Indicators in the Child and maternal health profiles and Sexual and reproductive health profiles have been updated. The profiles give data at a local, regional and national level to inform the development and provision of family planning, antenatal and maternity care.

This release updates indicators relating to:

• conceptions, abortions and birth rates for women under 18 and conceptions for women under 16
• ethnicity and age of mothers
• premature births
• admissions of babies aged under 14 days
• deliveries by caesarean section
• ectopic pregnancy
• pelvic inflammatory disease

Indicators which were due to have been updated in November 2021 have also been updated for:

• general fertility rates
• neonatal and post-neonatal deaths
• stillbirths
• multiple births
• low birthweight and very low birthweight of all babies

These indicators were not updated in 2021 because the coronavirus (COVID-19) pandemic has led to delays in birth and death registrations which has delayed the publication of statistics by the Office for National Statistics which are the source data for these indicators.

Data on teenage conceptions at ward level has been analysed by quintiles and are presented as maps to illustrate the variation whilst avoiding the risk of disclosing information on individuals. Under 18 conception rates at ward level were produced by aggregating the number of conceptions to all girls aged under 18 over three year periods (2000-2002 and 2001-2003) and calculating the rate as the number of conceptions per 1,000 women aged 15-17 resident in the area using the mid year ward population estimates. Quintiles were then produced by ranking ward level under 18 conceptions rates from the lowest to highest at National level and then allocating wards to one of five equal groups based on the total number of wards. Quintile 1 therefore includes wards with the lowest rates, whilst quintile 5 includes wards with the highest rates in England and Wales. Source: Office for National Statistics (ONS) Publisher: Neighbourhood Statistics Geographies: Ward, Local Authority District (LAD) Geographic coverage: England and Wales Time coverage: 2000-2002, 2001-2003 Type of data: Administrative data

The number of conceptions to girls aged under 18 per 1,000 girls aged 15-17, aggregated into 3 yearly time periods. Up until 2009 there were approximately 40,000 conceptions a year to teenagers under 18 in England. With teenage pregnancies in England and Wales now at the lowest level since records began, the UK nevertheless retains one of the highest rates of teenage births in Western Europe. The Teenage Pregnancy Strategy suggested three possible reasons for this: low expectations (1), a lack of accurate knowledge about contraception (2), and mixed messages from the adult world (3). Teenage pregnancy rates are known to be higher in the more deprived areas. Half of all under-18 conceptions occur in the most deprived 20% of wards. Teenage mothers are less likely to finish their education, less likely to find a good job, and more likely to end up bringing up their children solo and in poverty. Teenage parents tend to have poor ante-natal health, lower birth-weight babies and higher mortality rates among their infants. Their health and their children's are worse than average. Legacy unique identifier: P01079

Quarterly statistics on conceptions to women aged under 18 years resident in England and Wales; numbers and rates are by regions and other local authority areas.

Teenage conception rate for under 16 year olds and the % of conceptions that lead to abortion Source: Teenage Pregnancy Unit Publisher: Office for National Statistics (ONS) Geographies: Local Authority District (LAD), County/Unitary Authority, Government Office Region (GOR), National Geographic coverage: England Time coverage: 2001-2004 and 2005-2007 Type of data: Administrative data

Legacy unique identifier: P01079

This study, sponsored by the Office of Adolescent Pregnancy Programs, involved a nationwide survey of adolescent pregnancy projects. Part of a national investigation of the problems associated with adolescent pregnancy and of methods for improving services to those directly affected by teenage childbearing, the study sought to "delineate, identify, describe, and evaluate existing programs at the federal, state, and local levels associated with the problem of adolescent pregnancy and adolescent parents". To these ends, data were obtained regarding (1) the general characteristics of the program (e.g., location, catchment area, sponsorship, age of program , and age-range of clients), (2) the types of services offered by the program and the mode of provision of those services, and (3) key administrative features of the project, including demographic data regarding the clients served, program monitoring and evaluation procedures, and sources of progra m funding.

Provides the quarterly number of conceptions to women aged under 18 for England and Wales by regions and other local authority areas. Source agency: Office for National Statistics Designation: National Statistics Language: English Alternative title: Quarterly Conceptions to Women Aged Under 18, England and Wales

The pregnancy and birth profiles include the breastfeeding profiles. The profiles bring together a range of data indicators by local area related to:

• conception
• pregnancy and delivery
• breastfeeding
• maternity
• teenage conceptions

The http://fingertips.phe.org.uk/profile-group/child-health/profile/child-health-pregnancy" class="govuk-link">pregnancy and birth profiles provide information to help improve decision making when planning local services for pregnant women or to support new mothers and their children.

Evidence – qualitative and quantitative – was generated from interviews with adolescents aged 10-19 years in Ethiopia, Malawi, and Zambia to understand how adolescent abortion-related care-seeking differs across a range of socio-legal national contexts. Our comparative study design includes countries with varying levels of restriction on access to abortion: Ethiopia (abortion is legal and services implemented); Zambia (legal, complex services with numerous barriers to implementations and provision of information); and Malawi (legally highly restricted). Most adolescents (98%) in Ethiopia obtained a medically safe abortion, with most adolescents (64%) in Zambia and almost all adolescents (94%) in Malawi obtaining a less medically safe abortion.

A total of 313 facility-based interviews were carried out with adolescents aged 10-19 in 2018/19 in Ethiopia (n=99), Malawi (n=104), and Zambia (n=110). Adolescents were seeking public sector care for either safe abortion or post-abortion care for complications from an abortion initiated elsewhere. Adolescent recruitment was initiated by a study-trained senior nurse, who identified and invited eligible participants to participate in the study upon their readiness for discharge.

Our research assistants (RAs) were all females in their twenties or early thirties and were recruited after the completion of intensive (two weeks) training from the project team that included role-playing and pilot interviews. We completed paid training for more RAs than the project required; performance during training and piloting were explicitly part of our RA recruitment process. Interviews with adolescents were conducted in a private setting in each facility by RAs fluent in all major local languages. Informed consent was obtained from adolescents aged 18 and above, while for those under 18, consent was sought from an accompanying parent or guardian with the respondent's assent. Unaccompanied respondents under 18 were considered emancipated minors, and their independent consent was obtained.

Each adolescent in our study had one interview. A set of approaches were used to maximize the likelihood of disclosure of abortion-related behaviors, and to elicit the details, many of which were multiple attempts to end the pregnancy interwoven into a complex trajectory over weeks or months. For interviews where consent or assent was granted, they were recorded and subsequently transcribed (qualitative) and data entered (quantitative) by the RAs.

In each interview, there were normally two RAs: one RA (Interviewer 1) conducted the interview in a conversational style to put the participant at ease and facilitate the narrative flow, whilst a second RA (Interviewer 2) completed the datasheet seated to the side of or behind Interviewer 1, so as not to influence or distract her from the conversation. Interviewer 2 was always positioned to be visible to the respondent [i.e.: not behind her]. As Interviewer 1 conducted the interview using a conversational style to follow and probe the responses, Interviewer 2 completed the datasheet (see below). Interviewer 1 did not write and was able to maintain eye contact and react to the adolescent’s body language, facial expressions, and emotions. Before closing the interview, Interviewer 1 re-introduced Interviewer 2 who would ask supplementary questions building on the conversation she had listened to. During training RAs had learnt and internalized the overall logic of the research project, so that when they were Interviewer 1 they knew the topics and questions that they needed to probe for.

Our research project wanted to understand – in detail –adolescent abortion-related care-seeking. We wanted to generate quantitative and qualitative evidence quickly to minimize burden on respondents who may be feeling uneasy or uncomfortable after receiving abortion-related care. We needed a tool that would collect data quickly and facilitate disclosure. We refined a datasheet approach that had previously been used in a study of abortion care-seeking in Zambia (Coast and Murray 2016). Due to the number of closed questions, the datasheet shows superficial similarities to a survey questionnaire. Critically, however, the order of the questions was not pre-determined – RAs were able to decide which questions to ask depending on the conversation. Interviewer 2 added the information to the data sheet by following the flow of the conversation rather than a pre-determined order. The size of the datasheet (A3) allowed for notes on the tone or content of the discussion to be written on the margins or for detailed notes if consent to record was not given. RAs understood that “messiness” on the datasheet was not a problem; what mattered was capturing the complexity of adolescents’ experiences. Datasheets for each country are available.

To minimize the burden on respondents and maximize likelihood of completion, we did not want to conduct separate qualitative and quantitative interviews. A survey instrument demanding specific question order response patterns would be inappropriate for understanding the complexity of abortion-related care-seeking. We needed an instrument that would allow for the simultaneous collection of quantitative and qualitative evidence. Narratives about abortion care-seeking are not linear, and we needed an approach that would allow us to respond to the adolescent’s narrative whilst ensuring that quantitative evidence was generated to allow for aggregation and comparison. In many survey instruments on abortion-related care-seeking there is little detailed questioning about concurrent and/or unsuccessful abortion attempts, and nearly all instruments have a linear chronological design. Our approach was purposely nonchronological and nonlinear to respond to adolescents’ narratives. Our datasheet allowed us to capture non-linear and concurrent trajectories to be recorded in detail in a way that would be impossible with a structured chronological questionnaire.

Our prior experience meant that we knew that attempting to gain disclosure of abortion attempt(s) and care-seeking is difficult – for very good reason. Adolescents are afraid of admitting to behaviors that are stigmatized, might be potentially criminalized, and have punitive outcomes (e.g.: police involvement, abuse from health professionals or from parents or partners). We developed a flipchart in each setting as a way of helping to identify local (perceived) abortifacients (e.g.: medications, toxic substances). We produced a flipchart booklet of locally produced photographs of all the ways in which adolescents might attempt or have an abortion in each context. To generate the photographs, during training we had an intensive and iterative group discussion amongst the RAs and country team members – to generate a long list of all the possible abortion methods, irrespective of efficacy, that anyone had ever heard about. These discussions served a useful secondary purpose of eliciting, debating, and discussing RAs’ beliefs and understandings about abortion methods. The RAs then took photographs of each of these methods in community settings and created a laminated flipchart booklet. The photographs were context-specific, and all three countries had different pictures.

The flipchart was a low cost and low technology option that yielded positive results in terms of facilitating the disclosure of abortion – and abortion methods – by adolescents. The flipchart helped with recall because many adolescents make multiple, sequential, and concurrent attempts to try and terminate a pregnancy. It helped to identify pharmaceuticals that adolescents did not know the names of. Finally, the flipchart helped respondents to define the steps, components, and timelines of their abortion trajectory.

Our use of a flipchart – locally produced in each context – served multiple purposes. First, it served to normalize adolescent’s behaviours in relation to the stigmatized issue of abortion; when an adolescent sees and points at – but does not necessarily speak about – something that she used or did, it communicates to her that others have also done this. Second, it helped to identify more accurately – especially in relation to pharmaceuticals – what medication adolescents had used. Finally, it was a time-effective way of eliciting information; RAs did not have to verbally describe a range of methods and wait for a response. We know that adolescents often lack accurate information on abortion and the flipchart was an important way of enabling and adding detail to abortion disclosure.

The LH-like molecule chorionic gonadotropin (CG) is secreted by the macaque conceptus during and following implantation, “rescuing” the CL from impending regression and extending its functional lifespan in early pregnancy for approximately two weeks. CG binds to the same receptor as LH; i.e., LHCGR, and promotes production of steroids and other factors such as relaxin (RLN1). Our research group recently used Affymetrix™ rhesus macaque total genome arrays to compare the effects of CG on the luteal transcriptome from rhesus females during simulated early pregnancy (SEP) with changes during luteal regression in the non-fecund menstrual cycle. This analysis demonstrated that CG-rescue affected expression levels of 4,500 mRNA transcripts between days 10 and 15 of the luteal phase. Previous analyses indicated that a portion of the transcriptome in the macaque CL of the menstrual cycle was regulated indirectly by LH via the local actions of steroid hormones, including progesterone (P). Therefore, this study was designed to distinguish CG-regulated luteal genes that are dependent versus independent of local steroid (P) action. A protocol of increasing dosages of hCG (SEP) was begun on day 9 of the luteal phase in rhesus females combined with concurrent administration of the 3BHSD inhibitor trilostane (TRL) +/- the synthetic progestin (P) R5020. CL were collected on day 10 (no treatment) of the luteal phase to serve as a baseline comparison (n=8), 1 day of SEP (Day 10+hCG+/-TRL+/-R5020) and 6 days of SEP (Day 15+hCG+/-TRL+/-R5020); n=4/group. In the presence of CG, treatment with TRL reduced serum P levels to less than 1 ng/ ml after 1 day and all of the Day 15+h+TRL-treated females initiated menses before CL collection. The isolated CL were processed for total RNA and hybridized to microarrays. Compared to hCG treatment alone, 50 significantly altered mRNA transcripts were identified on day 10, rising to 95 on day 15 (P<0.05, ≥ 2-fold change in gene expression). The mRNA levels for several genes were validated in CL by real-time PCR. RNL1 levels increased with CG-treatment, but were not affected by steroid ablation, similar to previously reported relaxin protein expression. Steroid-sensitive genes included CDH11, IL1RN, INSL3, LDLR, OPA1, SERPINE1, SFRP4, and TNSF13B1; however differential sensitivity was observed and effects of steroid ablation and P replacement varied by day. Expression of some genes (e.g., 3BHSD2, ADAMTS1, ADAMTS5, MMP9, STAR, and VEGFA) previously identified as steroid regulated in the macaque CL during the menstrual cycle were not significantly altered by steroid ablation and P replacement during CG exposure in SEP. These data indicate that the majority of CG-regulated luteal transcripts are differentially expressed independently of local steroid actions. The proportion of steroid sensitive mRNA transcripts in the presence of CG is much smaller than in the presence of LH during the non-fecund cycle. Nevertheless, the steroid-regulated genes in the macaque CL may be essential during early pregnancy, based on the previous report that TRL treatment initiates premature structural regression of the CL during SEP. These data reinforce the concept that the structure, function, and regulation of the rescued CL in early pregnancy is different from the CL of the menstrual cycle. A protocol of increasing dosages of hCG (SEP) was begun on day 9 of the luteal phase in rhesus females combined with concurrent administration of the 3BHSD inhibitor trilostane (TRL) +/- the synthetic progestin (P) R5020. CL were collected on day 10 (no treatment) of the luteal phase to serve as a baseline comparison (n=8), 1 day of SEP (Day 10+hCG+/-TRL+/-R5020) and 6 days of SEP (Day 15+hCG+/-TRL+/-R5020); n=4/group.The isolated CL were processed for total RNA and hybridized to Affymetrix Rhesus Genome microarrays.