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Unplanned Teenage Pregnancyand the Support Needs of Young Mothers

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					                         DEPARTMENT OF
                         HUMAN SERVICES
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     Unplanned
        Teenage
     Pregnancy
and the Support
 Needs of Young
        Mothers

        Part C: Statistics
                             Prepared by
    Krystyna Slowinski and Arthur Hume
Research, Analysis and Information Team
                           October 2001
             TABLE OF CONTENTS

Executive Summary……………………………………                            2

1. Introduction………………………………………….                           4

2. Data Quality……………………………………….…                           4

    A. Data Collections………………………………………………..…………………..      4
    B. Definition of terms ..……………………………………………..………………    6
    C. Quality of Data………………………………………………………………..…..…      6

3. Australian & International Statistics………….……            8

    A. Teenage Births………………………………………………..………………………         8
    B. Teenage Abortions and Pregnancy rates……………………...   10

4. What impacts on teenage pregnancy rates?…….….          11

5. South Australian Statistics…………………………..                11

    A. Teenage Births…………………………………………………………………………         12
    B. Teenage Abortions……………………………………………….………………...      17

6. Hazards of adolescent pregnancy……….……….…..             18

    A. Health risks………………………………………………………………………………..       18
    B. Social risks………………………………………………….………………………………       21

Conclusion………………………..…………………..….                          23

References……………………………………….………..                           24
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Executive Summary
The paper presents and examines statistical information relating to teenage births,
abortions, and pregnancies. Issues relating to the quality and availability of data are
considered. Data sources and collection processes are described and resulting issues
summarized. The following points have emerged from the analysis:

    Accurate data is difficult to obtain. There are issues with the availability, quality
    and comparability of data on births, abortions and pregnancy rates for teenagers.
    Problems relate to:
                           Different collection methods and reporting systems;
                           Lack of accurate abortion data;
                           Limited information on “younger” adolescents;
                           Problems with the accuracy and availability of Aboriginal
                           statistics.
    The analysis and interpretation of data, particularly with regard to national and
    international comparisons, must take data limitations and differences into account.

    Australia’s teenage fertility has been declining since 1970s, reaching its lowest
    rate of 18.1 births per 1000 women aged 15 to 19 (based on registration data) in
    1999. This reflects international trends. Improved access to contraception and
    abortion, and changing educational and career opportunities for women are seen
    as the most significant influences on this trend.

    Comparisons with other developed countries place Australia behind the USA,
    Canada, New Zealand, UK, where teenage birth rates are higher (ranging from
    51.1 in the US to 20.2 in Canada). However, a number of Asian and most
    Western European countries have considerably lower rates (for example, 3.9 in
    Japan and 7.9 in France).

    The recent analysis of teenage abortion data (based on 1994 data) places Australia
    with the second highest rate (of 23.8) amongst developed countries (after USA
    with a rate of 29.2). However, the quality and availability of abortion data, both
    nationally and internationally, is an issue and comparisons are only tentative.

    The comparison of teenage pregnancy rates places Australia (with a rate of 43.7)
    behind the US, New Zealand, Canada, England and Wales (with rates ranging
    between 83.6 in the US and 45.3 in Canada). Some Asian and most Western
    European countries have much lower rates (ranging from 10.1 for Japan to 20.2 in
    France). However, the problems relating to accuracy and availability of abortion
    data again impact on the robustness of this statistic.

    The South Australia’s 1999 teenage fertility rate of 15.5 per 1000 (registration
    data) is below national average. However, different collection processes give
    different outcomes, with the teenage confinement rate for 2000 based on Perinatal
    Statistics Collection being much higher at 18.6. South Australia has a third lowest
    teenage fertility and confinement rate in Australia.



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    The South Australian Perinatal Statistics Collection data for 2000 indicates 926
    births to young women under 20. This is a reduction from 1019 in the previous
    year. In 2000, there were 1121 abortions recorded for women under 20,
    suggesting that more than 2000 teenage women become pregnant each year in this
    State.

    The age distribution of teenage confinements in SA shows the numbers increasing
    with age, with nearly 70% of young women giving birth being aged 18 and 19.

    There is a considerable variation in birth rates in the metropolitan region with the
    majority of young women who continued with their pregnancy and gave birth
    residing in the northern metropolitan Adelaide. The highest rates of teenage
    confinements are in the areas of high social and economic disadvantage (for
    example Playford recorded a rate of 51.7 in 2000).

    The teenage birth rate in South Australian country regions is double the
    metropolitan rate, with the highest recorded in the Northern Country region (46.1).

    The Aboriginal teenage fertility rate in Australia is about four times the rate for all
    Australian teenage women. The South Australian Aboriginal teenage confinement
    rate for 2000 was 93.5 (compared to 18.6 for all teenagers).

    The high representation of very young Aboriginal women in South Australian
    statistics is of concern. For example, 30% of Aboriginal teenage confinements in
    2000 were to women aged 16 and under (compared to 15% for non-Aboriginal
    teenage women).

    The South Australian teenage abortion rate for 2000 was 22.4 (a decrease from
    23.7 in 1999 and 24.8 in 1998).

    More than half (53%) of known teenage pregnancies in 1999 were terminated.
    The highest abortion proportion (of 0.85) was recorded for very young adolescents
    (aged 13 and 14). However, the largest number of pregnancy terminations was
    carried out for women in the older age group.

    Only 6.8% of terminations (in 2000) were performed in country hospitals,
    pointing to potential issues of confidentiality and access for country women.

    The analysis of teenage abortion trends in South Australia indicated a decline in
    the 1980s, followed by an increase in the early 90s, with higher rates being
    maintained in mid 90s, and slight decline recorded in 1999 and in 2000.

    The statistical information confirms the higher risk levels, both health and social,
    for teenage mothers, particularly those aged 16 and under.

The available statistics confirm that teenage pregnancy carries significant risks, both
medical and social, for mother and child. The decline in teenage birth rates is
encouraging but it is clear that birth rates in such groups as Aboriginal young women,
those living in the country and those from disadvantaged areas are still very high.



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1. Introduction
The following paper presents and examines statistical information relating to teenage
births, abortions, and pregnancies. The information is based on publications of the
Australian Bureau of Statistics, the Australian Institute of Health and Welfare, the
South Australian Pregnancy Outcome Unit and other relevant sources. The South
Australian Perinatal Collection data for 2000 was used to examine most recent
statistics on teenage births in the State.

The report forms a part of the research project into unplanned teenage pregnancies
conducted by the Research, Analysis and Information Team in Metropolitan Division
of the Department of Human Services. The main goal of the research is to develop
the necessary evidence base for service planning and development aimed at reducing
prevalence of unplanned pregnancies in South Australia and supporting young people
in relation to the pregnancy and the parenting role.

In addition to collation and analysis of the relevant statistical data, the research
includes a review of literature and research, service system mapping and direct
information gathering from young women who become pregnant or give birth.



2. Data quality
After examining literature on teenage pregnancies Moore and Rosenthal (1993)
concluded that the inconsistencies in the reported figures suggest accurate data is
difficult to obtain. While some improvements in data collecting and analysis have
been achieved since, there are still issues around availability, reliability and
comparability of data. In order to highlight the complexities and limitations of the
available information on the topic an outline of sources and nature of data collections
in Australia are provided as a background to the statistical information.

A. Data collections
    Births
In Australia, statistics on teenage births originate from two main sources:

        ♦ The Australian Bureau of Statistics reports on the basis of data made
          available by the Registrar of Births, Deaths and Marriages in each State
          and Territory and representing registrations of live births and perinatal
          deaths in a given year.
        ♦ The Perinatal Statistics Collection is based on data collected by
          midwives and other health practitioners for each live and still birth which
          takes place in hospital. Home births are also included. Each
          State/Territory produces yearly reports from the data (in SA the Pregnancy
          Outcome report is produced by the Pregnancy Outcome Unit). AIHW


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            reports on national data in a yearly “Australia’s Mothers and Babies”
            report.

There are considerable discrepancies between the two data collections. In 1997 The
National Perinatal Statistics collection recorded 5,690 more births than the Birth
Registration collection. A lag between birth and registration and non-registration of
some births is offered as an explanation for these differences (ABS, 2000). It has
been suggested that late registrations or non-registrations are more likely to occur
with teenage mothers.

While it is generally accepted that the Perinatal collection provides most
comprehensive and reliable information about antenatal care, complications of
pregnancy and labour, and health of the baby at birth, it does not include much
information about the father (a particular issue in determining Aboriginal births) and
provides limited information about social and demographic characteristics of the
mother. It has also been suggested that the collection is likely to underestimate
perinatal deaths because neonatal deaths are not always identified through linkage
with perinatal death registration (McLennan & Madden, 1999).

    Abortions
Complete national statistics on induced abortions are not available. While Northern
Territory and South Australia have been collecting termination data for some time,
(following the introduction of relevant legislation in 1970 and 1974 respectively),
Western Australia and ACT began their collections recently (in 1998 and 1999). The
remaining States do not collect specific abortion data.

In South Australia the Pregnancy Outcomes Unit is responsible for the Abortion
Statistics Collection based on notifications made by doctors of medical termination
of pregnancy under the Criminal Law Consolidation (Medical Termination of
Pregnancy) Regulations, 1996.

Other sources of information, used in estimating abortion rates, include:

♦ Medicare records - these cover procedures other than those performed for public
  patients in public hospitals. The collection is incomplete as a woman undergoing
  the procedure must have a Medicare card and needs to present it in order for the
  record to be made. A study conducted in NSW (Adelson et al., 1995) indicated
  that about 15% of women attending private clinics for termination either could not
  or did not intend to use a Medicare card. It can be speculated that teenage women
  are more likely not to have access to their own Medicare card and may be more
  concerned about privacy. Other limitations of this data include the fact that,
  unless specifically requested, it reports on the basis of where the card was issued
  not where the procedure took place.

♦ Hospital Morbidity data provides information about abortions including those for
  public patients in public hospitals (not claimed on Medicare). Such data has been
  available nationally since 1993. Hospital Morbidity data collection includes mis-
  abortions (late spontaneous miscarriages) leading to a slight over-estimation of the
  numbers.


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There are considerable differences between the States and Territories with regard to
legislation and abortion practice. For example, New South Wales and Queensland
carry out most of the abortions in private clinics. This is in direct contrast to, for
example, South Australia where the majority of abortions are carried out in public
hospitals or a specialist clinic. In this context, comparisons between the States and
Territories are made on the basis of different data collections. While South Australia
reports each year on the basis of its Abortions Statistics Collection, obtaining
information from some of the States that do not collect such data is more difficult. As
a result, no national data on teenage abortions is available on a regular basis.


B. Definition of terms
Information relevant to teenage pregnancy is reported in various ways, which again
may lead to confusion. Some of the definitions of statistics used most frequently in
reporting on this subject are listed below:

♦ Teenage fertility rate – number of live births registered in a calendar year to
  mothers under 20 per 1000 of estimated female resident population aged 15 to 19
  years on 30 June of that year. Females aged 13 and 14 years are included in birth
  count but not in population number as they account for a very small proportion of
  births.

♦ Teenage confinement rate – number of women giving birth in a given calendar
  year per 1000 of estimated female resident population aged 15 to 19 years.

♦ Teenage abortion rate – number of induced terminations of pregnancy per 1000
  of estimated female resident population aged 15 to 19 years.

♦ Abortion proportion – number of abortions as a proportion of abortions and
  births in the same time period. Abortion ratio is a similar concept – abortions as
  a proportion of live births (although definitions vary with Singh & Darroch (2000)
  describing the ratio as the percentage of pregnancies that end in abortion).

♦ Teenage pregnancy rate – number of induced abortions and births per 1000 of
  estimated female resident population aged 15 to 19 years.

♦ Perintal deaths – fetal deaths (stillbirths) and neonatal deaths.




C. Quality of data
The wide range of collecting methods and recording practices in Australia impact on
the availability and quality of statistical information on teenage pregnancies. In this
context, comparisons between States/Territories have to take into account some of the
limitations of statistical information. Similarly, international comparisons are
hampered by availability and quality of data as well as different collecting and


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recording practices. Some of the issues impacting on comparability of national and
international data are outlined below.

    Limited abortion data
The most significant gap in the national and international data relates to lack of
consistent data on abortions. In their recent publication Singh & Darroch (2000)
attempted to compare statistical information relating to teenage abortion and
pregnancy rates. Out of 46 “developed” countries selected for comparison, no
abortion data was available for 13 countries and 10 countries provided incomplete
data.

This is of particular concern, as abortion rates, in combination with birth rates, are
used to determine and compare pregnancy rates for teenagers. However, the
availability, comparability and accuracy of such data, both nationally and
internationally, is questionable. Difficulties and inaccuracies associated with
calculating and interpreting teenage pregnancy rates were highlighted by Moore &
Rosenthal (1993).

    Limited information on “younger” adolescents
The “younger” adolescents form a particularly vulnerable group. In looking at
statistics it is therefore important to distinguish between those aged 16 and under and
those aged 17 to 19. Comparisons along those lines are at times difficult as collected
and reported data varies in presentation. This is particularly a problem with regard to
abortion rates where age specific data is difficult to obtain, therefore limiting the
ability to interpret it (Singh & Dorroch, 2000).

    Variations in availability of the most recent data
International comparisons often rely on the most recently available data. In practice
this means that comparisons are often made on data from different years. For
example, the recent analysis of teenage birth, abortion and pregnancy rates by Singh
& Dorroch (2000) is based on data from 1996, 1995,1994 (Australia), 1992 and 1990.

    Issues with accuracy and availability of Aboriginal statistics
Nationally, accuracy and availability of data relating to Aboriginal young people is an
issue. As indicated previously, the Perinatal Collection does not include information
about the race of the father, leading to underestimation of Indigenous births.
Registration data includes father’s details but, as with any collection, it relies on an
accurate identification process. In recent years a greater emphasis has been placed on
identifying race for the Perinatal Statistics Collection. The South Australian Abortion
Statistics Collection at this stage does not record race/ethnicity however Hospital
Morbidity Data can provide this information.




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    Comparability of data
The two collections relating to births in Australia highlight the differences in
collection methods, the differences in statistical outcomes and problems with
comparability of such data. Similarly, abortion data may be influenced by an
inclusion/exclusion of less common termination procedures (an issue for Medicare
and Hospital Morbidity data).

Collection methods and measures are of particular concern in international
comparisons, where a range of factors may impact on the nature of data. These may
include:

    Different registration systems;
    Differences with compliance with the registration process;
    Differences in reporting age between different countries (e.g. as age a woman
    would attain in the year in which event occurred rather than completed years of
    age - resulting in lower teenage rates (Singh &Darroch, 2000));
    Different practices with regard to registration of stillbirths (throughout Australia
    all births of 20 weeks gestation or 400g are registered, while the Australian
    statistics are reported as per the World Health Organization recommendations of
    500g birthweight/22 weeks gestation. International comparisons refer to births of
    at least 1000g or 28 weeks gestation and some reports in the literature were based
    on 24 weeks gestation).

The range of reporting methods and measures opens up a possibility of a variety of
interpretations on this highly emotive issue. While some international comparisons,
such as those carried out by the Alan Guttmacher Institute, adjust for some of the
variations in data collections and clearly identify any shortcomings this is not true for
all publications. In view of the above, considerable care is required in interpretation
and comparison of statistics nationally and internationally.



3. Australian and international statistics
A. Teenage Births
The teenage fertility rate has been declining since 1970s. Currently, teenage mothers
represent 5.2% of all births (ABS, 2000). By comparison this proportion is 13% in
the USA, a country with the highest teenage births rates in the developed world (AGI,
1999).

The rate of childbearing among Australian teenagers peaked at 55.5 babies per 1,000
women in 1971 and reached its lowest rate of 18.1 per 1,000 women in 1999 (ABS,
2000). In addition to improved information about methods of and access to
contraception and abortion it has been suggested that social and economic factors
such as women’s educational and career aspirations have influenced these trends
(Moon et al, 1999).




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Similar trends were followed overseas with most developed countries experiencing a
decline in teenage births between 1970 and 1995 (Singh & Darroch, 2000).

In comparison to other countries Australia has a lower teenage fertility rate than USA,
New Zealand, United Kingdom and Canada but considerably higher rate than Japan,
Hong Kong and a number of Western European countries (Table 1).

Table 1: Fertility rate for women aged 15 to 19 years
                             Year Births per 1,000 females
Australia                    1999              18.1
Canada                       1997              20.2
France                       1993               7.9
Greece                       1995              13.0
Hong Kong                    1996               5.8
Italy                        1995               6.8
Japan                        1996               3.9
Malaysia                     1996              13.4
Netherlands                  1996               4.1
New Zealand                  1998              29.8
Singapore                    1997               7.0
Sweden                       1996               7.8
United Kingdom               1996              29.7
United States of America 1998                  51.1
(ABS, Births Australia – Cat. No.3301.0)

Singh & Darroch’s (2000) analysis of trends in teenage birthrates between 1970 and
1995 indicated a decline of an order of 70-75% for most of the Western European
countries. During that time, Australia’s teenage birthrate declined by 61%. By
comparison, in England & Wales, New Zealand, and Spain teenage birthrates declined
by about 45%, while in US the decline was only by 20%. Japan’s teenage birthrate
declined by only 12%, highlighting the traditionally low teenage birthrate in that
country. In contrast, a number of Eastern European countries recorded increases in
teenage birthrate in that time period.

It is generally accepted that consequences of pregnancy are often greater for younger
teenagers (those aged 15-17 years) therefore it is important to consider birth rates for
this age group. The birth rate for “younger” Australian teenagers (15 to 17 years of
age) was 10.6 in 1994, compared to 35.0 for the “older” group (18-19 years old)
(Singh & Darroch, 2000). By comparison, Japan recorded a birth rate of 1.1 for the
younger group, Sweden 2.7, France 3.5 and Germany 4.4, while United States
recorded 33.8, New Zealand 19.2, England & Wales 14.6 and Canada 13.6.




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B. Teenage abortions and pregnancy rates
    Abortions
Fertility or birth rates understate the actual occurrence of pregnancy as they exclude
induced and spontaneous abortions. Pregnancy rates are based on birth and abortion
rates (still excluding spontaneous abortions) and are affected by the quality of
abortion data. Spontaneous abortions in teenagers have been estimated at about 14%
of pregnancies (AGI, 1999).

Singh & Darroch (2000) examined available statistics on abortion and pregnancy
amongst teenagers in a number of “developed” countries. As indicated previously,
their study was affected by lack of or incompleteness of information on abortions in
23 out of 46 countries they examined.

In comparison to other developed countries Australia’s abortion rate for 1994 was
second highest to the USA (23.8 compared to 29.2 for the US). The Alan
Guttmacher Institute report (1999) provided information on the Australian abortion
rates for 1995-96. According to that data, Australian women under 20 years of age
had an abortion rate of 23.9, while US had a rate of 33.6. The teenage abortion rates
were quite low in Japan (6.3) as well as in a number of Western European countries,
such as Germany (3.6), Italy (5.1), and Belgium (5.0) (Singh & Darroch, 2000).

However, the proportion of abortions to pregnancies was high in Sweden (69.6),
Denmark (62.6), and Norway (59.2). Australia’s abortion ratio for 1994 was 54.1,
indicating that just over half of teenage pregnancies end in abortion. The countries
with lower abortion ratio included USA (34.9), Canada (40.4), and New Zealand
(37.2). Abortion ratio was lowest in Northern Ireland (17). It could be speculated that
access to information and services as well as relevant legislation impact on these
rates.

Lack of reliable data makes analysis of trends in relation to abortion difficult. Singh
& Darroch’s assessment points to an increase in teenage abortion rate in Australia
between 1985 and 1995 (from 17.8 in 1985 to 23.8 in 1990), again most likely
reflecting improved information, access and legislative changes.

    Pregnancy
The comparisons of pregnancy rates (based on birth and induced abortion, but
excluding spontaneous abortions) for different countries is influenced by the
limitations associated with the availability and accuracy of abortion data. Again,
countries such as United States of America, New Zealand, England and Wales, and
Canada are indicated to have high teenage pregnancy rates at 83.6; 54.0; 46.9; 46.9
per 1,000 respectively (Singh & Darroch, 2000). Australia, with a rate of 43.7 has a
higher incidence of teenage pregnancy compared to most Western European countries
and Japan (Table 2). According to statistics used by Sign & Darroch, Australia’s
teenage pregnancy rate increased between 1985 and 1990 (from 40.5 to 44.6) and
subsequently declined slightly to reach a figure of 43.6 in 1995.



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Table 2: Teenage pregnancy rates in selected developed countries

                                 Year            Pregnancy rate
Australia                        1994                 43.7
Canada                           1995                 45.4
England & Wales                  1995                 46.9
France                           1995                 20.2
Germany                          1995                 16.1
Italy                            1995                 12.0
Japan                            1996                 10.1
Netherlands                      1992                 12.2
New Zealand                      1995                 54.0
Sweden                           1996                 24.9
United States of America         1996                 83.6
(Source: Singh Darroch, 2000)




4. What impacts on teenage pregnancy
rates?
A range of factors has been identified as influencing teenage pregnancy rates and
trends. Some of these include:

    Racial and ethnic composition of a region (for example, higher proportion of
    Aboriginal population in NT);
    Distribution of the population (in Australia teenage birthrate and birthrate in
    general is higher in country areas and particularly in remote areas);
    Socio-economic factors, particularly high levels of poverty;
    Better knowledge of and access to contraception;
    Changes in society’s expectations and norms are also seen as influencing the
    decline in teenage births.

These issues will be examined in more detail in the report reviewing the literature and
research relating to teenage pregnancies.




5. South Australian statistics
South Australia has a long established and high quality data collection system for
births and abortions providing reliable information on a range of predominantly
medical issues relating to teenage pregnancy and birth. The following information
relies on these collections but also examines birth registration data in order to
highlight the differences and allow some comparison to national and international


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data. Papers and reports based on South Australian Perinatal and Abortion data
collections were also used to provide relevant information and comparisons of
statistics over time. Where possible, the most recent (2000) information was used.

A. Teenage Births
The South Australian Perinatal Statistics Collection data for 2000 indicates 926 births
to young women under 20. This is a reduction from 1019 in the previous year. In
2000 there were 1121 abortions recorded for women under 20, suggesting that more
than 2000 teenage women become pregnant each year in this State.

According to the birth registration data, South Australian teenage fertility rate for
1999 was 15.5 births per 1,000 women aged 15 to 19 (ABS, 2000). This is below the
national average of 18.1 (Chart 1). South Australia has maintained this position over
the years, with only ACT and Victoria recording consistently lower rates (in 1999
ACT’s teenage fertility rate was 11.8 and Victoria’s was 10.8 births per 1,000 women
aged 15 to 19) (Chart 2).


Chart 1: Trends in teenage fertility rate in Australia and South Australia


                                                    T e enage fertility rate                             Aus tralia
                       60.0
                                                                                                         SA

                       50.0


                       40.0
     Births per 1000




                       30.0

                       20.0


                       10.0


                        0.0
                         71

                               73

                                    75

                                         77

                                               79

                                                    81

                                                         83

                                                               85

                                                                    87

                                                                         89

                                                                              91

                                                                                    93

                                                                                         95

                                                                                              97

                                                                                                    99
                       19

                              19

                                   19

                                        19

                                              19

                                                   19

                                                        19

                                                              19

                                                                   19

                                                                        19

                                                                             19

                                                                                   19

                                                                                        19

                                                                                             19

                                                                                                   19




(ABS, Australian Historical Population Statistics - Births – 3105.0.65.001 2001 Table 38 Age-specific
fertility rates and total fertility, Australia, 1921 onwards)




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Chart 2: Trends in teenage fertility in South Australia and other Australian
                        States/Territories

                                                                                                 NSW
                                             Teenage fertility rates
                                                                                                 Vic.
                     180.0
                                                                                                 QLD

                     160.0                                                                       SA
                                                                                                 WA
                     140.0
                                                                                                 Tas.
                     120.0                                                                       NT
   Births per 1000




                                                                                                 ACT
                     100.0

                      80.0

                      60.0

                      40.0

                      20.0

                       0.0
                        71

                        73

                        75

                        77

                        79

                        81

                        83

                        85

                        87

                        89

                        91

                        93

                        95

                        97

                        99
                      19

                      19

                      19

                      19

                      19

                      19

                      19

                      19

                      19

                      19

                      19

                      19

                      19

                      19

                      19
(ABS, Australian Historical Population Statistics - Births – 3105.0.65.001 2001 Table 39 Age-specific
fertility rates and total fertility, States and Territories, 1947 onwards)



While the rate based on Perinatal Statistical Collection is considerably higher (the
South Australian confinement rate for the same year was 20.6) the position of South
Australia with regard to other States/Territories remains the same. The South
Australian teenage confinement rate for 2000 was 18.6 per 1,000 women aged 15 to
19, which represents a decline from pervious years.

        “Younger” and “Older” teenagers

The age distribution of teenage confinements shows the numbers increasing with age
(Table 3) with nearly 69% of young women giving birth being aged 18 and 19.

While the numbers of very young women giving birth are relatively small, it appears
that their proportion has increased when compared to the analysis of teenage
pregnancy trends in South Australia between 1986-88 (Zhang & Chan, 1991). During
that time, teenage women under 17 years of age represented 12% of confinements to
all teenagers in the State, while in 2000 this proportion was 14.8%.




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Table 3: Teenage confinements in South Australia (2000) by age of mother
                                        Estimated
  Age of                                 resident
  mother                                population       Rate per
  (years)        No         Percent     June 2000         1000

13                     2         0.3        9,838             0.2
14                    10         1.1       10,044             1.0
15                    23         2.8        9,927             2.3
16                   101        10.6       10,204             9.9
17                   153        16.5        9,995            15.3
18                   275        29.8        9,867            27.9
19                   362        38.8        9,944            36.4
Total                926       100.0       69,819
(Source: SA Perinatal Statistics Collection, 2000)



     Country and metropolitan statistics
Based on ABS information, all States and Territories, with an exception of Tasmania,
have a lower teenage fertility rate in the capital cities compared to the rest of the state.
High rates of teenage pregnancy are a particular issue in remote areas, with an
estimated rate of 85.4 babies per 1,000 women. This is in contrast to highly
accessible areas where the rate is 15.6 (ABS, 2000).

Based on Perinatal Statistics Collection, South Australia’s teenage rate of
confinements for 2000 for country regions was 30.8, nearly double that of
metropolitan area (at 15.9). As indicated by Table 4, the highest teenage pregnancy
rates were recorded in the Northern country region (46.1). This in fact represents an
increase in confinement rate, compared to figures for 1986-88, when Northern
country region recorded a rate of 40.9 (based on CURB regions; Zhang & Chan,
1991). Similarly, Murray Lands and Yorke and Lower North regions have recorded
slightly higher teenage confinement rates in comparison to 1986-88 figures, which
were 28.1 and 20.9 respectively.
Table 4: Teenage confinements in South Australia (2000) by Statistical Division
                                                                       Estimated
                             Non-                                     Population
Statistical Division       Aboriginal Aboriginal           Total     Female 15 - 19 Rate/1000
Adelaide                            560           33           593           36,767      16.1
Outer Adelaide                        44             2          46            3,513      13.1


Yorke and Lower North                 21             1          22            1,147      19.2
Murray Lands                          56             9          65            2,066      31.5
South East                            43             0          43            2,150      20.0
Eyre                                  14          14            28            1,089      25.7
Northern                              93          29           122            2,645      46.1
Country                             227           53           280            9,097      30.8


 South Australia                   831*           88*        919             49,377      18.6
*7 teenagers confined in SA had residential postcodes outside if this Sate
(Source: SA Perinatal Statistics Collection, 2000 & Population by age and sex SA, ABS 3235.4 June
2000)


Unplanned Teenage Pregnancy Research Project – Statistics
                                                                                                           14



Variations in confinement rate were evident at both regional and sub-regional level.
While the rates for South East and Eyre have declined, the closer examination of
preliminary regional data by SLA regions have revealed the highest rate of
confinements in Ceduna at 97.25 per 1000 women aged 15 to 19.

Similarly, metropolitan areas very significantly with regard to teenage confinement
rates, with disadvantaged areas recording higher levels (Table 5).

Table 5: Teenage Confinements (2000) by Local Government Area

                                                                        Estimated
                                                                         resident
                                                                        population
                                                          Confinements June 2000
                                      Non-                maternal age Female 15 -19              Rate /
Local Government Area               Aboriginal Aboriginal   < 20 yrs       yrs                    1000
Adelaide (C)                                   1            0               1              547        1.8
Adelaide Hills (DC)                            3            0               3            1,409        2.1
Burnside (C)                                   3            1               4            1,480        2.7
Campbelltown (C) (SA)                        11             1              12            1,473        8.1
Charles Sturt (C)                            41             3              44            2,890       15.2
Gawler (M)                                   15             0              15              644       23.3
Holdfast Bay (C)                               3            0               3              931        3.2
Marion (C)                                   26             1              27            2,482       10.9
Mitcham (C)                                  12             0              12            2,247        5.3
Norwood Payneham St Peters (C)                 3            0               3            1,072        2.8
Onkaparinga (C)                             107             1             108            5,629       19.2
Playford (C)                                112             8             120            2,320       51.7
Port Adelaide Enfield (C)                    71           10               81            2,923       27.7
Prospect (C)                                   3            1               4              570        7.0
Salisbury (C)                                85             4              89            4,022       22.1
Tea Tree Gully (C)                           34             1              35            3,713        9.4
Unley (C)                                    10             0              10            1,180        8.5
Walkerville (M)                                .            .               0              286        0.0
West Torrens (C)                             19             1              20            1,456       13.7

Adelaide Metropolitan Area                  560           33              593          37,274        15.9

 South Australia                               831*           88*           919          49,377      18.6
*7 teenagers confined in SA had residential postcodes outside if this Sate
(SA Perinatal Statistics Collection & Population by age and sex, SA, ABS 3235.4 June 2000)


The highest rates of teenage confinements are in the northern metropolitan region,
particularly in areas of high socio-economic disadvantage, e.g. Playford , Port
Adelaide Enfield, Gawler, and Salisbury. The analysis of teenage fertility rates
(based on provision data for 2000) by smaller SLA regions identified Playford (C) –
Elizabeth, Port Adelaide (C )Enfield – Port, Playford (C ) – West Central and
Salisbury (C) – Central as having highest confinement rates in the metropolitan area.




Unplanned Teenage Pregnancy Research Project – Statistics
                                                                                                                           15


     Aboriginal young women
Indigenous young women tend to have children at a younger age. In 1996, 22% of
Aboriginal births were to teenage mothers, in contrast to 5% for the total Australian
population (Day et al., 1999).

The Indigenous teenage fertility rate in 1999 was 77.6 births per 1000 women, more
than four times the rate for all Australian teenage women. The proportion of
Indigenous population in each State/Territory, particularly those residing in rural and
remote areas, would have a considerable impact on the teenage birth rates in that
region. Table 6 provides information on Aboriginal teenage birth rates in each State
and Territory (ABS, 2000).

Table 6: Teenage fertility rate - Indigenous and All Births

                                           Births to
                                          Indigenous                  All births
                                           mothers*
New South Wales                              66.3                       18.6
Victoria                                     39.8                       10.8
Queensland                                   71.2                       22.4
South Australia                              71.9                       15.5
Western Australia                            96.8                       21.2
Tasmania                                     37.4                       27.1
Northern Territory                           127.3                      67.6
Australian Capital
                                               27.3                     11.8
Territory
Australia                                      77.6                     18.1
* Indigenous rates based on the 1996 Census-based projected population for 1999, low series. Experimental Projections of the
Aboriginal and Torres Strait Islander Population, 1996-2001 (ABS Cat. no. 3231.0).



In 2000, 90 Aboriginal & TSI teenage women gave birth in South Australia
representing 9.7% of all teenage confinements (Table 7). This represents a decline
from 1999 statistics with 109 teenage Aboriginal confinements, representing 10.8% of
all teenage confinements for the year. 24.4% of Aboriginal confinements that year
were to teenagers. While this decline is encouraging the high representation of
Aboriginal young women in teenage statistics continues to be of concern. For
example, 30% of Aboriginal teenage confinements in 2000 were to young women
aged 16 and under (compared to 13.1% for Caucasian women) (Table 7).

Table 7: Confinements (2000) - race of mother by age of mother

Race of Mother             16 yrs and under             17 - 19 yrs                  Total            Total Confinements
                                  N         %              N            %            N            %            N           %
Caucasian                       106         77.9         705          89.2         811         87.6     16,159          91.8
Aboriginal and/or TSI            27         19.9           63          8.0          90          9.7         420           2.4
Asian                              2         1.5           16          2.0          18          1.9         788           4.5
Other                              1         0.7            6          0.8            7         0.8         237           1.3

Total                           136        100.0         790        100.0          926       100.0       17,604        100.0
(Source: SA Perinatal Statistics Collection, 2000)




Unplanned Teenage Pregnancy Research Project – Statistics
                                                                                       16


The Aboriginal confinement rate in 1986-88 was 93.6 per 1000 women aged 15-19
and was nearly five times the non-Aboriginal rate. In 2000, the South Australian
confinement rate for Aboriginal teenage women was 93.5 per 1000.

B. Teenage abortions
In 2000, 1121 South Australian teenage women had an abortion. The teenage
abortion rate for that year was 22.4 per 1000 women (a decrease from 23.7 in 1999
and 24.8 in 1998). Teenage abortions accounted for 20.6% of all abortions (teenagers
being the third largest group to undergo abortion after 20-24 & 25 to 29 year olds).

More than half (53%) of known teenage pregnancies in 1999 were terminated (the
highest proportion with regard to age groups). The highest abortion proportion, of
0.85, was recorded for very young adolescents – those aged 13 and 14. However, the
largest number of pregnancy terminations has been carried out for women in the
“older” teenage group (Chart 3).

Chart 3: Abortions for each age group as a proportion of all teenage abortions

                                  Abortions in SA by age                          2000
                                                                                  1999
                                                                                  1998
           19

           18

           17
     Age




           16

           15

           14

           13

                0       5          10         15            20   25       30     35
                         Proportion of all teenage abortions in a given year

(Source: Report on Abortions Notified in SA, 1999 & 2000)

The majority of abortions in 2000 was performed for women residing in the
Metropolitan region (82.5% of all abortions). It is likely that the same is true for
teenage abortions. Only 6.8% of terminations were performed in country hospitals,
pointing to potential issues of confidentiality and access for country women.

According to Zhang & Chan (1991), in 1986-88 very young women (those aged under
15) represented only 1.3% of all teenage abortions. In 1998 this climbed to 1.8% and
in 1999 to 3.0%, with a drop to 2.6% in 2000. This is a concerning trend, although the
numbers in this age group are still very small and prone to fluctuation.


Unplanned Teenage Pregnancy Research Project – Statistics
                                                                                          17


The majority of terminations in 2000 was performed in the first trimester, 85.7% of
abortions for those aged under 15 and 94.1% for those aged 15 to 19. Those under 15
had the highest proportion (14.3%) of second trimester abortion of all age groups,
while women aged 15 to 19 had the lowest proportion (5.9%). This is in contrast to
1999 figures where women aged 15 to 19 had the second highest proportion of 2nd
trimester abortions (8.3%) after the over 40 group (10%). 17.7% of teenagers
undergoing abortion in 2000 had a previous termination (a reduction from 18.9% in
1999). 3.6% of those aged under 15 who had an abortion in 2000 had a previous
abortion. For women aged 15 to 19 this proportion was 18%. From the 197 women
in the “older” group who had previous terminations, 153 had one previous abortion,
34 had two and 10 had three previous terminations.

The analysis of teenage abortion trends in South Australia indicated a decline in the
1980s (Chan et al., 1994), followed by an increase in the early 90s, with higher rates
being maintained in mid 90s, and slight decline recorded in 1999 and in 2000.
Teenage women in the 1994 study by Chan et al., had a high level of unplanned
pregnancy (62% in a group that continued with a pregnancy) and lower level of
contraception use (for example, 8% never used contraception compared to 2% for all
women in the study). The study supported existing evidence linking teenage
parenthood with poor education, low income, having a large family and a mother that
had her first child as a teenager (Harris, R. et al., 1987).




6. Hazards of adolescent pregnancy
Teenage pregnancy, particularly for young women under the age of 18, still carries
significant social and health risks. The risk of repeated pregnancies and abortions is
higher for those young women who fall pregnant at an early age. Teenage pregnant
women are more likely to have fewer antenatal visits and experience medical or
obstetric complication during pregnancy (for example, higher frequency of pre-term
deliveries and low-birth weight babies (Zhang & Chan, 1991)).

The following statistics review the available data relating to health and social issues
for young women who give birth.

A. Health risks
    Perinatal outcomes
Higher perinatal mortality rate, pre-term deliveries and low birthweight are some of
the health risks associated with teenage pregnancies. South Australian statistics for
2000 suggest that just under one percent (0.8%) of teenage confinements resulted in
fetal deaths compared to 0.6% for confinements to women over 20 (Table 8). The
perinatal mortality rate for babies born to mothers aged 16 and under was 29.2,
compared to 11.3 for mother’s aged 17 to 19 and 8.9 for women 20 and over.
(However, due to small numbers involved these rates have to be treated with caution
and are only indicative).


Unplanned Teenage Pregnancy Research Project – Statistics
                                                                                                                         18


Length of hospital stay is another indication of health problems, with statistics
indicating that babies of teenage mothers stay in hospital longer. In 2000, 4% of
babies of teenage mothers were in hospital for 28 days or more, compared to 2.4% for
over 20 group. Babies of “younger” adolescents were staying in hospital longer –
5.8% being in hospital at 28 days, compared to 3.7% for older adolescents.

The above statistics confirm the particular “at risk” status of younger teenage mothers
and their children.

Table 8: Births (2000) - Perinatal outcome by age of mother

Outcome of baby          16 yrs and under                 17-19 yrs                     20+ yrs               Total
                                 N             %            N             %               N           %        N         %
Fetal Death                      1            0.7           6            0.8            99          0.6     106         0.6
Discharged                     125           91.2         756           95.2     16,386            96.7   17,267       96.6
In hospital at 28 days           8            5.8          29            3.7        404             2.4     441         2.5
Neo natal death                  3            2.2           3            0.4            51          0.3       57        0.3

Total                          137      100.0             794       100.0        16,940           100.0   17,871      100.0
(Source: SA Perinatal Statistics Collection, 2000)



     Birthweight
Last year 10.3% of teenage confinements resulted in low birth babies (under 2500
gms). For women over 20 this figure was 7.1% (Table 9). 13.1 % of “younger”
teenagers gave birth to low weight babies compared to 9.9% in the “older” group.
Babies of Aboriginal young mothers were at particular risk of low birth weight, with
22% of confinements to Aboriginal young women being under 2500 grams (20
confinements out of 90).

Some of the factors contributing to low birthweight are smoking in pregnancy (Chan,
et al., 2001) and socio-economic disadvantage (Adelson et al., 1992).

Table 9: Births (2000) - Birthweight by age of mother

Birth weight (gms    16 yrs and under               17-19 yrs                     20+ yrs                     Total
                           N            %             N            %                N                %          N        %
< 1000                     4           2.9           11           1.4            147                0.9      162        0.9
1000-1499                  3           2.2            6           0.8            146                0.9      155        0.9
1500-1999                  6           4.4           18           2.3            231                1.4      255        1.4
2000-2499                  5           3.6           43           5.4            675                4.0      723        4.0
2500 or more             119          86.9          716          90.2          15,741              92.9    16,576      92.8

Total                    137         100.0          794         100.0          16,940             100.0    17,871     100.0
(Source: SA Perinatal Statistics Collection, 2000)



     Antenatal care
Adequate antenatal care is seen as a significant factor in ensuring good pregnancy
outcomes. An arbitrary level of what can be viewed as “adequate” care has been
proposed as 7 antenatal visits. The proportion of teenage mothers who made less than
7 antenatal visits was 15.0% (Table 10). This represents a slight decline from 1986-


Unplanned Teenage Pregnancy Research Project – Statistics
                                                                                                                 19


88 when 15.7% of pregnant teenagers made less than 7 visits (Zhang & Chan, 1991).
In 2000, 1.5% of teenage mothers have been identified as not having antenatal care at
all (in 1986-1988 this figure was 0.7%).

Table 10: Confinements (2000) - Number of antenatal visits by age
Number
of             16 yrs and under             17-19 yrs                   20+ yrs                       Total
antenatal             N         %             N             %             N              %             N         %
None                  5         3.7            9           1.1          55              0.3          69         0.4
1-6 visits          18         13.2         108           13.7        1,176             7.1        1,302        7.4
7+ visits           96         70.6         570           72.2       12,927            77.6       13,593       77.3
Unknown             17         12.5         103           13.0        2,493            15.0        2,613       14.9

Total             136         100.0           790        100.0       16,651           100.0       17,577      100.0
(Source: SA Perinatal Statistics Collection, 2000)


Less than half (43.3%) of Aboriginal teenage mothers were reported to have, what is
considered an adequate antenatal care. A much higher proportion, in comparison to
non-Aboriginal teenage mothers, had no visits at all, had fewer than 7 visits, or
information about their antenatal care was unknown (Table 11).

Table 11 : Teenage confinements (2000) - Number of antenatal visits by
           Aboriginality

Number of
antenatal           Aboriginal             Non-Aboriginal                     Total
visits                    N           %              N           %            N               %
None                      4        4.4             10        1.2          14              1.5
1-6 visits             21        23.3          105          12.6         126             13.6
7+ visits              39        43.3          627          75.0         666             71.9
Unknown                26        28.9              94       11.2         120             13.0

 Total                 90         100.0         836        100.0         926            100.0
(Source: SA Perinatal Statistics Collection, 2000)



    Previous pregnancies
For the majority of teenage mothers in 2000 (82.3%) this was their first pregnancy
(Table 12). This is a considerably higher proportion in comparison to 1986-88 figures
where only 70.3% of teenagers giving birth were pregnant for the first time (Zhang &
Chan, 1991). For 15.7% of teenagers in 2000 this was their second pregnancy
(considerably less than in 1986-88 where the teenage mothers experiencing a second
pregnancy comprised 23.2% of all teenage confinements).




Unplanned Teenage Pregnancy Research Project – Statistics
                                                                                                                        20


Table 12: Confinements (2000) - Previous pregnancies by age
Number of
previous           16 yrs and under            17-19 yrs                      20+ yrs                       Total
pregnancies               N        %             N                %             N              %             N          %
0                      132           97.1      630            79.7          6,445            38.7        7,207       41.0
1                          4          2.9      141            17.8          5,931            35.6        6,076       34.6
2                      -              0.0        17              2.2        2,743            16.5        2,760       15.7
3 or more              -              0.0            2           0.3        1,532             9.2        1,534         8.7

Total                  136          100.0      790           100.0         16,651           100.0       17,577      100.0
(Source: SA Perinatal Statistics Collection, 2000)


However, the trend towards earlier motherhood is reflected in the figures for
Aboriginal teenage mothers with only 68.9% being pregnant for the first time and
28.9% having a previous pregnancy (Table 13).

Table 13: Teenage Confinements (2000) - Previous pregnancies by Aboriginality

Number of
previous              Aboriginal              Non aboriginal                        Total
pregnancies             N              %           N         %                      N               %
0                          62        68.9        700             83.7          762             82.3
1                          26        28.9        119             14.2          145             15.7
2                           2         2.2            15            1.8              17          1.8
3 or more                  0          0.0                2         0.2                  2       0.2

 Total                   90        100.0         836          100.0            926            100.0
(Source: SA Perinatal Statistics Collection, 2000)


B. Social risks
     Marital status
Most teenage women who choose to continue with their pregnancy become single
parents, a choice that carries a high social and economic cost. In 2000, the majority
of South Australian teenagers who were confined were never married or living in a
defacto relationship (Table 14). This was the case for 77.9% of those aged 16 and
under and 51.3% of 17 to 19 years olds. In contrast, only 9.6% of women aged over
20 were never married.

Table 14: Confinements (2000) - Marital status by age

Marital status       16 yrs and under                17-19 yrs                 20+ yrs                      Total
of mother                   N       %                  N               %        N               %           N          %
Never married              106        77.9           405         51.3        1,596            9.6        2,107       12.0
Married/defacto                30     22.1           378         47.8      14,762            88.7       15,170       86.3
Widowed                    -           -                 1        0.1               8         0.0           9         0.1
Divorced                   -           -                 1        0.1          90             0.5          91         0.5
Separated                  -           -                 5        0.6         195             1.2         200         1.1

 Total                    136       100.0          790        100.0        16,651           100.0       17,577      100.0
(Source: SA Perinatal Statistics Collection, 2000)




Unplanned Teenage Pregnancy Research Project – Statistics
                                                                                                                                        21


     Occupation
Many single teenage mothers are caught in a poverty trap, having limited education,
fewer employment opportunities, and inadequate income. The available information
on mother’s occupation at confinement confirms that picture. The majority of women
aged 16 or under were identified as either students (40.4%) or unemployed (37.5%).
Those aged 17 to 19 were mostly unemployed (29.6%). By comparison, only 4.2% of
women aged 20 and over were identified as unemployed (Table 15).

Table 15: Confinements (2000) - Mothers occupation by age
Occupation of baby's mother                16 yrs and under         17-19 yrs                     20+ yrs                    Total
                                                    N         % N           %             N            %            N            %
Managers and administrators                    -          -             7         0.9          1,088          6.5        1,095         6.2
Professionals                                  -          -             1         0.1          1,689         10.1        1,690         9.6
Para-professionals                             -          -         -             -            1,062          6.4        1,062         6.0
Tradespersons                                       1     0.7        15           1.9            575          3.5          591         3.4
Clerks                                         -          -          27           3.4          2,285         13.7        2,312        13.2
Sales persons & personal service workers            7     5.1       135          17.1          2,436         14.6        2,578        14.7
Plant & machinery operators & drivers               2     1.5           7         0.9            154          0.9          163         0.9
Labourers & related workers                         3     2.2        30           3.8            724          4.3          757         4.3
Student                                            55    40.4       103          13.0            344          2.1          502         2.9
Home duties                                        10     7.4       204          25.8          5,099         30.6        5,313        30.2
Pensioner/invalid pens                              1     0.7           4         0.5             76          0.5           81         0.5
Other                                               1     0.7           4         0.5            166          1.0          171         1.0
Unemployed                                         51    37.5       234          29.6            698          4.2          983         5.6
Unknown                                             5     3.7        19           2.4            255          1.5          279         1.6

Total                                         136       100.0       790         100.0         16,651        100.0       17,577       100.0
(Source: SA Perinatal Statistics Collection, 2000)


For young women with partners the situation is not necessarily better. About a
quarter of teenage women had partners who were unemployed, compared to only
5.8% of women aged 20 and over (Table 16).

Table 16: Confinements (2000) - Fathers occupation by age
Occupation of baby's father                16 yrs and under         17-19 yrs                    20+ yrs                     Total
                                                    N         %         N             %            N           %             N          %
Managers and administrators                        3      2.2        29           3.7          2,886        17.3         2,918        16.6
Professionals                                 -           -             4         0.5          1,895        11.4         1,899        10.8
Para-professionals                                 2      1.5           4         0.5           998          6.0         1,004         5.7
Tradespersons                                      8      5.9       109          13.8          3,075        18.5         3,192        18.2
Clerks                                        -           -             6         0.8           429          2.6          435          2.5
Sales persons & personal service workers           2      1.5        26           3.3           871          5.2          899          5.1
Plant & machinery operators & drivers              7      5.1        41           5.2          1,099         6.6         1,147         6.5
Labourers & related workers                       22     16.2       172          21.8          2,253        13.5         2,447        13.9
Student                                           17     12.5        34           4.3           291          1.7          342          1.9
Home duties                                   -           -             3         0.4            50          0.3           53          0.3
Pensioner/invalid pens                        -           -             2         0.3            94          0.6           96          0.5
Other                                              1      0.7        11           1.4           284          1.7          296          1.7
Unemployed                                        36     26.5       205          25.9           967          5.8         1,208         6.9
Unknown                                           38     27.9       144          18.2          1,459         8.8         1,641         9.3

Total                                         136       100.0       790         100.0         16,651       100.0        17,577       100.0
(Source: SA Perinatal Statistics Collection, 2000)




Unplanned Teenage Pregnancy Research Project – Statistics
                                                                                     22



Conclusion
The available statistics confirm that teenage pregnancy carries significant risks, both
medical and social, for mother and child. The decline in teenage birth rates is
encouraging but it is clear that birth rates in such groups as Aboriginal young women,
those living in the country and those from disadvantaged areas are still very high.




Unplanned Teenage Pregnancy Research Project – Statistics
                                                                                     23



References
Australian Bureau of Statistics (ABS) (2000) Births Australia 1999 ABS Cat. No.
3301.0, Canberra.

Adelson, P., Frommer, M., Pym ,M., Rubin, G. (1992) “Teenage Pregnancy and
Fertility in New South Wales: an Examination of Fertility Trends, Abortion and Birth
Outcomes” Australian Journal of Public Health, Vol. 16, No. 3, 238-244.

Adelson, P., Frommer, M. & Weisberg, E. (1995) “A survey of women seeking
termination of pregnancy in New South Wales” Medical Journal of Australia vol.
163, no.8 Oct, 419-422.

The Alan Guttmacher Institute (AGI) (1999) Sharing Responsibility: Women, Society
and Abortion Worldwide.

Chan, A., McColl, M., Versteeg, J., Gameau, B., Scanlan, C., Pridmore, B. (1994) A
South Australian Study on Contraception and Abortion South Australian Health
Commission & The Queen Elizabeth Hospital, Adelaide.

Chan, A., Scott, J., Nguyen, A., Keane, R. (1999) Pregnancy Outcome in South
Australia Pregnancy Outcome Unit, DHS, Adelaide.

Chan, A., Keane, R., Robinson, J. (2001) “The contribution of maternal smoking to
preterm birth, small for gestation age and low birthweight among Aboriginal and non-
Aboriginal births in South Australia” MJA Vol. 174, 16 April 2001, 389-393.

Day, P. et al., (1999) Indigenous Mothers and Babies, Australia 1994-96 Perinatal
Statistics Series No. 8, AIHW, Canberra.

Harris, R., Merrett, S., Bond, M., Roberts, L. (1987) Teenage Pregnancy Decisions:
The role of unemployment - A report of research with young pregnant women in South
Australia. Department of Primary Health Care, The Flinders University of SA.

McLennan, W. & Madden, R. (1999) The Health and Welfare of Australia’s
Aboriginal and Torres Strait Islander Peoples ABS, Canberra.

Moon, L., Meyer, P. & Grau, J. (1999) Australia’s Young People: Their Health and
Well-being AIHW, Canberra.

Moore, S. & Rosenthal, D. (1993) Sexuality in adolescence Routledge, London, UK.

Singh, S. & Darroch, J. (2000) “Adolescent Pregnancy and Childbearing: Levels and
Trends in Developed Countries” Family Planning Perspectives Volume 32, no. 1,
Jan/Feb., 14-23.

Zhan, B. & Chan, A. (1991) “Teenage Pregnancy in South Australia, 1986-1988” The
Australian and New Zealand Journal of Obstetrics and Gynaecology Vol. 31, no. 4,
Nov., 291-298.


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