It is easier to state the facts on teenage pregnancy than to track the root causes with certainty, not least because so many different cultural, social and practical factors come into play. Nonetheless some clear patterns are discernable.

Lack of information about sex and relationships

Many would think that parents and school would and should be important sources of information about sex for teenagers. Yet when asked where they get such information, youngsters in England and Wales cite their peers, television, pornography and increasingly the internet. And when I asked a group of students at Treorchy comprehensive, only one of the students out of 30 said they had ever talked about sex with their parents. Although a similar group at Tonypandy Comprehensive suggested that more there had talked about sex with their parents, both groups were very dismissive of the sex education they had received at school. They were equally dismissive of traditional church teaching on sex.

Together with the teenage mothers at Books and Babies, all argued that their school sex education was wholly inadequate. One young mother said, ‘’it was just about pads and tampons and putting a condom on a fake willy’. One girl at Treorchy said, ‘Nobody wants to look silly or be embarrassed in sex education so you daren’t ask a simple question.’ Many complained that the only time sex had been mentioned at school was in a science lesson when they had been taught the biological facts about sex rather than anything else. Some had had a single lesson about puberty in the last year at primary school, but most had not had any sex and relationship education that they cold recall.

It is not surprising therefore that in March 2007 Estyn reported that ‘only a minority of Welsh schools teach sex and relationships education to high standards. In the majority of cases, schools rely on individual sessions that provide basic factual information, but with few opportunities for learners to engage in discussions about moral and emotional issues. This approach is often due to a lack of confidence or embarrassment on the part of teachers’. In addition Susan Lewis, Her Majesty’s Chief Inspector of Education and Training in Wales, said that ‘In some cases, the narrow views of governors, headteachers and sometimes parents, who wish to protect children from developing into young adults too soon, influence what is taught.’

The same is true in England. Ofsted reported in April 2007 that there had been considerable improvements in Personal Social and Health Education over the last 5 years, but reported that ‘Many young people say that many parents and some teachers are not very good at talking about the more sensitive issues in PSHE, such as sex and relationships. They feel that parents and teachers often leave it too late and do not talk about such issues until they have reached puberty or have started feeling sexual desire. In the case of SRE, young people do not want just the biological facts but want to talk about feelings and relationships.’

The dangers of ignorance about sex are clear. Without proper information, many teenagers will not acquire the personal confidence or social skills to be able to make informed choices about sex before the onset of puberty and before sexual opportunities arise. A reliance on providing just the basic biological facts, rather than the emotional or indeed spiritual context for sex can leave many youngsters painfully exposed to highly sexualised media messages and peer pressure. What is more, the evidence from countries like Holland and some LEAs such as Camden, is that good sex and relationship education can help delay first sex and cut teenage pregnancy rates. At the moment it seems that embarrassed silence is our default position. Articulate, confident parents may be able to breach this gap in middle class communities. Elsewhere, we abandon youngsters to uncontrollable pressures. Britain’s natural embarrassment about all matters sexual is betraying our youngsters.

‘There is a great deal of variety of provision, but there is no specialist provision, some children effectively relying on science lessons to learn the facts of life. In some primary schools girls may start their periods without having had any sex education at all.’ - Estyn report, Sex and Relationship Education in Wales 2007

‘Callers tell me that in their biology lessons, they might be shown how to put a condom on a cucumber, but they aren’t told how to go out and get condoms and then actually use them in real life situations. It’s almost like a paragraph has been left out of the bottom of the lesson plan – the paragraph explaining how to use contraception in the real world.’ -Childline counsellor.

Starting early

The most recent comparative study of teenage sexual activity suggests that British teenagers start having sex younger than their European counterparts, with an average age for first sexual experience of 16½. Dr Emmanuelle Godeau’s study produced in January 2008 (although referring to 2002 data) also shows nearly 38% of English 15 year olds had had sex, compared to just 14% in Croatia. This is very different from the 1950s, when the average age of first sex was 20/21. Now, according to a Lancet survey nearly a quarter become sexually active before they are 16.

Availability of contraception

When I asked a group of students at Treorchy Comprehensive School in the Rhondda what they thought was the main reason for the high number of teenage pregnancies locally, they were all critical of the local availability of contraception. As one boy put it, ‘Maybe it’s different if you live in Cardiff but it’s pretty embarrassing buying condoms in the Rhondda. If you go into a chemist’s in Treorchy, the girl behind the counter will almost certainly know your mum. So people just don’t buy them. The same goes for visiting the Family Planning Clinic in Ynyswen. And it’s more expensive to buy them from the machine in the pub. They should be available free from a nurse in school.’

Equally several of the girls said they didn’t want to go on the pill in case their mother found out and complained that parents were very contradictory, saying they would kill their daughter if she got pregnant but also saying they shouldn’t be on the pill.

It is not just that many teenagers have sex without contraception. It is also the case that many British teenagers rely on less reliable forms of contraception. So in 2006/07 of 16-19 year-old women who used contraception 63% used a male condom and only 48% used the pill. By contrast these figures were reversed for 20-24 year-olds, with 39% using a condom and 64% the pill. These figures are very different in France and other European countries, where many youngsters will use both the pill and a condom.

There may be many reasons for this. Many girls are worried that they will put on weight if they go on the pill. Many parents are reluctant for their daughter to go on the pill as it is a tacit acceptance that she is sexually active. Going on the pill requires more forward planning than a condom. Many believe, incorrectly that the male condom is a more effective form of contraception. And many young people believe that since condoms will provide protection against sexually transmitted infections, there is no need for a second layer of protection.

All this has pushed many youngsters towards a heavy reliance on the male condom, which is less reliable as a form of contraception (90-98% reliability compared to nearly 100% for the pill) and is often jettisoned in the heat of the moment. The most recent survey of first time use of the male condom suggests it fails in as many as 14.5% of cases.

Emergency Contraception

Legislation introduced in January 2001 has meant that progestogen only contraception (‘the morning after pill’) is available without prescription for women aged 16 years and over. The change in the law has clearly been successful, with evidence that between 2000 and 2001 there was a 52% reduction in the number of women attending emergency departments with requests for emergency contraception in two typical London areas. More women are now getting their emergency contraception without prescription from pharmacies as compared with emergency departments.

Emergency contraception is available in the Rhondda either from the family planning clinic, from a GP or from a chemist. Students at Treorchy pointed out that the family planning clinic is not open on Saturdays or Sundays – potentially the most useful days in the week – and that although it was available from the chemist it cost more than £20, a figure that many girls would not be able to afford. In fact, since then the Local Health Board has introduced a scheme whereby after training chemists can give emergency contraception for free and be reimbursed by the LHB.

There is some evidence that a series of scare stories about emergency contraception have discouraged many girls from using it – and that erroneously many believe that its efficacy falls off rapidly after the first 24 hours.

‘I’m four weeks late. I can’t be bothered with condoms – they’re a hassle – and I don’t want to go on the pill ‘cos it’ll make me fat and I’ll probably forget to take it anyway.’ Girl calling Childline, 14

Planned pregnancies and mixed messages

It is difficult to avoid the fact that although some girls get pregnant accidentally, there are many who deliberately opt to get pregnant – or at least are reckless about whether they get pregnant when having sex. One teacher at Treorchy Comprehensive told me she asked a girl why she wasn’t trying very hard at school. The girl replied, ‘well, miss, there’s no point really as I’m going to get pregnant next year and then I won’t be coming to school any more’. The teacher tells me the girl didn’t care who the father was going to be. One of the pupils echoed this, saying, ‘I’ve heard girls say, “’I’m fed up. I’m just going to have a baby. It’s easier”’

For many this may seem incomprehensible. How could someone deliberately choose such a ‘career pregnancy’? But if a girl feels undervalued or unloved at home and is having difficulties either socially or academically at school, she may see motherhood as a form of career choice that guarantees her at least one person who will dote on her – her child. As two students in Treorchy put it, ‘the thing is, a baby is seen as a recreation’ and ‘there are so many support groups for teenage mums that it’s more fun than staying in school’.

In addition, society sends out very mixed messages about sex and teenage pregnancy. Television, popular music, teenagers’ magazines all push out a constantly sexualized message for teenagers. Moreover the response to a teenage pregnancy is often either contradictory or even hypocritical.

So, as one girl put it, ‘The moment a girl is pregnant everyone is all of a sudden her best friend, even if some of them are thinking “my god, how could she be so stupid!”’ Interestingly, the girls at Books and Babies mirrored this comment with their own: ‘My mam told me “you’re either having an abortion or get out”. I was really angry, ‘cos she had me when she was only 18. All the girls at school were coming up and being nice to my face but slagging me off behind my back.’

Moreover the state does its best to rally round when a young girl gets pregnant. Having been ignored when under-achieving at school, a newly pregnant girl may suddenly have support from a social worker, a child psychologist, a GP, a gynaecologist, a midwife, a nurse and a housing officer.

The 2006 Joseph Rowntree report, ‘Planned’ Teenage pregnancy by Suzanne Cater and Lester Coleman, based on interviews with 41 teenage mothers and 10 teenage fathers, makes the point that ‘planning’ can vary enormously between those who openly and intentionally choose, after discussion, to have a child early and those who adopt a fatalistic approach towards pregnancy and contraception. The report highlighted several issues:

• The high visibility and acceptance of other young parents in the neighbourhood reduces the stigma for many young girls;

• Many see becoming a parent as a means of escaping family hardship and unhappiness, a chance for independence and an opportunity to gain a new identity;

• For others, bringing up a baby is seen as an alternative, more satisfying career than having a low-paid, ‘dead-end’ job;

• Where there had not been an explicit decision to try and get pregnant, many poorer girls chose to continue with the pregnancy, partly out of a fatalistic acceptance of what life threw at them and partly because of the general acceptability of young parenthood in the area, whilst wealthier girls had terminations. (As a Times headline put it, ‘Pregnant teenagers live in different worlds: the rich have abortions, the poor have babies’)

These findings fly in the face of the Social Exclusion Unit’s 1999 report that suggested that ‘the first conscious decision that many teenagers make about their pregnancy is whether to have an abortion or continue with the pregnancy.’ The truth is that many teenagers, especially in deprived communities, deliberately choose to get pregnant and if we are to tackle teenage pregnancy rates we shall have to accept that planned teenage pregnancy is a fact.

‘Don’t ask me why my body got pregnant – that’s up to my body. I wanted a baby, so I was happy, but it was the right time otherwise my body wouldn’t have had one.’ female, 16 ‘Because I was so unhappy – I was so – you know – so unhappy. I didn’t have a place for anything. I hated school, I didn’t – I didn’t have anything (um) and B [baby son] gave me that – B gave me my purpose and my place in life, and my goal.’ female,13 ‘My mum’s never had a job – she just had me and my sisters – like, quite young. Like, a housewife-type thing. And that’s what all my friends’ mums are too. There’s tons of teenage mums round here – I don’t know why – nobody looks at me funny ’cos there’s so many of us. [laughs]’ female, 17 - Joseph Rowntree report, ‘Planned’ teenage pregnancy

‘If a girl sleeps with lots of boys, she’s a slag, but if a boy does, he’s a hero.’ ‘All the images are wrong on TV. You always see a rapper with twenty really young women on his arm.’ ‘When you see a teenage mum you know she’ll be a single girl – there won’t be a father around.’ - Comments from students at Treorchy Comprehensive

Poverty and poverty of aspiration

All the international comparisons suggest that deprivation is intimately linked with high rates of teenage pregnancy. So for instance, in Italy the teenage birth rate in the well-off central regions is only 3.3 per 1,000, but, in the poorer Mezzogiorno it is 10.0 per 1,000 (which is still a quarter of the figure in the Rhondda). Likewise, a 2001 study in California showed that in the wealthier Marin County there was a teenage pregnancy rate of 5 per 1,000, whilst in the poorer Tulare County the rate for Caucasians was 50 and for the poorer Hispanics 100.

Exactly the same is true across England and Wales. Poorer communities have significantly higher rates than wealthier ones and Wales has higher rates than England. So, the English region with the highest rates is the North East, followed by London and Yorkshire and the Humber. Wales, at 45.1 is some way ahead of the average for England, but short of the North East on 50.6 per 1,000.

Within Wales the same is true. The poorest Valley communities, of Rhondda Cynon Taff, Merthyr Tydfil, Torfaen and Wrexham have the highest rates whilst the more affluent areas of Monmouthshire have a rate that is a third of the others (Monmouthshire 21.6, Torfaen 66.9).

Based on average rates between 2002 and 04, Rhondda Cynon Taff County Borough has the highest teenage pregnancy rate in Wales at 60.3 per 1,000.

The relation between deprivation and teenage pregnancy is not a precise equation, not least because some local authorities and health organisations have had more success than others in tackling the problem, but there is an almost direct equivalence between the map of teenage pregnancy and the poverty map of Britain.

Nor is there a direct causal relationship between poverty and teenage pregnancy. The vast majority of poor people do not have children before their 20th birthday. But a girl growing up in a household where nobody works is far more likely to become a teenage mother and her daughter is in turn more likely to get pregnant young. So poverty – like wealth – is all too often inherited.

This is nowhere better exemplified than in the figures for girls in care or leaving care who have repeatedly been shown to be at higher risk of teenage pregnancy. Survey findings have shown that a quarter of care leavers had a child by the age of 16, and nearly half were mothers within 18 to 24 months after leaving care. Equally disturbing is the fact that Nearly 20% of births to under-18s are to young women who are already teenage mothers, for whom childbirth has clearly become an alternative to school, training or work.

We will never manage to break the cascade of poverty through the generations without further reducing the teenage pregnancy rate. Nor shall we able to cut these rates without tackling poverty and deprivation. Enhancing the self-worth and the range of personal opportunities in life of the most vulnerable and the poorest children in Britain must be a key aim of social policy.

Alcohol and under-age drinking

The statistics on teenage and under-age drinking in England and Wales are mixed. On the one hand the authoritative ESPAD survey (repeated in 1995, 1999 and 2003), which is based on self-reporting by teenagers, shows the UK, Ireland and Denmark at the top of the league in terms of the number of 15-16 year olds who have been drunk 10 or more times in the last 12 months. It also found in 2003 that

• The vast majority of the students in the United Kingdom had drunk alcohol during the last 12 months (91%), well above the average of all ESPAD countries (83%).

• The proportion saying they had got drunk during the same period is markedly higher in the UK than elsewhere.

• More girls than boys (29% as opposed to 25%) admitted at least one binge drinking experience within the previous month – a marked increase since 1999.

Other surveys have seen similar worrying trends. The Department of Health reported in 2001 that the amount of alcohol consumed by 11-15 every week doubled in the 1990s. In 2006, 41% of 15-year-olds admitted to having drunk alcohol in the last week, 16% of 13-year-olds, 8% of 12-year-olds and 3% of 11-year-olds.

On the other hand, since 2001 the number of 11-15 year olds in the UK who say they have drunk alcohol in the last week has slowly fallen and the proportion who say they have never drunk alcohol has gone up, from 38% to its current 46%.

The percentage of young people who say they have drunk alcohol in the past week, is also down from 26% in 2001 to 21% today.

What this seems to suggest is that while the overall number of youngsters drinking is falling, those who are drinking under-age are drinking more and more often and are getting drunk more often.

As with deprivation, there is no direct link with teenage pregnancy. Drinking doesn’t make you pregnant. But, as a report by Alcohol Concern in 2002 put it, ‘alcohol affects people’s judgement, it lowers inhibitions, it gives people an excuse for behaviour that they might otherwise find difficult to explain and of course young people drink alcohol in places where they expect and hope to meet sexual partners.’

This is a particularly strong cocktail when it comes to young teenagers, who when drunk are more likely to overcome their natural anxieties about having sex, are more likely to have their first sexual experience, are more likely to have sex with someone they have not known for more than 24 hours and may either deliberately or accidentally have sex without contraception. So, as Alcohol Concern have pointed out, citing several different surveys:

• Three quarters of 16-20 year olds use contraception while sober, compared to 59% who are moderately intoxicated and just 13% of those who are strongly intoxicated.

• Among 15-16 year olds one in 14 said they had unprotected sex after drinking, and one in seven 16-24 year olds said they had done so.

• When asked why they had sex the first time 20% of men and 13% of women aged 15 to 19 said alcohol was a main reason.

• Forty per cent of sexually active 13 and 14 year olds were "drunk or stoned" at first intercourse.

• Of 15 to 19 year olds who have had sex with someone they knew for less than one day, 61% of females and 48% of males gave alcohol or drugs as a reason.

‘I got drunk and had sex with a 17 year old at a party. I’ve just taken the pregnancy test and it’s positive. They boy said it isn’t his. I want to do my A-levels, but I’ve ruined my life’. Girl – 16 ‘When by boyfriend and I are drunk, sometimes we don’t bother with condoms. I told him I think I’m pregnant and he said it would be all right. Of course it will be for him – he’s not the one who’s going to have to deal with it’. Girl – 15 Two of the 6,921 children who rang Childline to talk about pregnancy issues in 2007.