These inequalities have been explored in a new book, Teenage Pregnancy and Young Parenthood, by Alison Hadley OBE, Director of the Teenage Pregnancy Knowledge Exchange, based at the University of Bedfordshire.

In the two decades following the introduction of the Labour government’s Teenage Pregnancy Strategy (TPS), England has seen a 72% fall in the under-18 conception rate. However, significant inequalities persist across the country and some outcomes for young parents and their children are worsening. Notably the most recent conception data in 2021, collected by the Office for National Statistics, shows the first increase in 14 years, an upward trend which continued into the first half of 2022.

The book, which Alison has co-authored with experts from the University of Southampton, University of Bradford and the World Health Organization (WHO), reviews the latest evidence and data, dissects the impact of the TPS, and looks at what has happened since 2018 in the UK and internationally.

The authors conducted comprehensive interviews in England from national and local teams involved in reducing teen pregnancy rates since the end of the strategy to see what factors supported or hindered progress. The support for young parents was also reviewed, and these interviews informed recommendations to government to support further progress.

Speaking about this research, Alison said: “Against these challenges, there has been remarkable commitment by individuals at local level to maintain the principles and actions from the strategy, illustrated by the many excellent case studies on both prevention and support for young parents. But progress cannot and should not rely on passionate individual champions. There is a clear call for national leadership to recommit to this priority and to reverse the severely det­rimental effects of long-term austerity.

“Going forward, the government must invest in delivery of effective relationships, sex and health education, increase local authority budgets, provide easily accessible contraception services, improve support for young parents and re-establish national partnerships which are the backbone of successful local strategies. Unless greater recognition and funding is given to councils to invest in prevention services, an increase in young people facing unplanned pregnancy and STIs − and the worsening of outcomes for young parents and their children, is now a real risk. Spending on young people now is investment for the future.

“As Labour returns to office, this is the time to develop a new cross-government youth strategy, with health and wellbeing at the centre, to re-build the scaffold of services to reach and support young people. This will provide a secure policy context for the next chapter of the teenage pregnancy strategy and prevent the legacy of a highly successful programme of work from unravelling.”

While respondents reported some supportive factors - notably the introduction of statutory relationships, sex and health education in all schools, there were some significant challenges which have affected both young people and how local areas have been able to meet their needs.

Issues and concerns most commonly cited were:

• The impact of austerity and cost of living crisis on local authority and public health budgets, with funding cuts fracturing well-established partnerships and upstream prevention shifting to downstream crisis management, and on young people, some of whom have experienced an increase in the risk factors for early pregnancy - family poverty and disengagement from education, an impact clearly evidenced in the increased vulnerability of teenage parents.

• The impact of the Covid-19 pandemic which exacerbated many of the pre-existing problems for services and young people with stress, long-term sick leave and retirement further depleting staff numbers and weakening the fragile multi-agency partnerships, and a large rise in numbers of pupils absent from education in years 9-11 (14-16)

• Digital services and social media. A welcome for the positive innovations to simplify and increase access to contraception and sexual health services but caution about the dominance of online services jeopardising access for marginalised young people, and a recognition of the potential for social media to disseminate accurate information but concerns over some types of pornography and other negative content normalising a peer culture of unhealthy and sometimes violent relationships. Social media is also influencing negative views of hormonal contraception with personal opinions of ‘influencers’ carrying more weight than health professionals.

• Losing the priority. Despite the persistent inequalities, respondents often encountered a sense of complacency that the ‘rates are down, so the job is done’ with a lack of national leadership or monitoring making it hard for local prioritisation.