Abstract
Background
Since the late 1990s, the British government has launched major strategies to address high teenage pregnancy and abortion rates in England. These have focused in part on improving access to contraception through national campaigns. This study assessed teenage pregnancy and abortion rate trends since 1998 and possible associations with usage of long-acting reversible contraceptives (LARCs).
Methods
Teenage conception rates and age-specific abortion rates were obtained from the Office for National Statistics and the Department of Health. LARC usage data was obtained for Depo-Provera, Implanon/Nexplanon, intrauterine devices, Mirena, and Noristerat from the IMS British Pharmaceutical Index, IMS Hospital Pharmacy Audit, IMS Disease Analyzer, and KT-31 reports. Through linear regression methods, changes in conception and abortion-related outcomes during 1998–2011 and the associations with LARC usage were assessed.
Results
Conception rates for girls younger than 18 years of age decreased significantly between 1998–2011, from 46.6 to 30.7 per 1,000 girls. A statistically significant association was observed between this decrease and increased LARC usage (P=0.0024) in this population. Abortion rates among females aged <18 years or aged 18–19 years decreased between 1998–2011, and their associations with increased LARC usage were statistically significant (P=0.0029 and P=0.0479, respectively). The pattern in older women was complex; abortion rates in women aged 20–24 years or 25–34 years increased slightly from 1998 to 2011, with stabilization during 2007–2011.
Conclusion
Increased LARC usage in England was significantly associated with decreased teenage pregnancy rates and abortion rates in females aged <20 years. Government strategies appears to have a positive impact on these outcomes; however, abortion rates among women over 20 years of age remain an issue.
Supplementary materials
Table S1 Data collection and aligning methods for conception, abortion, and LARC usage methods
Table S2 Estimated average duration of LARC use
Reference
- National Institute for Health and Care ExcellenceCG30: Long-acting reversible contraception [webpage on the Internet]London, UKNICE2014 Available from: http://publications.nice.org.uk/long-acting-reversible-contraception-cg30Accessed June 22, 2014
Acknowledgments
We thank Venkata Putcha, freelance statistician contracted by HERON – A PAREXEL® Company, for his contribution to the statistical analyses. We also thank Samuel Stoddard and Catherine Kielar, scientific writers at HERON – A PAREXEL® Company, for the feedback they provided by reviewing this manuscript.
Author contributions
All authors made substantial contributions to data generation and analysis, drafting or critical revision of the manuscript, and approval for the final version to be published.
Disclosure
This study was sponsored by Merck Sharp & Dohme Ltd. Samantha Humphreys is a current employee of Merck Sharp & Dohme Ltd. Guilhem Pietri (HERON – A PAREXEL® Company) was contracted by Merck Sharp & Dohme Ltd to conduct the study analysis and develop the manuscript. Jingbo Yu is a current employee of Merck and Co, Inc. Anne Connolly presently consults, and in the past has consulted, with manufacturers of products discussed in this article. The authors report no other conflicts of interest in this work.