20% of Nottingham’s population are below 18 years of age, 64.8% of whom live in households where no adults work, or where household income is low. This is statistically higher than the national average. In 2015, unemployment in Nottingham was around 9.1%. Over the period 2013-15, life expectancy was 76.8 years for men and 81.4 for women in Nottingham.
Nottingham City has approximately 16,200 13-17 year olds, equating to 5.1% of the population in 2014 (ONS 2014 mid-year estimates). According to the 2017 Nottingham Health Profile (Public Health England, March 2017), Nottingham has higher than average levels of deprivation and poor health with around 34.3% of under-16s living in poverty as compared to the national average of 18.6%.
In Nottingham 580 (5.8%) young people aged between 16 and 18 years were NEET in 2015, the England average was 4.2%.
The teenage population is projected to grow by around 12% between 2014 and 2020 (from 25,000 to 28,000). Most of the growth is in the 10-14 year age group, with 15‑17 year olds remaining static (at around 9,600 persons).
2.2 Teenage Conceptions
Teenage conception figures are published quarterly after a 14-month time lag
. The most recent annual figures are for 2015 and show that the teenage pregnancy rate in Nottingham City stood at 31.2 pregnancies per 1000 15-17 year old girls. This rate was 58.2% lower than the 1998 baseline and was a 4.9% decrease from the same period in 2014. This can be compared to a 55.4% reduction in the under-18 conception rate in England from 47.1 in 1998 to 20.8 in 2015. Current rates, both in Nottingham and England as a whole, are the lowest since data collection began in 1969. This indicates that high rates are not inevitable, even in deprived areas like Nottingham.
As figure 3 illustrates, there is also a strong correlation in Nottingham between deprivation at ward level and teenage conception rates. This reflects the national picture.
Figure 3: Relationship between deprivation and teenage conception rate for Nottingham Wards 2012‑14
Source: Office for National Statistics (2015)
Ward Conception Rates – confidential data
In Nottingham, during 1998 there were 380 under-18 conceptions compared to 152 in 2015. This represents a 60% reduction in numbers over the 17-year period.
The wards with the highest three-year aggregated rates of under-18 conceptions, over 2012-14 (the latest available data) were Arboretum, Aspley and Bulwell, though due to the overall reduction in the number of conceptions, only Aspley was significantly higher than the Nottingham average.
Wollaton West rate was significantly lower than the Nottingham average and two wards had such low numbers that they have been suppressed due to risk of disclosure (Dunkirk & Lenton and Wollaton East & Lenton Abbey). The wards with the highest and lowest rates remained unchanged between 2009 and 2014 though numbers of conceptions have fallen to such an extent that only Aspley is now significantly higher than average; this can be seen throughout the maps in Figure 4.
Figure 4: Nottingham ward conception rates 2009 – 2014
Source: Office for National Statistics (2015)
Ward conception rates 2009-11, 2010-12, 2011-13 and 2012-14 - confidential data.
Figure 5 illustrates that the under-16 conception rate was 7.4 girls per 1000 aged 13-15 years during 2015. This equated to 34 conceptions under the age of 16 in Nottingham during 2015. This was a slight increase on the previous two years after a steady decrease from 2008 and was statistically higher than the England average rate of 3.7 per 1000.
Figure 5: Trend in under-16 conception rates 2009-2015
Source: Office for National Statistics (2017) Dataset of conception statistics, England and Wales 2015
Figure 6 contrasts reductions in under-18 and under-16 conceptions and shows that under-16 conceptions do not show the same significant downward trend as under-18s.
Figure 6: Trend in under-18 and under-16 teenage conception rates in Nottingham
Source: Office for National Statistics (2017) Dataset of conception statistics, England and Wales 201
Of the 152 under-18 conceptions in Nottingham during 2015, 39.5% (CI 32% – 47.4%) led to a termination. This equated to the termination of 61 conceptions. As Figure 7 illustrates this is not a statistically significant change from 1998 when the under-18 termination rate in Nottingham was 28.4%. This proportion of conceptions resulting in termination is significantly lower than the 2015 England average under‑18 termination rate of 51.1%.
Figure 7: Trend in proportion of conceptions under-18 years resulting in termination in England and Nottingham (2008 to 2015)
Source: Office for National Statistics (2008 – 2015) Abortion statistics, England and Wales
Figure 8 shows that 47.1% of under-16 conceptions in Nottingham in 2015 led to a termination compared to the national average of 59.5%. Further investigation is necessary to establish any potential reasons for these variations in the under‑16 conception and termination rates as under-16 year old conceptions are not reducing as rapidly as in the 15-17 year old cohort.
Figure 8: Trend in proportion of under-16 conceptions resulting in termination
Source: Office for National Statistics (2016) Dataset of conception statistics, England and Wales 2015
Nottingham City Council has a statutory duty under Section 19 of the Education Act 1996 to arrange suitable full time education for any pupils of compulsory school age that would not otherwise received such an education. This includes pupils of compulsory schools age who become pregnant or who are teenage parents. The Education Support Officer (Teenage Pregnancy) undertakes the statutory duty of the local authority, in line with national good practice, to support and track education access and outcomes for this cohort.
Education provision has been reformed following the closure of Nottingham’s education centre for pregnant teenagers and teenage parents, due to dwindling numbers which made the centre financially unviable. Now, a model is in place to provide broad and balanced access to the curriculum for pregnant teenagers and teenage parents within mainstream schools settings.
In Nottingham, real time data for school-age teenage pregnancies is available via the EOTP. During 2015, there were 22 school-age conceptions that led to live births in Nottingham. Most referrals to the EOTP were from the wards of Berridge, Radford and Park, The Dales and Aspley; this does not correspond with the local picture of under-18 conceptions where most are found in Aspley, Arboretum and Bulwell. We are not clear about the reasons for this variation. The data from the EOTP illustrates a wide variation in the number of teenage pregnancies across schools.
Whilst the majority of the school-age pregnancies are from a White British background, Nottingham is becoming a more diverse city with an increasing number of citizens from diverse backgrounds, culture and heritage and there has been a clear shift over the last two years in the ethnicities of under-16s who become pregnant. Within Nottingham the number of girls conceiving in the under-16 age group from groups other than ‘White British’ increased from 15% of the Education Officer for Teenage Pregnancy’s caseload in the academic year 2012-13 to 52% of the caseload in the academic year 2014-15.
2.3 Contraception and sexual health services
In 2015-16, around 20,000 Nottingham city residents attended sexual health
services including outreach services. Approximately, 9% of attendees were aged 13‑17. As can be expected some people attended more than once; there were 29,500 attendances in total. 1788 young people aged 13-17 attended 3,014 times (10% of attendances) and 675 young people attended more than once.
Around 73% of all clients were female with 79% of those aged 13-17 years being female. 80% of attendances in those aged 13-17 years were for contraceptive services from a sexual health services clinic. Some clients may also have received STI tests, advice and/or treatments. The majority of young people received a mixture of long and short term contraceptives including:
Condoms (586 attendances).
The contraceptive pill (712 attendances at clinics during 2015-16).
Emergency hormonal contraception (155 attendances).
IUD fitting/the coil.
Implants (implants (295 attendances).
Patches (48 attendances).
Contraceptive injections (186 attendances).
Clients received a range of other services including sexual health screening, pregnancy testing, termination of pregnancy counselling and other specialist counselling. Figure 9 shows the number of girls aged 11-17 years at ward level and the number of attendances at sexual health services. It should be noted that many girls choose to attend a clinic away from where they live to protect their anonymity.
Source: Nottingham City Council
Service monitoring data.
The sexual health services uptake rate in 2015 for those aged 11-17 years was 109 attendances per 1000 population. This varied at ward level between 34 per 1000 in Radford and Park and 174 per 1000 population in Clifton South. As Figure 10 illustrates there was a weak positive correlation between high service uptake and teenage pregnancy rate (r² =22%).
Figure 10: Relationship between attendance at sexual health clinics and teenage conceptions for Nottingham Wards.
Source: Nottingham City Council
Service monitoring data.
In Nottingham, 56 out of 71 pharmacies provide emergency hormonal contraceptive (EHC) (Nottingham City Pharmaceutical Needs Assessment, 2015). Levonorgestrel Emergency Hormonal Contraceptive (EHC) is supplied free of charge to young people aged 13 years or older in order to reduce levels of unplanned pregnancy.
Figure 11 shows the number of teenage girls per ward in Nottingham plotted alongside the location of pharmacies that provide EHC.
Figure 11: An illustration of the number of girls living in Nottingham Wards in relation to pharmacies offering Emergency Hormonal Contraception.
Source: Nottingham City Council.
STI and contraception services
Provisional quarterly conception figures are published 14 months after the quarter has ended as conceptions include pregnancies which lead to one or more live births or stillbirths hence statistics can only be compiled once births relating to conceptions in the reference year are registered - registration of a birth is legally required within 42 days of its occurrence.