| Summary: | BACKGROUND The United Kingdom has the highest rate of teenage pregnancy in Western Europe, and also ranks highly on an international level. Previous research has shown that factors such as socio-economic status are strongly associated with variations in pregnancy rates and outcomes of pregnancy. However, the impact of service provision, specifically primary care based services, is less clear. AIMS AND OBJECTIVES The primary aim of this thesis is to describe the incidence of teenage pregnancy in the former Trent health region, and to identify any factors associated with variations in rates and outcomes. The specific objectives are as follows: To describe the incidence of teenage pregnancy in Trent, and identify any factors associated with outcome of pregnancy, and with risk of intervention at delivery. To describe general practice and family planning services in Trent, with an emphasis on services specifically provided for teenagers. To identify any potentially modifiable general practice characteristics associated with variations in teenage pregnancy rates. To explore the opinions and attitudes of GPs towards key issues such as prescribing contraception to under 16s, and relate these to both GP characteristics and pregnancy rates. METHODS Data for all pregnancies in women aged under 20 years at the time of hospital admission during the period 1994-1997, were collected from the Trent hospitals admissions database. General practice characteristics data for all 826 practices in existence in Trent in 1997 were collected from all health authorities that were part of the Trent region at the start of the study period (1994). These data were collected for inclusion in a cross sectional survey of potentially modifiable practice characteristics associated with variations in teenage pregnancy rates. Hours of service and location of family planning clinics within Trent were identified through a survey of all clinics in existence in 1997. A cross sectional survey of all GPs and practice managers from four health authority areas, was carried out to identify both the number and nature of teenage specific initiatives running during the study period, and also to explore GPs attitudes and opinions towards key issues relating to the care of young teenagers. RESULTS A total of 18692 pregnancies were identified, and 5.1 % of these were to women aged under 16 years. Outcome of pregnancy was significantly associated with deprivation status, with women from poorer areas being more likely to continue with their pregnancy (OR 4.04 95%CI 2.40-6.78, P<0.001). Of the 10554 women who continued with their pregnancy, 22% experienced intervention at delivery, and this was associated with place of treatment (hospital), with women who delivered at one hospital for example, having 1.5 times the risk of experiencing either a vaginally assisted birth or a caesarean section (OR 1.53 95%CI 1.30-1.81, P< 0.001). Risk of intervention at delivery was not associated with age or deprivation status. In terms of service provision, of the 826 general practices identified, 58% had at least one female GP and 39% had at least one GP aged under 36 years. Twenty one percent of practices from the four health authority areas studied in detail, offered teen specific services, and 11 % had a specific confidentiality policy for under 16s. In terms of family planning services, 108 clinics were identified, which provided 498 hours of service and 261 of these were accessible to younger teenagers. General Practices with younger GPs (OR 0.67 95%CI 0.49-0.93, P=0.02) and practices that were running teenage specific initiatives (OR 0.61 95%CI 0.41-0.91, P=0.02) had significantly lower teenage pregnancy rates in women aged under 16 years. In terms of attitudes towards key issues related to the care of younger teenagers, age of GP was significantly associated with most issues, with older GPs being less likely to prescribe contraception to under 16s without parental consent (OR 0.55 95%CI 0.33-0.93, P<0.001) and also being more likely to believe it was illegal to do so (OR 4.27 95%CI 1.50-12.22, P<0.001). CONCLUSION Deprivation status was associated with incidence and outcome of teenage pregnancy. General Practices with younger GPs (aged under 36 years) were found to have independently lower teenage pregnancy rates in women aged under 16, as were practices that were running a teenage specific initiative. Younger GPs were found to be more likely than older GPs to prescribe contraception to young women aged under 16 without parental consent, and to believe that it was legal to prescribe contraception to this age group. These issues of age of GP, and the impact of teen specific services,should be further researched in order to fully understand their relationship with variations in teenage pregnancy rates.
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