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1
Department of Primary Care
and Public Health, School of
Medicine, Cardiff University,
Cardiff, Wales, UK; 2 Royal
Gwent Hospital, Cardiff Road,
Newport, Wales, UK
Correspondence to:
Professor David Fone,
Department of Primary Care and
Public Health, School of
Medicine, Cardiff University, 4th
Floor Neuadd Meirionnydd,
Heath Park, Cardiff CF14 4YS,
Wales, UK; Foned@cf.ac.uk
Accepted 14 October 2008
Published Online First
19 November 2008
Arch Dis Child 2009;94:239–245. doi:10.1136/adc.2007.115915
Teenage pregnancy: who suffers?
S Paranjothy,1 H Broughton,1 R Adappa,2 D Fone1
ABSTRACT
In this review, we examine the epidemiology of teenage
pregnancy (girls aged 15–17 years) in the UK and
consider the evidence for its impact on the health and
well-being of the mother, the baby, the father and society.
There has been some decrease in the teenage pregnancy
rate over the last decade in the UK but rates are still
considerably higher than those in other European
countries. Pregnancy and childbirth during the teenage
years are associated with increased risk of poorer health
and well-being for both the mother and the baby, possibly
reflecting the socio-economic factors that precede early
pregnancy and childbirth. There is little evidence
concerning the impact of teenage fatherhood on health
and future studies should investigate this. The effect on
society is a perpetuation of the widening gap in health
and social inequalities. Public health interventions should
aim to identify teenagers who are vulnerable and support
those who are pregnant with evidence based interven-
tions such as teenage antenatal clinics and access to
initiatives that provide support for early parenthood.
The UK is reported to have the highest rate of
teenage pregnancies (girls aged 15–17 years) in
Europe, being eight times that in The Netherlands,
five times that in France and three times that in
Germany.1 In addition to the potential health
effects for the mother and the baby, the socio-
economic impact of teenage pregnancy and its
effect of widening health and social inequalities
have led the UK government to set targets to halve
the under-18 conception rate in England by 2010
from the 1998 rate of 46.6 per 1000.2 3 As the
deadline for this target approaches, local strategies
led by local authorities and primary care trusts are
now in place with targets for reductions of
between 40% and 60%.4
Teenage mothers and their babies are at
increased risk of poor health outcomes, but there
is debate as to whether young maternal age is
intrinsically a risk factor for adverse health out-
comes or if the increased risk is attributable to the
socio-economic circumstances leading to and fol-
lowing pregnancy in this group.5–7 Some teenage
pregnancies are planned. It has been suggested that
concern over teenage pregnancies is misplaced as
teenagers can be physically and mentally better
suited for pregnancy than older couples.8 9
However, for young girls who live in deprived
areas, pregnancy can increase the risk of social
exclusion and socio-economic disadvantage, lead-
ing to poorer health and well-being.2 7
In this review, we examine the epidemiology of
teenage pregnancy in the UK and consider the
evidence for its impact on the health and well-
being of the mother, the baby, the father and
society.
Review
METHODS
We searched the published literature using the
search strategy and databases shown in box 1. Two
authors (SP and HB) independently screened the
titles and abstracts to identify articles that were
relevant for this review. We categorised articles
according to the outcomes that were reported for
mothers, babies, fathers and society. Data on the
epidemiology of teenage pregnancy were obtained
from the Office for National Statistics website for
England and Wales,10 the Information Services
Division website for Scotland,11 the Department
of Health, Social Services and Public Safety in
Northern Ireland12 and the Eurostat website13 for
comparative European data.
Epidemiology of teenage pregnancy
Within Europe teenage birth rates vary widely
from 1.5 per 1000 females aged 15–17 years in
Switzerland to 16.6 in the UK in 1998.1 13 Rates in
The Netherlands, France and Germany were 2.2,
3.4 and 5.3 per 1000, respectively.1 13
The Office for National Statistics (ONS) in the
UK defines conception as pregnancies resulting in
live births, stillbirths or legal terminations.14
Conception rates are available from the ONS for
the under-20 (15–19 years) and under-18 (15–
17 years) age groups. In this paper we discuss
conception rates for the under-18 age group, as this
is the government target group. In England and
Wales, the under-18 conception rate per 1000
females decreased from 47.1 in 1998 to 42.4 in
2003 and 41.4 in 2005.15 In Scotland these rates
were 44.9 in 1998, 40.3 in 2003 and 41.5 in 2005.11
Data on conceptions are not available for Northern
Ireland; however, the fertility rate in the under-20
age group decreased from 27.8 per 1000 in 1998 to
21.7 in 2005.12
Although overall conception rates are similar
between the UK home nations, there is large
variation between regions, and between local
authority areas within regions. Provisional data
for 2006 from ONS suggest that under-18 concep-
tion rates in England range from 48.3 per 1000 in
the North East to 32.9 per 1000 in the South East
and South West.16 Twenty five per cent of unitary
authorities in England had rates below 33 per 1000
and a further 25% had rates above 52 per 1000. The
overall rate in Wales was 44.8 per 1000 females,
ranging from 58.9 in the highest to 31.8 in the
lowest local authority areas.16 Similar variation has
been observed in Scotland, partially attributed to
variation in population and socio-economic char-
acteristics within the country.2 17
The average age at first birth in the UK has
increased from 26 in 1996 to 27 in 2006.18 However,
these data are based only on married women and
therefore may not be accurate as teenage girls are
239
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Box 1
Databases searched
c ASSIA
c CINAHL
c Cochrane Library
c Embase
c HMIC
c Medline
c PsycINFO
c Science Citation Index
c Social Science Citation Index
c Social Services Abstracts
c Sociological Abstracts
Search strategy
c 1 (Teen$ mother$ or adolescent mother$).mp.
c 2 *Pregnancy in Adolescence/
c 3 Teenage Pregnanc$.mp.
c 4 *‘‘Pregnancy, Unplanned’’/
c 5 (2 or 3 or 4) and 1
c 6 (teen$ mother or young mother).mp.
c 7 (baby or babies or child$).mp.
c 8 (adolescent father or adolescent mother).mp.
c 9 teen$ parent$.mp.
c 10 or/6–9
c 11 5 and 10
unlikely to be married when they become pregnant. In 2006,
93% of births to teenagers occurred outside of marriage, an
increase from 88% in 1986.18
Approximately 7% of live births in England and Wales are to
females aged less than 20 years, although this varies according
to the mother’s country of birth.14 Nine per cent of Bangladeshi
mothers were under 20, compared with less than 3% of mothers
born in India, East Africa, Australia, Canada or New Zealand.14
However, this may be partly attributable to differences in the
age structures of these populations with more recent immigra-
tion from Bangladesh compared to other countries.14 Early
marriage and childbearing is traditional in some populations and
so the social circumstances and hence outcomes associated with
younger childbirth may be different for these populations.
Teenage mothers in the UK are reported to have a lower
socio-economic background, more siblings and parents who
show less interest in their education or live in a lone parent
family.19–22 The risk of becoming a mother before the age of 20 is
nearly one in three for teenagers from vulnerable backgrounds.
Having a mother with no qualifications, low educational
attainment or a mother who herself had a teenage pregnancy
is associated with increased risk of teenage pregnancy.23 24
Compared with girls in social class 1, the risk of becoming a
teenage mother is nearly ten times higher for girls whose family
is in social class V.14 25
DOES THE MOTHER SUFFER?
In this section we consider the impact of teenage pregnancy on
the health and well-being of the mother, with effects ranging
from obstetric complications during pregnancy to psychosocial
and mental health morbidity in the longer term. The majority
of studies investigating the effects of teenage pregnancy
compare a young 16–19-year-old age group with an older group.
This can make comparisons difficult as it does not allow for
240
differences in physical or psychological maturity over the range
of the teenage years.
The evidence for obstetric complications associated with
teenage pregnancy is shown in table 1.26–30 Three studies have
reported that teenagers were approximately twice as likely to be
anaemic (haemoglobin ,10.5 g/dl).26–28 The most common
cause of this anaemia was iron deficiency attributed to poor
nutrition.26 27 Although severe anaemia during pregnancy is
associated with poor health outcomes for the mother, the
significance of moderate anaemia is less clear.31
While there is some evidence for increased risk of pregnancy
induced hypertension (relative risk (RR) 1.7, 95% CI 1.3 to 2.4)
for pregnant nulliparous teenagers compared with adults,27
studies that have investigated the incidence of pre-eclampsia
or proteinuric disorders among nulliparous teenagers compared
with adults did not find any difference between the two groups
after adjusting for confounding factors such as cigarette
smoking,26 29 supporting the view that teenage pregnancy
complications can be prevented with regular ante- and postnatal
care.32
Although teenagers are 46% less likely to have an emergency
or elective caesarean section compared with women aged 25–
29 years,30 they are at higher risk of instrumental deliveries.
Teenagers under 16 are twice as likely to have forceps delivery
compared with women aged 20–24 years.27 The reason for the
higher rates of instrumental delivery is not clear, although it is
postulated to be due to the physical immaturity of the younger
mother33 or ‘‘fright and lack of cooperation’’ in the second stage
of labour.27 A systematic review has shown that social support
interventions (such as home visits) for pregnant teenagers are
effective in reducing caesarean section rates in this group.34
In developing countries, complications from pregnancy and
childbirth are the leading cause of death among teenagers.35 In the
UK, maternal mortality is rare (14 per 100 000 maternities)36 and is
even lower in the under twenties, at 9.9 per 100 000 maternities.36
In the most deprived areas of England, maternal mortality is 46%
higher than in the least deprived areas, and unemployment is
associated with a sevenfold increased risk of maternal death (RR
7.4, 95% CI 5.6 to 9.0).36 Although young maternal age is not itself
an identified risk factor for maternal mortality in the UK, some of
the vulnerable circumstances that are risk factors for mortality,
such as socio-economic disadvantage, are also risk factors for and
the consequences of teenage pregnancy.7 36
The longer term health implications for the teenage mother
were assessed in a Swedish population based cohort study using
record linkage of census data with at least 30 years’ follow-up.37
Compared with mothers aged 20–24 years at first birth, there
was a 70% increase in the risk of premature death for mothers
aged 17 years or under at first birth, and a 50% increase for
those aged 18–19 years.37 The major causes of death associated
with a previous teenage birth were cervical cancer, ischaemic
heart disease, suicide, and death following violence, assault and
homicide. These increased risks are related to health damaging
lifestyles, poor psychosocial health or a violent environment, all
factors known to be closely associated with poverty and
deprivation.19 Although these increased risks remained statisti-
cally significant after adjustment for socio-economic status,
they are less likely to be due to younger age at childbirth than
the effect of residual confounding from individual lifestyle
variables such as smoking status, alcohol use and obesity that
were not measured in this study.
In the UK, research on mothers of twins showed that
compared with adult mothers, teenage mothers experienced
more deprivation and more mental health difficulties and had
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Table 1 Association between teenage pregnancy and adverse outcome for the mother
Adverse maternal outcomes
Study type, sample size, Pregnancy induced
comparison group, hypertension or pre- Urinary tract Operative
Author setting and date Adjusted for Anaemia eclampsia infection delivery

Jolly et al26 Retrospective database study. Smoking, ethnicity, ,10 g/dl Pre-eclampsia OR 1.60
North West Thames region, parity, body OR 1.82 OR 1.30 (99% CI 1.11 to 2.31)
1988–1997 mass index, (99% CI 1.63 to 2.03) (99% CI 0.94 to 1.82)
Total population – 341 708 hypertension
completed singleton at booking
pregnancies and emergency
,18 years, n = 5246 caesarean
18–34 years, n = 336 462 section
>35 years were excluded,
n = 48 658

Konje et al27 Retrospective study of case ,10.5 g/dl Pregnancy induced RR 1.6 Forceps delivery
records. Hull health district RR 2.53 hypertension (95% CI 1.26 to 2.01) RR 2.37
hospitals, 1977–1988 (95% CI 2.19 to 2.92) RR 1.69 (95% CI 1.8 to 3.12)
Nulliparous 10–16 years, (95% CI 1.28 to 2.4) Caesarean section
n = 671 Pre-eclampsia (emergency and
Nulliparous 20–24 years RR 1.07 elective)
(control group), n = 2325 (95% CI 0.81 to 1.43) RR 0.55
(95% CI 0.4 to 0.75)
Briggs et al28 Retrospective chart review. Body mass Hb ,110 g/l
Kingston, Ontario, 1996–2004 index and 26–35 weeks of gestation
Primiparous (19 years, smoking OR 2.6
n = 207 (95% CI 1.52 to 4.5)
Primiparous >20 years, Pre-delivery anaemia at
n = 415 entry to prenatal care
OR 2.53
(95% CI 1.19 to 5.38)
Gilbert et al29 Birth and death certificates Race, ethnicity Pre-eclampsia
and maternal and neonatal and maternal 11–15 years
hospital discharge records age, parity OR 1.5
data set analysis. California, (99% CI 0.8 to 2.8)
January 1992–December 16–19 years
1997. Nulliparous women OR 1.0
with singleton gestations. (99% CI 0.9 to 1.1)
11–15 years, n = 31 232
16–19 years, n = 271 470
20–29 years (comparison
group), n = 662 752
Non-Hispanic white women
Paranjothy et Cross-sectional study. 216 Ethnicity, previous Caesarean section
al30 maternity units in England vaginal deliveries, before labour
and Wales, May–July 2000 previous caesarean OR 0.54
Singleton pregnancies, section, gestation, (95% CI 0.48 to 0.61)
n = 147 077 mode of onset Caesarean section
12–19 years, n = 7% of labour, during labour
20–24 years, n = 17% presentation and OR 0.54
(reference group) birth weight (95% CI 0.50 to 0.59)

lower levels of educational attainment, and more emotional and
behavioural problems.7 Teenage mothers are three times more
likely to be living in poverty compared with mothers in their
thirties,39 and are less likely to complete their education and
training.7 They therefore face restricted job opportunities,
potentially reinforcing the cycle of deprivation and teenage
pregnancy.7 24 38
However, it is recognised that some mothers who have an
early childbirth have better psychosocial outcomes than others.7
Evidence from the 1970 British Cohort Study showed that some
of the health disadvantage suffered by teenage mothers is
explained by their parental background and childhood char-
acteristics.39 A large retrospective cohort study in the USA found
that teenage mothers who suffered adverse childhood experi-
ences had increased risk of psychosocial outcomes (high stress,
uncontrollable anger and serious or disturbing problems with
their families, jobs and finances) compared with those who did
not have adverse childhood experiences.40 The authors suggest
that the psychosocial consequences for the mother are a result
of the childhood experiences that precede the teenage preg-
nancy, rather than the pregnancy and childbirth itself. These
findings may however be subject to recall bias, which is a
limitation of retrospective cohort studies.
A systematic review of the effectiveness of preventive
psychosocial and psychological interventions compared with
usual ante-partum, intra-partum or post-partum care to reduce
the risk of post-partum depression found that intensive
professionally based post-partum support may be helpful,
particularly if this is targeted at an at-risk group which includes
teenage mothers.41 Evidence from randomised controlled trials
in the USA42 showed that the home visiting interventions that
form the basis of the Nurse-Family Partnership programme43
have positive effects for mothers, such as fewer and more widely
spaced pregnancies and better financial status. The Nurse-
Family Partnership programme was piloted in 10 sites in
England, and the evaluation reported high enrolment of women
under 20, a 17% relative reduction in smoking during pregnancy
and high rates of initiating breast feeding.43

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THE BABY
Teenage pregnancy is a risk factor for adverse baby outcomes
such as pre-term delivery, low birth weight, small for
gestational age, and neonatal and infant mortality
(table 2).28 29 44–48 However, the socio-economic and behavioural
factors (tobacco, alcohol or recreational drug use, poor nutrition
and poor antenatal care attendance) associated with teenage
pregnancy are also risk factors for these adverse baby outcomes.
A study of births to women aged under 25 years of age in the
USA found that after adjustment for confounding factors (state
of birth, maternal race, marital status, tobacco smoking and
alcohol use during pregnancy, and prenatal care status), teenage
pregnancy was independently associated with the increased
risks of very pre-term delivery, pre-term delivery, very low birth
weight, low birth weight, small for gestational age and neonatal
mortality.44 These findings did not change when the analysis
was restricted to white married mothers with age-appropriate
education, who received adequate prenatal care and did not
smoke or drink during pregnancy. The authors conclude that
their findings challenge the argument that many of the adverse
outcomes associated with teenage pregnancy are attributable to
low socio-economic status.44 However, this study did not
adequately control for employment status or occupation,
neither did the study measure the effect of using recreational
drugs or psychological and emotional stress during pregnancy as
potential confounders. These factors have been identified in
other studies as risk factors for pre-term birth.49–51
Low birth weight is an important determinant of childhood
mortality, especially in developing countries.34 Young maternal
age is associated with increased risk of low birth weight,29 44 45 47
which is generally used by clinicians as a proxy measure for intra-
uterine growth restriction (IUGR). The social aetiology of IUGR
includes psychosocial stress which can result from social isolation,
homelessness and violence.51 52 Low birth weight, small for
gestational age and prematurity are important because of their
associated medical complications and poor neonatal survival.47
One limitation of studies on teenage mothers is the lack of
information on whether or not pregnancy is wanted, as this
could affect behaviour during the pregnancy and attitudes
towards antenatal care.25 Estimates from the Millennium
Cohort Study suggest that only 15% of teenage mothers plan
their pregnancy.53 Teenagers are five times more likely to smoke
throughout the pregnancy compared with older mothers.54 In
addition, the prevalence of poor diet, alcohol and drug misuse is
higher among younger age groups in the population and can
impact negatively on the pregnancy, particularly in unplanned
circumstances.55
Babies born to teenage mothers are at increased risk of
maltreatment or harm, and have higher rates of illness, accidents
and injuries as well as cognitive, behavioural and emotional
complications.7 39 However, higher levels of behavioural problems
in children born to teenage mothers have been attributed mostly
to the mother’s mental state rather than the young age of the
mother.39 The association between younger age at childbirth and
poorer cognitive and behavioural outcomes in children is unlikely
to be causal, as developmental outcomes in children have been
shown to be associated with maternal age at first birth rather than
at the given child’s birth.6 Analysis of data from sisters has shown
that the disadvantage of children born to younger mothers is
greatly reduced after controlling for maternal family background.6
Further evidence suggests that the difficulties and disadvantages
associated with early first childbirth are long-lasting with poorer
behavioural and emotional outcomes for children born to mothers
who were under 20 years of age at first childbirth compared with
242
those who were in their twenties.7 Recent developments in our
understanding of child development have highlighted the impor-
tance of early environments, nurturing relationships and the
health and well-being of the child’s parents,56 forming the basis for
community based interventions such as Head Start in the USA,57
SureStart58 and more recently the Nurse-Family Partnership
programme42 43 in the UK. A meta-analysis of home visiting
programmes for families with young children has shown better
child development outcomes associated with this intervention.59
Other interventions include comprehensive social and med-
ical care using antenatal clinics specific for teenagers, which has
been shown to reduce the pre-term birth rate among females
under 18 years of age in a randomised controlled trial.60
However, there is no evidence that provision of social support
on its own to pregnant teenagers, for example with additional
home visits, although useful for reducing caesarean section
rates, reduces the incidence of pre-term birth or low birth
weight babies in teenagers.34
THE FATHER
Studies on teenage pregnancies tend to focus on the mother and
baby. The limited research available indicates that young fathers
have low socio-economic status backgrounds, with low levels of
education and low earning potential.39 Men who become fathers
in their teens or early twenties are twice as likely to be
unemployed, receive benefits and require social housing, after
allowing for the poorer backgrounds and lower educational
ability that predisposed to young fatherhood.39
A qualitative study of low-income young fathers suggests
that young fathers use their own fathers as a benchmark of
what to do and what not to do, and that those who have grown
up without a father want to do things differently.61 62 The
inability to adequately provide financial support can be
damaging to a young father’s confidence and sense of self,
while accepting parenting responsibilities and being signifi-
cantly involved with their child is associated with positive
benefits for father and child.61 63 Higher levels of paternal
engagement have positive effects on child development with
reported lower levels of delinquency, higher IQ scores and fewer
behavioural problems.63
A UK based study interviewed young first-time fathers and
found that many of them felt excluded from being involved in
the pregnancy by healthcare professionals who, in turn,
reported knowing little about the fathers.64
Interventions such as nurse home visiting (Nurse-Family
Partnership programme) are also associated with positive
outcomes such as higher levels of paternal engagement.42 43
Improving parent–child interaction is important, particularly
as evidence suggests that this has a significant influence on the
child’s development.65 The impact of fatherhood during the
teenage years on longer term health and well-being is poorly
studied and warrants further exploration.
FROM A SOCIETAL PERSPECTIVE
Teenage pregnancy is perceived by the UK government to be a
social and economic problem.2 In some countries (such as the UK
and the USA) the increase in teenage birth rates is partially
attributed to society moving away from traditional family values,
described by Kmietowicz as entering a ‘‘socio-sexual transforma-
tion’’.66 Countries that have prepared for an increasingly
sexualised society and ensure that their young are well informed
(eg, The Netherlands) have lower teenage pregnancy rates.66
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Table 2 Association between teenage pregnancy and adverse outcome for the baby
Adverse pregnancy outcomes
Small
gestational Neonatal
Very pre- Pre-term Very low Low birth age (birth mortality (Apgar
Study type, sample size term delivery delivery birth weight weight weight ,10th scores and
Author and comparison groups Adjusted for (,32 weeks) (,37 weeks) (,1500 g) (,2500 g) percentile) neonatal death)
28
Briggs et al Retrospective chart review. Body mass index p = 0.038 p = 0.005
Kingston, Ontario, 1996– and smoking
2004
Primiparous (19 years,
n = 207
Primiparous >20 years,
n = 415
Gilbert et al29 Birth and death certificates Race, ethnicity 11–15 years 11–15 years 11–15 years
and maternal and neonatal and maternal age, OR 1.9 OR 1.8 OR 2.7
hospital discharge records parity (99% CI 1.7 (99% CI 1.6 (99% CI 1.6
data set analysis. California, to 2.1) to 21) to 4.7)
January 1992–December 16–19 years 16–19 years 16–19 years
1997. Nulliparous women OR 1.33 OR 1.3 OR 1.8
with singleton gestations (99% CI 1.3 (99% CI 1.27 (99% CI 1.4
11–15 years, n = 31 232 to 1.4) to 1.4) to 2.2)
16–19 years, n = 271 470
20–29 years (comparison
group), n = 662 752
Non-Hispanic white women
Chen et al44 Retrospective cohort study State of birth, RR 1.32 RR 1.17 RR 1.25 RR 1.24 RR 1.23 Apgar score ,4
using nationally linked birth/ maternal race, (95% CI 1.32 (95% CI 1.14 (95% CI 1.17 (95% CI 1.20 (95% CI 1.21 RR 1.23
infant death data. USA, marital status, to 1.40) to 1.20) to 1.33) to 1.27) to 1.26) (95% CI 1.09
1995–2000 tobacco, alcohol, to 1.40)
10–19 years, n = 1 879 prenatal care, age Apgar score ,7
714 appropriate RR 1.15
20–24 years (comparison educational level (95% CI 1.09
group), n = 2 006 650 to 1.22)
Neonatal death
(,28 days)
RR 1.32
(95% CI 1.18
to 1.48)
Amini et al45 Computerised perinatal Ethnicity, socio- 12–15 years 12–15 years 12–15 years
database analysis. Ohio, economic status, OR 1.2 OR 1.3 OR 1.6
1975–1993 parity, marital (95% CI 1.07 (95% CI 1.0 (95% CI 1.4
12–15 years, n = 1875 status to 1.4) to 1.76) to 1.9)
16–19 years, n = 17 359 16–19 years 16–19 years 16–19 years
Comparison group: adult OR 0.93 OR 1.2 OR 1.2
mothers (20+ years) (95% CI 0.88 (95% CI 1.06 (95% CI 1.1
to 0.98) to 1.33) to 1.25)
Olausson et al46 Population based cohort Year of delivery 13–15 years
study, births recorded in and educational OR 2.7
Swedish Medical Birth attainment (95% CI 1.5
Registry, 1973–1989 to 4.8)
13–24 years, n = 320 174 16–17 years
Comparison group 20–24 OR 1.4
years old (95% CI 1.1
to 1.8)
18–19 years
OR 1.1
(95% CI 0.97
to 1.3)
Fraser et al47 Stratified analysis of Adequate ,17 years ,17 years ,17 years
singleton, first born infants antenatal care, RR 1.9 RR 1.7 RR 1.3
in Utah between 1970 and education and (95% CI 1.7 (95% CI 1.5 (95% CI 1.2
1990. marital status to 2.1) to 2.0) to 1.4)
13–24 years, n = 134 088 18–19 years 18–19 years 18–19 years
Comparison group aged RR 1.5 RR 1.2 RR 1.1
20–24 years (95% CI 1.4 (95% CI 1.1 (95% CI 1.0
to 1.6) to 1.4) to 1.2)
Scholl et al48 A meta-analysis of Year of delivery (19 years
pregnancy complications and setting/ RR 1.46
country (95% CI 1.2
to 1.77)

Moffit et al argued that much of the evidence of the effects of
teenage pregnancy has been from UK cohorts from 1946 and
1958, therefore referring to a population that were teenagers in
the 1960s and 1970s, at a time when early marriage and
childbearing was the norm. As society has changed over time,
women have delayed childbirth; women who have early
childbirth risk disruption of their education and hence are at
risk of disadvantage when compared with their cohort peers,
many of whom would have continued on to post-secondary
education. Therefore, childbirth in the teenage years has become

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even more ‘‘deviant’’.7 Moffit’s work on a cohort of twins shows
that mothers who had their first child before the age of 20 in the
late 1980s and early 1990s have continued to experience similar
difficulties as earlier cohorts, with more socio-economic
deprivation, less human social capital and more mental health
problems than women who gave birth in their twenties.7
Children of women who chose to postpone motherhood in
order to complete education and compete in the work place are
associated with positive growth and development. However,
the cohort of young ‘‘NEET’’ (not in education, employment or
training) mothers have a wide range of difficulties related to
their social background, which can have long term implications
for their children,7 and hence society in the future. Furthermore,
evidence suggests that children with absent fathers in early
childhood are more likely to be sexually active at a younger age
and have a teenage pregnancy, therefore perpetuating the
cycle.67 This can inevitably result in widening the inequalities
gap. Investment in programmes such as SureStart59 and the
Nurse-Family Partnership43 aim to provide early interventions to
reduce future inequalities by improving behaviour and language
development in children from disadvantaged backgrounds,
targeting young mothers in deprived areas.
It is estimated that the cost to the NHS alone of pregnancy
among under 18 year olds was over £63 million per year in
2002.25 The national policy target is to halve teenage pregnancy
rates by 2010, but data from the Social Exclusion Unit show
that despite the slow and steady decline in conception rates for
under 18 year olds (15–17 years), the 2010 target will not be
met.3 Further examination of these data has shown that the
majority of the observed decrease is attributable to reductions in
less deprived areas.3 In areas of higher deprivation, there has
been little change, resulting in renewed efforts and interven-
tions to meet this target, and a shift from national to more
localised initiatives.3
CONCLUSION
There has been little change in the teenage pregnancy rate over
the last decade in the UK and rates are still considerably higher
than those in other European countries. The aim of this review
was to consider who suffers from the consequences of teenage
pregnancy. Pregnancy and childbirth during the teenage years
are associated with increased risk of poorer health and well-
being for both the mother and the baby, reflecting more the
socio-economic factors that precede and follow early pregnancy
than the biological effects of young maternal age. There is little
evidence concerning the impact of teenage fatherhood on
health, and future studies should investigate this. The impact
on society is a perpetuation of the widening gap in health and
social inequalities. Government initiatives, interventions and
support services aimed at young mothers should continue to be
targeted at vulnerable groups of society with specific socio-
economic and demographic characteristics, as the available
evidence suggests that these groups and their children are at
highest risk of poor health and social exclusion. Further research
should examine the longer term morbidity for teenage mothers,
young fathers and their children, to gain a better understanding
of how much of this morbidity is attributable to socio-economic
characteristics and the pathways that mediate this.
Acknowledgements: We are very grateful to Mala Mann, funded by the National
Public Health Service for Wales and based at the Support Unit for Research Evidence
(SURE), Duthie Library, Cardiff University, for carrying out the literature searches.
Competing interests: None.
244
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Teenage pregnancy: who suffers?

S Paranjothy, H Broughton, R Adappa, et al.

Arch Dis Child 2009 94: 239-245 originally published online November
19, 2008
doi: 10.1136/adc.2007.115915

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