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

9 3 | A u t u m n 1 9 9 8 P o p u l a t i o n T r e n d s 9 3 | A u t u m n 1 9 9 8 P o p u l a t i o n T r e n d s
Teenage mothers and the
health of their children
Beverley Botting, Michael Rosato and Rebecca Wood
Demography and Health
ONS
I NTRODUCTI ON
Teenage conceptions tend to be both a symptom and
a cause of social inequality. They can become a cycle
of deprivation
1
The seriousness of teenage pregnancy as a health issue was
reflected in the previous Governments 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 DEMOGRAPHI C TRENDS
Conc e pt i ons
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.
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
circumstances. These factors in turn influence
their health and long term opportunities.
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 20
P o p u l a t i o n T r e n d s 9 3 | A u t u m n 1 9 9 8
Using this definition of conception, conception rates (per
thousand girls aged 1519) 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.
Bi r t hs a nd a bor t i ons
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 1519 in 1996. This is lower
than the conception leading to maternity rate, because it is based
on the girls 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.
Ma r i t a l s t a t us a nd numbe r of c hi l dr e n
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
Conception rates by age of woman, England and
Wales 1969-1996
Figure 1
Source: ONS Series FM1
1969 1972 1975 1978 1981 1984 1987 1990 1993 1996
0
20
40
60
80
100
120
140
R
a
t
e


p
e
r

1
,
0
0
0

w
o
m
e
n

i
n

a
g
e

g
r
o
u
p
Year
<16
<20
14
15
16
17
18
19
Conceptions terminated by abortion by age of
woman, England and Wales 1969-1996
Figure 2
Source: ONS Series FM1
Livebirths to teenagers by marital status and
registration, England and Wales 1978-1996
Figure 3
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 1315, 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
1978 1981 1984 1987 1990 1993 1996
0
5000
10000
15000
20000
25000
30000
35000
40000
N
u
m
b
e
r
Year
Registered by the
mother alone
Registered jointly outside marriage
Registered inside marriage
1969 1972 1975 1978 1981 1984 1987 1990 1993 1996
0
10
20
30
40
50
60
70
P
e
r
c
e
n
t
a
g
e
Year
<16
<20
14
15
16
17
18
19
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 21
9 3 | A u t u m n 1 9 9 8 P o p u l a t i o n T r e n d s
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
SOCI AL AND GEOGRAPHI C VARI ATI ON
Fa mi l y ba c k g r ound
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 socio-
economic 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.
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.
Soc i a l c l a s s
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.
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 childs birth
registration, social class is available for the childs father. Social
class (based on the Registrar Generals classification) is derived
from occupation information for 10 per cent of all live births.
Based on the occupation of the babys 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 2024, 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 1 Risk of teenage motherhood by indicators of socioeconomic status
and family circumstances as determined at the 1981 Census
Indicators of risk Hazard Confidence
ratio intervals
Family
social class 1.32+ (1.29 - 1.35)
I 1.00
II 2.36 (1.64 - 3.39)
IIIN 3.59 (2.51 - 5.17)
IIIM 6.41 (4.51 - 9.12)
IV 7.10 (4.96 - 10.15)
V 9.96 (6.83 - 14.53)
Other 9.16 (6.41 - 13.11)
Housing tenure 1.88+ (1.81 - 1.96)
owner occupier 1.00
rent: private 1.64 (1.38 - 1.94)
rent: local authority 3.54 (3.27 - 3.82)
Absence of father 1.77 (1.61 - 1.94)
of LS teenager in
household
Number of siblings 1.39+ (1.34 - 2.45)
none (lone child) 1.00
one 0.69 (0.61 - 0.79)
two 1.15 (1.01 - 1.31)
three or more 1.81 (1.59 - 2.06)
Note: + result shows results for the main effects model.
Source: ONS Longitudinal Study (LS).
Table 2 Percentage distribution of live births by social class, marital
status, and mothers age, England and Wales 1994-1996
(combined) Percentages
Marital status Age of mother All ages
<20 20-24 25+
Inside marriage 13.3 46.6 76.0 65.9
Outside marriage/ 58.1 41.2 19.6 26.5
joint registration
Sole Registration 28.6 12.2 4.4 7.5
Social class of father*
All 71.4 87.8 95.6 92.5
I, II 6.0 14.2 36.3 29.8
IIIN 5.2 7.9 10.3 9.5
IIIM 25.5 33.4 29.0 29.7
IV 16.7 17.8 12.2 13.6
V 9.1 7.7 4.1 5.2
Other 9.5 6.6 3.8 4.8
Total 100 100 100 100
Base numbers 128,600 396,549 1,436,597 1,961,746
Source: ONS Series DH3.
* Fathers social class is not available for sole registrations.
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Count r y of bi r t h
In 1996, 7 per cent of all births were to girls aged under 20. This
varied, however, by the mothers 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.
While 29 per cent of lone mothers aged 18 or 19 live in someone
elses household, this proportion rises to 80 per cent for lone
mothers aged under 18. Thus the youngest lone mothers are mostly
living in someone elses 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.
Educ a t i on l eve 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.
Ge og r aphi c a l a r e a
Teenage conception and live birth rates vary across England and
Wales. In 1996 in England and Wales 63 girls in every 1,000 aged
1519 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 1519. 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 1315). 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.
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 1519 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 under-
16s birth rates in 1994-96.
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.
Li v i ng a rr a ng e me nt s
Table 4 shows the proportions of lone mothers who head their own
household by the mothers age. Overall 9 per cent of all lone
mothers live in someone elses 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 18 or 19 20 + All lone parents
Head of household 20 71 93 91
In someone elses household 80 29 7 9
All 100 100 100 100
Base numbers 10,000 35,000 740,000 785,000
Source: DETR unpublished data.
Table 3 Mothers country of birth by mothers age at childbirth,
England and Wales 1996
Numbers, percentages and rates
<20 All ages Percentage of Age-specific rates*
births to by mothers country
teenage mothers of birth
<20 All ages
All 44,668 649,489 6.9 30 60
United Kingdom 41,757 566,356 7.4 30 58
Irish Republic 217 4,968 4.4 .. ..
Rest of European Union 453 8,604 5.3 .. ..
Australia, Canada, 62 3,182 1.9 .. ..
New Zealand
New Commonwealth 1,618 47,104 3.4 47 97
India 78 6,608 1.2 23 68
Pakistan 516 12,319 4.2 86 164
Bangladesh 637 6,930 9.2 90 178
East Africa 70 5,114 1.4 18 68
Caribbean 84 2,754 3.1 62 61
Other 561 19,275 2.9 .. ..
* Rates per 1,000 live births
.. Not available
Source: ONS Series DH3 and FM1.
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
9 3 | A u t u m n 1 9 9 8 P o p u l a t i o n T r e n d s
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.
HEALTH OF THE WOMAN
Cont r a c e pt i on us a ge
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 1519 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.
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
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 1619 visited these clinics.
Teenage birth rates for groups of local authorities in England and Wales, 1994
Figure 4
Source: Population Trends 87
England
and
Wales
Coast
and
country
Mixed urban
and rural
Growth
areas
Most
prosperous
areas
Services
and
education
Resort and
retirement
areas
Mixed
economies
Manu-
facturing
Ports and
industry
Coalfields Inner
London
0
5
10
15
20
25
30
35
40
45
R
a
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p
e
r

1
,
0
0
0

w
o
m
e
n
Group
Teenage births as a proportion of all births by level of
deprivation, England and Wales, 1994-1996
Figure 5
Source: ONS birth statistics
Least
deprived
2 3 4 Most
deprived
0
2
4
6
8
10
12
14
T
e
e
n
a
g
e

b
i
r
t
h
s

a
s

%

o
f

a
l
l

b
i
r
t
h
s
Level of deprivation (Carstairs index)
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 24
P o p u l a t i o n T r e n d s 9 3 | A u t u m n 1 9 9 8
Dr i nk i ng a l c ohol a nd s mok i ng
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.
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.
He a l t h dur i ng pre g na nc 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.
Table 5 Percentage distribution of delivery method by
mothers age, England 1994-1996(combined)
< 20 All ages
Spontaneous 79 73
Forceps & Ventouse 10 11
All Breech 1 1
Elective caesarian 3 7
Emergency caesarian 7 9
Other 0 0
Total 100 100
Base numbers 23,977 604,300
Source: DH HES Maternity Statistics.
De l i ve r y me t hod
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
mothers
7
(Table 5). As a result, 79 per cent of teenage mothers had
a spontaneous delivery compared with 73 per cent of all women.
Long t e r m out c ome s f or t he wome n
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 1619 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.
Prevalence of drinking before and during pregnancy,
United Kingdom 1995
Figure 6a
Source: Infant feeding survey 1995
< 20 20-24 25-29 30-34 35+ All mothers
0
10
20
30
40
50
60
70
80
90
P
e
r
c
e
n
t
a
g
e
Age of mother
Before pregnancy During pregnancy
Prevalence of smoking before and during pregnancy,
England 1995
Figure 6b
Source: Infant feeding survey 1995
< 20 20-24 25-29 30-34 35+ All mothers
0
10
20
30
40
50
60
70
P
e
r
c
e
n
t
a
g
e
Age of mother
Before pregnancy During pregnancy
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
9 3 | A u t u m n 1 9 9 8 P o p u l a t i o n T r e n d s
Table 6 Percentage distribution of live births by birthweight and
mothers age, England and Wales 1994-1996 (combined)
Mothers age All ages
Birthweight (grams) <20 20-24 25+
<1500 1 1 1 1
<2500 9 8 7 7
<1000 1 0 0 0
1000-1499 1 1 1 1
1500-1999 2 1 1 1
2000-2499 6 5 4 5
2500-2999 21 19 15 17
3000-3499 38 37 35 36
3500-3999 24 26 30 29
4000+ 7 8 12 11
Not stated 1 1 1 1
All 100 100 100 100
Base numbers 128,600 396,549 1,436,597 1,961,746
(Live births)
Source: ONS Series DH3.
Proportion of low birthweight babies, England and
Wales 1996
Figure 7
Source: ONS birth statistics
HEALTH OF THE CHI LDREN
Bi r t hwe i g ht
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 shows the percentage distribution by birthweight for babies
born in England and Wales in 1994-96 by different mothers 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.
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 elses household, usually their parents. It
is likely, therefore, that these women receive care and support
during their pregnancy, resulting in fewer low birthweight babies.
Bre a s t f e e di ng
There is a strong association between a mothers 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 2024 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.
Mor t a l i t y
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
Incidence of breastfeeding by mothers age for first
babies only, Great Britain 1985, 1990 and 1995
Figure 8
Source: Infant feeding survey 1995
All live
births
Teenage
mothers
Sole
registrations
Teenage and
sole registrations
0
2
4
6
8
10
12
P
e
r
c
e
n
t
a
g
e
7.3
9.1
9.5
8.5
<20 20-24 25-29 30 and over
0
10
20
30
40
50
60
70
80
90
100
P
e
r
c
e
n
t
a
g
e
Mother's age
1985 1990 1995
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 26
P o p u l a t i o n T r e n d s 9 3 | A u t u m n 1 9 9 8
Table 7 Infant mortality by social class and mothers age, England and
Wales 1994-1996 (combined)
Rates per 1,000 live births
Age of mother All ages
<20 20-24 25+
Total 9.6 7.1 5.4 6.0
Marital status
Inside marriage 9.6 6.8 5.0 5.3
Outside marriage/ 9.8 7.4 6.6 7.3
joint registration
Sole Registration 9.1 7.4 7.5 7.9
Social class
All 9.8 7.1 5.3 5.9
I, II 6.1 5.9 4.5 4.6
IIIN 9.2 6.3 5.1 5.4
IIIM 8.9 6.3 5.5 5.9
IV 8.9 7.6 5.9 6.6
V 10.3 8.6 7.4 8.1
Other 12.2 10.0 7.3 8.7
Source: ONS Series DH3.
Table 8 Infant mortality by birthweight and mothers age, England
and Wales 1994-1996(combined)
Rates per 1,000 live births
Age of mother All ages
<20 20-24 25+
All 9.6 7.1 5.4 6.0
<1500 262.0 235.3 215.0 223.2
<2500 59.1 50.3 47.0 48.8
<1000 514.0 464.3 426.2 441.5
1000-1499 96.3 92.9 79.4 83.7
1500-1999 35.3 28.8 24.8 26.5
2000-2499 14.9 12.6 10.1 11.1
2500-2999 6.2 5.5 3.7 4.3
3000-3499 3.9 2.8 2.0 2.3
3500-3999 3.4 2.1 1.5 1.7
4000+ 3.4 3.1 2.1 2.3
Not stated 43.5 27.1 24.5 26.0
Source: ONS Series DH3.
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.
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.
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
He a l t h
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 mothers 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.
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 2024,
76 per cent of those aged 2529 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.
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
Infant mortality rates by age of mother, England and
Wales 1975-1996
Figure 9
Source: ONS Linked infant mortality data
1975 1978 1981 1984 1987 1990 1993 1996
0
5
10
15
20
25
R
a
t
e


p
e
r

1
,
0
0
0

l
i
v
e

b
i
r
t
h
s
Year
All ages
<20
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 27
9 3 | A u t u m n 1 9 9 8 P o p u l a t i o n T r e n d s
per 10,000 live births for teenage mothers. This was 3 times higher
than the rate for mothers aged 2024 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 2529.
Long t e r m out c ome s f or t he c hi l dr e n
The chances of children experiencing the divorce or separation of
their parents are highest for children born to teenage parents.
31
This
higher chance of disruption for teenage mothers is not just a
consequence of these children being more likely to be born outside
marriage. There is an inverse relationship between the age of the
mother and the likelihood of a subsequent change in family
circumstances for any type of birth registration.
Results from the 1958 Birth Cohort showed that daughters of teenage
mothers were more likely to become teenage mothers themselves. It is
important to note, however, that most daughters of these teenage
mothers (80 per cent) did not have a birth while they were teenagers.
These increased risks are also seen in analyses from the ONS
Longitudinal Study. As seen in Table 10, the risk of becoming a
teenage mother for daughters of women who were themselves teenage
mothers was more than double that of girls with older mothers. There
is little variation in the risks of teenage motherhood for daughters from
the different age groups of older mothers.
CONCLUSI ONS
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.
Re f e r e nc e s
1 Tessa Jowell - DoH press release Wednesday 26 November
1997. Tessa Jowell announces action plan on teenage
pregnancy.
2 The Department of Health Health of the Nation. London:
HMSO (1992).
3 Green paper Our Healthier Nation February 1998.
4 Teenage Pregnancy in Scotland 1987-1996 ISD health
briefing number 98/01 issued January 1998.
5 John Haskey - personal communication.
6 Department of Social Security. Income Support Quarterly
Statistical Enquiry, February 1997.
7 Department of Health Hospital Episode Statistics (Maternity)
personal communication.
8 Kiernan K. Teenage motherhood - associated factors and
consequences - the experiences of a British birth cohort.
Journal of Biosocial Science 1980, 12, 393-405.
9 Manlove J. Early motherhood in an intergenerational
perspective : the experiences of a British Cohort. Journal of
marriage and the Family 1997, 59, 263-279.
10 Kiernan K. Lone motherhood, employment and outcomes for
children. International Journal of Law, Policy and the family,
1996 (10), 233-249.
11 Hudson F, Ineichen B. Taking it lying down : sexuality and
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12 Holmans A. Lone parents and their housing in Green H,
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13 Population and Health Monitor ONS (FM1 98/1) 60
12 March 1998, Conceptions in England and Wales, 1996.
Table 10
Risk of teenage motherhood by indicators of family
structure as determined at the 1981 census
Indicators of risk Hazard Confidence
ratio intervals
Age of LS teenagers mother at birth of
eldest sibling in household
20+ v to 19 2.31 (2.12 - 2.52)
Mothers age at birth of the LS teenager 0.82+ (0.79 - 0.85)
to 19 1.00
20-24 0.55 (0.48 - 0.61)
25-29 0.38 (0.33 - 0.43)
30-34 0.35 (0.30 - 0.41)
35-39 0.45 (0.37 - 0.53)
40 plus 0.49 (0.38 - 0.63)
Note: + result shows results for the main effects model.
Source: ONS Longitudinal Study (LS).
Table 9
Congenital anomalies - all babies notified, age of mother by
condition, England and Wales 1995-1996 combined
Numbers and rates per 10,000 total births
Age of mother
All ages < 20
Number Rate Number Rate
All babies notified 11,017 84.5 847 97.2
Central nervous system anomalies 492 3.8 49 5.6
Anencephalus 59 0.5 10 1.1
All spina bifida 135 1.0 10 1.1
Eye 134 1.0 10 1.1
Cleft lip and palate 1,128 8.7 76 8.7
Other face, ear and neck 397 3.0 24 2.8
Heart and circulatory 940 7.2 68 7.8
Respiratory 125 1.0 9 1.0
Alimentary 613 4.7 50 5.7
Genital organs 1,208 9.3 84 9.6
Urinary system 776 6.0 55 6.3
Musculoskeletal 4,141 31.8 364 41.8
Gastroschisis 182 1.4 65 7.5
Skin and integument 403 3.1 22 2.5
Chromosomal anomalies 863 6.6 46 5.3
Downs syndrome 634 4.9 32 3.7
Congenital metabolic disorders 159 1.2 16 1.8
Total live and still births 1,303,910 87,158
Source: Series MB3 no.11 Congenital anomaly statistics 1995 and 1996.
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 28
P o p u l a t i o n T r e n d s 9 3 | A u t u m n 1 9 9 8
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20 Balding J. Young people in 1995 Exeter Schools Health
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21 Department of Health. Family planning clinics services :
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22 Foster K, Lader D, Cheeseborough S. Infant feeding survey
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26 Meltzer H et al. The prevalence of psychiatric morbidity
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27 Breakwell G. Psychological and social characteristics of
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The politics of pregnancy, adolescent sexuality and public
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28 Peckham S. Preventing unplanned teenage pregnancies.
Public Health 1993, 107, 125-133.
29 Tan KH, Kilby MD, Whittle MJ, Beattie BR, Booth IW,
Botting BJ. Congenital anterior abdominal wall defects in
England and Wales 1987-93 : retrospective analysis of OPCS
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30 Byron-Scott R, Haan E, Chan A, Bower C, Scott H, Clark K.
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31 Clarke L, Joshi H, Di Salvo P, Wright J. Stability and
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