Trends in teenage pregnancy in England and Wales: how can we explain them?

Teenage pregnancy is associated with adverse social and physical outcomes for both mother and child. We drew on various sources-birth and abortion statistics from the Office for National Statistics, data from the National Survey of Sexual Attitudes and Lifestyles, and routinely collected data from family planning clinics-to identify trends in England and Wales and their possible determinants. The rate of teenage sexual activity has increased steadily and consistently over the past four decades, whilst the rate of teenage fertility has shown greater variation. When the teenage fertility rate is calculated against the denominator of sexually active women, rather than the total sample of teenage women, the underlying trend in teenage fertility over the past four decades has been downwards, though not consistently so. Fluctuations in the teenage fertility rate seem to track intervention-related factors such as access to, and use of, contraceptive services and the general climate surrounding the sexual health of young people

Staff training in integrated sexual health services

Coordination of family planning and GUM services has the potential to boost the effectiveness of bot

The role of fathers in breastfeeding: Decision-making and support

Background In recent years closer attention has been paid to the role of fathers in both the decision about whether to breastfeed and in supporting a breastfeeding mother. This qualitative study explores couples' decision-making regarding infant feeding, parents' views on the father's role in relation to breastfeeding, and examines some dilemmas fathers face when supporting a breastfeeding partner. Methods Eighteen men and women using maternity services at the Royal Sussex County Hospital were interviewed by telephone. Results Fathers acknowledged that the decision to breastfeed should be made by the mother and a father's role was to endorse his partner's decision and provide practical and emotional support. Those who faced breastfeeding difficulties described the processes involved in deciding whether to continue. Conclusions This small study draws upon the views of men and women living in the south-east of England in a city with high rates of breastfeeding initiation. Findings may not be generalizable to the wider population. However, in this setting new parents need information about breastfeeding and support to make informed decisions about duration and further input from health professionals when facing difficulties. </jats:sec

Uses of routine data sets in the evaluation of health promotion interventions: opportunities and limitations

Practitioners are under constant pressure to evaluate their work. In the current environment, health professionals frequently have limited time and financial resources, and opportunities for using existing data sets must be exploited. Routinely collected data provide a potentially useful resource for use in this context. The aim of this paper is to discuss the potential uses of routinely collected data in the evaluation of health promotion interventions. Opportunities for and limitations of routine data are discussed, drawing on examples primarily from the field of sexual health, to demonstrate principles which are also relevant in other areas of health care

The role of gender relations in uptake of mass drug administration for lymphatic filariasis in Alor District, Indonesia.

BACKGROUND: The Global Programme to Eliminate Lymphatic Filariasis has set 2020 as a target to eliminate lymphatic filariasis (LF) as a public health problem through mass drug administration (MDA) to all eligible people living in endemic areas. To obtain a better understanding of compliance with LF treatment, a qualitative study using 43 in-depth interviews was carried out in Alor District, Indonesia to explore factors that motivate uptake of LF treatment, including the social and behavioural differences between compliant and non-compliant individuals. In this paper, we report on the findings specific to the role of family and gender relations and how they affect compliance. RESULTS: The sample comprised 21 men and 22 women; 24 complied with treatment while 19 did not. Gender relations emerged as a key theme in access, uptake and compliance with MDA. The view that the husband, as head of household, had the power, control, and in some cases the responsibility to influence whether his wife took the medication was common among both men and women. Gender also affected priorities for health care provision in the household as well as overall decision making regarding health in the household. Four models of responsibility for health decision making emerged: (i) responsibility resting primarily with the husband; (ii) responsibility resting primarily with the wife; (iii) responsibility shared equally by both husband and wife; and (iv) responsibility autonomously assumed by each individual for his or her own self, regardless of the course of action of the other spouse. CONCLUSIONS: (i) Gender relations and social hierarchy influence compliance with LF treatment because they inherently affect decisions taken within the household regarding health; (ii) health care interventions need to take account of the complexity of gender roles; (iii) the fact that women's power tends to be implicit and not overtly recognised in the household or the community has important implications for health care interventions; (iv) campaigns and other preventive interventions need to take account of the diversity of patterns of health care decision-making and responsibility in specific communities so that social mobilisation messages can be tailored appropriately

Adolescent Sexual Activity, Contraceptive Use, and Pregnancy in Britain and the U.S.: A Multidecade Comparison.

PURPOSE: Pregnancy rates among adolescents have declined in the U.S. and Britain but remain high compared with other high-income countries. This comparison describes trends in pregnancy rates, recent sexual activity, and contraceptive use among women aged 16-19 years in the U.S. and Britain to consider the contribution of these two behavioral factors to the decline in pregnancy rates in the two countries and the differences between them. METHODS: We use data from two rounds of the U.S. National Survey of Family Growth, conducted 2002-2003 and 2011-2015, and the British National Survey of Sexual Attitudes and Lifestyles, conducted 2000-2001 and 2010-2012, to describe population-level differences between countries and over time in sexual activity and contraceptive use. We calculate pregnancy rates using national births and abortions data. RESULTS: Pregnancy rates declined in both countries; this began earlier in the U.S. and was steeper. There was no change in sexual activity in Britain, but in the U.S., the proportion reporting recent sex declined. In both countries, there was a shift toward more effective contraception. A higher proportion in Britain than the U.S. reported ever having had sex (65% vs. 49%) and sex in the last year (64% vs. 45%), 6 months (59% vs. 45%), and 4 weeks (48% vs. 45%). A higher proportion in Britain reported using more effective contraception (68% vs. 52%). CONCLUSIONS: In both countries, improvements in contraceptive use have contributed substantially to declines in pregnancy rates; however, the steeper decline in the U.S. likely also reflects declines in recent sex occurring only in that country

'Once the stuff's left my body, it's not me': service users' views on unlinked anonymous testing of blood for HIV.

This paper reports on the qualitative component of a mixed-methods study on unlinked anonymous testing for HIV in genitourinary medicine (GUM) clinics in two English cities. Unlinked anonymous testing is a system of monitoring population prevalence by testing residual blood samples taken for diagnostic purposes after they have been unlinked and anonymised from their source. Little is known about how individuals feel about their blood being tested in this way without their explicit consent, nor is it clear whether the process of unlinking blood affects how people feel about the use of their bodily material for public health surveillance purposes. We report participants' views on these issues, drawing on in-depth interviews with 20 GUM clinic users. The majority thought it preferable for blood samples to be used for population surveillance rather than being discarded. For most, blood and bodily tissue were not seen to represent personal identity even though participants understood that information about them could be gleaned from their analysis. The provision of information, rather than a strict consent process, was advocated as many felt that transactions between health professionals and patients should be as transparent as possible