title: Changes in conceptions in women younger than 18 years and the circumstances of young mothers in England in 2000-12: an observational study.
abstract: BACKGROUND
  In 2000, a 10-year Teenage Pregnancy Strategy was launched in England to reduce conceptions in women younger than 18 years and social exclusion in young parents. We used routinely collected data and data from Britain's National Surveys of Sexual Attitudes and Lifestyles (Natsal) to examine progress towards these goals.
  
  
  METHODS
  In this observational study, we used random-effects meta-regression to analyse the change in conception rates from 1994-98 to 2009-13 by top-tier local authorities in England, in relation to Teenage Pregnancy Strategy-related expenditure per head, socioeconomic deprivation, and region. Data from similar probability sample surveys: Natsal-1 (1990-91), Natsal-2 (1999-2001), and Natsal-3 (2010-12) were used to assess the prevalence of risk factors and their association with conception in women younger than 18 years in women aged 18-24 years; and the prevalence of participation in education, work, and training in young mothers.
  
  
  RESULTS
  Conception rates in women younger than 18 years declined steadily from their peak in 1996-98 and more rapidly from 2007 onwards. More deprived areas and those receiving greater Teenage Pregnancy Strategy-related investment had higher rates of conception in 1994-98 and had greater declines to 2009-13. Regression analyses assessing the association between Teenage Pregnancy Strategy funding and decline in conception rates in women younger than 18 years showed an estimated reduction in the conception rate of 11.4 conceptions (95% CI 9.6-13.2; p<0.0001) per 1000 women aged 15-17 years for every £100 Teenage Pregnancy Strategy spend per head and a reduction of 8.2 conceptions (5.8-10.5; p<0.0001) after adjustment for socioeconomic deprivation and region. The association between conception in women younger than 18 years and lower socioeconomic status weakened slightly between Natsal-2 and Natsal-3. The prevalence of participation in education, work, or training among young women with a child conceived before age 18 years was low, but the odds of them doing so doubled between Natsal-2 and Natsal-3 (odds ratio 1.99, 95% CI 0.99-4.00).
  
  
  CONCLUSIONS
  A sustained, multifaceted policy intervention involving health and education agencies, alongside other social and educational changes, has probably contributed to a substantial and accelerating decline in conceptions in women younger than 18 years in England since the late 1990s.
  
  
  BACKGROUND
  Medical Research Council, Wellcome Trust, Economic and Social Research Council, and Department of Health.
authors.affiliation: Centre for Sexual and Reproductive Health Research, London School of Hygiene & Tropical Medicine, London, UK. Electronic address: kaye.wellings@lshtm.ac.uk.
authors.forename: Kaye
authors.initials: K
authors.lastname: Wellings
authors.affiliation: Centre for Sexual and Reproductive Health Research, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Palmer
authors.affiliation: Research Department of Infection and Population Health, University College London, London, UK.
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Geary
authors.affiliation: Centre for Sexual and Reproductive Health Research, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Lorna J
authors.initials: LJ
authors.lastname: Gibson
authors.affiliation: Research Department of Infection and Population Health, University College London, London, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Copas
authors.affiliation: Centre for Sexual and Reproductive Health Research, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Jessica
authors.initials: J
authors.lastname: Datta
authors.affiliation: Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Glasier
authors.affiliation: Centre for Sexual and Reproductive Health Research, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Rachel H
authors.initials: RH
authors.lastname: Scott
authors.affiliation: Research Department of Infection and Population Health, University College London, London, UK.
authors.forename: Catherine H
authors.initials: CH
authors.lastname: Mercer
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Bob
authors.initials: B
authors.lastname: Erens
authors.affiliation: Centre for Sexual and Reproductive Health Research, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Wendy
authors.initials: W
authors.lastname: Macdowall
authors.affiliation: Centre for Sexual and Reproductive Health Research, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: French
authors.affiliation: Research Department of Infection and Population Health, University College London, London, UK.
authors.forename: Kyle
authors.initials: K
authors.lastname: Jones
authors.affiliation: Research Department of Infection and Population Health, University College London, London, UK.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Johnson
authors.affiliation: Research Department of Infection and Population Health, University College London, London, UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Tanton
authors.affiliation: Centre for Sexual and Reproductive Health Research, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Wilkinson
mesh_terms: D000293:Adolescent; D004739:England; D005260:Female; D006306:Health Surveys; D006801:Humans; D008019:Life Style; D009035:Mothers / Q000706:statistics & numerical data*; D011247:Pregnancy; D018873:Pregnancy Rate / Q000639:trends*; D011253:Pregnancy in Adolescence / Q000706:statistics & numerical data*; D015995:Prevalence; D012044:Regression Analysis; D012725:Sexual Behavior / Q000706:statistics & numerical data