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Spending cuts may have contributed to falling teenage pregnancy rates

Austerity cuts may have contributed to lower rates of teenage pregnancy in England. It may seem a surprising result, but that is what our analysis of cuts by local authorities to teenage pregnancy programmes has concluded.

Between 2007 and 2015, the under-18 conception rate in England almost halved. Some commentators, such as The Guardian columnist Polly Toynbee, have credited this decline to the 1999 Teenage Pregnancy Strategy. Running until 2010, the strategy saw hundreds of millions of pounds distributed to local authorities with the aim of expanding access to birth control and sex and relationships education.

These services have been a significant victim of recent government cuts, with spending falling by over 70% since 2008. This has led politicians and organisations working in the field to argue that decreases to conception rates would be put at risk. We tested this proposition in our paper, published in the Journal of Health Economics. Contrary to expectations, we found that, if anything, cuts have led to fewer teen pregnancies.

Our analysis compares changes in teenage pregnancy rates with changes in annual expenditure on teenage pregnancy services for 149 English local authorities between 2008 and 2014. The extent and timing of cuts varied significantly across areas. This meant we were able to test whether areas that reduced spending the most experienced smaller declines in pregnancy.

To our surprise, we found the opposite. Authorities making bigger cuts saw relatively larger decreases in both birth and abortion rates among teenagers. The effect was not huge – a 10% reduction in expenditure was associated with a decrease of just 0.25% in the under-18 conception rate – but it was strongly significant.

Correlation does not necessarily mean causation. It may be that areas that implemented the biggest cuts were those where conception rates would have gone down anyway. Although we cannot completely rule out this possibility, the results held up well to a battery of statistical tests and controls for other factors that might explain the correlation, such as education, poverty and the local political party in control.

Our results stand in contrast to those in a paper by Kaye Wellings and colleagues, recently published in the Lancet. They found that areas that received more funding under the Teenage Pregnancy Strategy experienced bigger reductions in under-18 conceptions.

However, their research is limited by the fact that funding was closely related to initial conception rates. Areas where conception rates were highest have seen the biggest falls. But the researchers were unable to distinguish the effect of funding from that of broader trends in teenage behaviour, which may have affected areas with higher starting conception rates the most. By focusing instead on changes in both expenditure and pregnancy rates, we are able to make this distinction.

The Akerlof explanation

How can we explain our findings? Many years ago, Nobel prize-winning economist, George Akerlof, showed how easier access to contraception could lead to an increase in risky sexual behaviour, which could ultimately increase, rather than decrease, unplanned pregnancies.

Nobel prize winner, George Akerlof. Yan Chi Vinci Chow/Wikimedia Commons, CC BY-SA

Policymakers have ignored Akerlof’s argument to their cost. A review of one of the most comprehensive teenage pregnancy programmes in England found that young women on the scheme were more likely to report pregnancy than those in a control group. Research in both the UK and the US has found that easier access to emergency birth control has not reduced teenage pregnancy or abortions, but has led to increases in sexually transmitted infections.

Policymakers need to use some caution when interpreting our results. We find that cuts to teenage pregnancy services, to date, have not increased conceptions. If the least effective projects have been cut first, it may be that further cuts to services would have different effects. Perhaps there will also be long-term consequences that we have not yet been able to observe. Though economic theory and evidence suggest reduced access to contraceptives will have worse effects in the short term.

Most importantly, it may not be possible to generalise the finding that cuts in public expenditure can be achieved without negative consequences. For example, Oxford University’s Rachel Loopstra and colleagues recently concluded that cuts to local authority spending on housing services and social care have contributed to increases in homelessness and in old-age mortality rates.

This leaves the question: why have teenage mothers been disappearing so quickly? One factor brought up in our research, and in previous research, is improvements in educational attainment – something which tends to increase aspiration and make early pregnancy less attractive.

Another, more speculative, explanation is the rise of “generation sensible” (possibly abetted by the growth of social media and lower childhood exposure to lead in petrol). Many countries, including the US, Ireland, Australia and New Zealand, have seen decreases in teenage pregnancy similar to the UK. Teenagers in these countries now smoke and drink less, take fewer drugs, and are less likely to commit crimes. Sex may be another risky activity they are turning away from.

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