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source: www.bmj.com (5 January)
Since up to 80% of unintended pregnancies result from contraceptive
failure (1), Alice McLeod wisely cautions that "differential access
to contraceptive services may be only one component" affecting
local variation in rates of teenage pregnancy (2). She mentions the
well- established association
between socio-economic deprivation and teenage pregnancies.
She does not mention however the equally well established link between
one-parent families and teenage pregnancy which is graphically
illustrated by (though not highlighted in the text of) the 1999 Social
Exclusion Report on teenage pregnancy. (3) 14-17 year olds who live in a
two-parent family are less likely to have ever had sexual intercourse
than young people living
in any other family arrangement, even after adjusting for potentially
confounding factors such as race, age and socio-economic deprivation.
(4)
This is hardly surprising, as children whose parents talk to them about
sexual matters and provide sexuality education at home are more likely
than others to postpone sexual activity. (5) There is likely to be an
overall
greater chance of good quality communication to both sons and daughters
if there are two parents rather than one.
Since cohabitations are four times more likely to break up than
marriages and less than 4% of cohabitations last ten years or more (6),
a child born outside of marriage stands very little chance in their
teenage years of being in the optimal family structure associated with
the lowest risk of unplanned pregnancy. Without better marriage
education and support in the UK (7), our teenage pregnancy rates are
likely to remain high even with increasing contraceptive availability.
1. Pearson VAH, Owen MR, Phillips DR, Pereira Gray DJ, Marshall MN.
Pregnant
teenagers knowledge and use of emergency contraception. BMJ 1995;
310:1644
2. McLeod A. Changing patterns of teenage pregnancy: population based
study of small areas. BMJ 2001 323 199-203
3. Social Exclusion Unit Teenage pregnancy p33 Figure 19 London HMSO
1999
4. Santelli JS, Lowry R, Brener ND, Robin L The association of sexual
behaviours with socioeconomic status, family structure and
race/ethnicity among US adolescents Am J Public Health 2000 90
1582-1588
5. Blake SM, Simkin L, Ledsky R et al. Effects of parent-child
communications intervention on young adolescents' risk for onset of
early
intercourse. Fam Plan Perspect 2001 33 52-61
6. Morgan P Marriage-lite: The rise of cohabitation and its consequences
p13
Institute for the Study of Civil Society (CIVITAS) London 2000
7. www.celebratingmarriage.com (accessed 28.7.2001)
Trevor Stammers
, tutor in general practice.
St George's Hospital Medical School, London SW17 0RE
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