farnworth, Halliwell and Tonge). However by simply comparing the rates to the average rate for Bolton, it could be said that Breightmet, Burnden, Daubhill, Derby, Farnworth, Halliwell, Harper Green, Tonge and Westhoughton are possibly experiencing higher rates of teenage conceptions than for Bolton as a whole. Since the previous analysis in 2004, some wards have shown substantial changes in their rate, however these are very unlikely to be statistically significant changes. For instance, Breightmet has increased from 77.1 to 92.3 and Derby from 50.5 to 62.6. However, some wards have seen drops in their conception rate, Bromley Cross from 41.8 to 26.0 and Tonge from 127.5 to 96.4. Overall 10 wards have shown and increase and 10 have shown a decrease in their rate of teenage conception.

The socio-economic information allows us to draw out some of the characteristics of the wards experiencing the highest rates. Those wards with the highest levels of deprivation, lowest educational attainment and highest proportions of BME population are also highlighted. Figures 3 to 7 provide a geographical perspective of the data.

1. Firstly, high rates of teenage pregnancy is strongly associated with deprivation with all but Westhoughton featuring amongst the most deprived quintile of wards.

2. It was noted in the analysis produced in 2004 that the vast majority of Bolton teenage pregnancies are seen in white British girls (89%). This was backed by data at ward level where Central and Derby, where the BME population form the majority, did not feature amongst the highest rates of teenage conceptions. However, Derby has in the most recent rates shown above average rates of teenage conceptions. Also Burnden, Daubhill and Halliwell do have significant BME populations (though far less than Central and Derby) and feature amongst the highest rates. The majority of the BME population of girls aged 15-17 (18% in total) in Bolton consist of girls of Indian origin (10%) and Pakistani origin (5%). The differing cultures of these two communities may play a part in where the highest rates of teenage conceptions exist. For instance, in Central (55%) and Derby (45%), girls of Indian origin form a substantial proportion of the wards population but these wards do not feature in the top teenage conception rates. Where as, in Burnden (29%) and Halliwell (21%), girls of Pakistani origin are the majority BME group and these two wards do experience higher rates of teenage pregnancy. Burnden and Halliwell also suffer from less deprivation than both Central and Derby. It is possible that this may be due to Pakistani Muslim girls marrying at a younger age and therefore having children whilst still in their teenage years. More up to date data and a further analysis is needed to confirm this but it may be possible to surmise that the majority of non-white teenage pregnancies experienced in Bolton are seen in girls of Pakistani origin. This may have an effect on the rate in the coming years as the Pakistani community is the fastest growing in Bolton.

3. In general, the wards showing the lower levels of educational attainment also experience the higher teenage conception rates.

Figure 3

Figure 4

Figure 5

Figure 6

Figure 7

3.2 Targeting ‘hot spots’

The evidence given in this section provides a case for targeting the following wards:

Breightmet Burnden Daubhill Derby Farnworth Halliwell Harper Green Tonge Westhoughton

• These wards have experienced the highest rates of teenage conception in the last three years that we have data for, suffer from deprivation and on the whole have poorer educational attainment. The Bolton Health Survey 2001 also tells us that people living in these wards suffer from poorer health and generally more unhealthy lifestyles (2007 survey analysis to be completed).

• Whilst it is understandable to want to target those wards suffering the highest rates of teenage conception, as decreases here will help targets to be met, this may overlook areas and populations that are also suffering from high rates but for various reasons, these rates are masked. For instance, we know that 91% of teenage mothers in Bolton between 1999-2001 were white British. We also know that deprivation and poor educational attainment are strongly linked to teenage pregnancy. However, through targeting the seven wards above, white deprived girls with poor educational attainment in wards such as Central may miss out on initiatives and thereby lead to rates rising in these areas (Derby may have been an example of this, displaying an increased rate in the most up to recent data).

David Holt Public Health August 2007