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1. Sexual and reproductive health and rights of migrant women attending primary care in England: A population-based cohort study of 1.2 million individuals of reproductive age (2009–2018)

Author

Neha Pathak, Claire X. Zhang, Yamina Boukari, Rachel Burns, Dee Menezes, Gregory Hugenholtz, Rebecca S French, Arturo Gonzalez-Izquierdo, Rohini Mathur, Spiros Denaxas, Andrew Hayward, Pam Sonnenberg, and Robert W. Aldridge

Subjects
Migration health, Migrant, Migration, Sexual and reproductive health and rights, Sexual health, Reproductive health, Public aspects of medicine, RA1-1270, Colonies and colonization. Emigration and immigration. International migration, JV1-9480
Abstract

Background: Evidence on the sexual and reproductive health and rights (SRHR) of migrants is lacking globally. We describe SRHR healthcare resource use and long-acting reversible contraceptives (LARCs) prescriptions for migrant versus non-migrant women attending primary care in England (2009–2018). Methods: This population-based observational cohort study, using Clinical Practice Research Datalink (CPRD) GOLD, included females living in England aged 15 to 49. Migration was defined using a validated codelist. Rates per 100 person years at risk (pyar) and adjusted rate ratios (RRs) were measured in migrants versus non-migrants for consultations related to all-causes, six exemplar SRHR outcomes, and LARC prescriptions. Proportions of migrants and non-migrants ever prescribed LARC were calculated. Findings: There were 25,112,116 consultations across 1,246,353 eligible individuals. 98,214 (7.9 %) individuals were migrants. All-cause consultation rates were lower in migrants versus non-migrants (509 vs 583/100pyar;RR 0.9;95 %CI 0.9–0.9), as were consultations rates for emergency contraception (RR 0.7;95 %CI 0.7–0.7) and cervical screening (RR 0.96;95 %CI 0.95–0.97). Higher rates of consultations were found in migrants for abortion (RR 1.2;95 %CI 1.1–1.2) and management of fertility problems (RR 1.39;95 %CI 1.08–1.79). No significant difference was observed for chlamydia testing and domestic violence. Of 1,205,258 individuals eligible for contraception, the proportion of non-migrants ever prescribed LARC (12.2 %;135,047/1,107,894) was almost double that of migrants (6.91 %;6,728/97,364). Higher copper intrauterine devices prescription rates were found in migrants (RR 1.53;95 %CI 1.45–1.61), whilst hormonal LARC rates were lower for migrants: levonorgestrel intrauterine device (RR 0.63;95 %CI 0.60–0.66), subdermal implant (RR 0.72;95 %CI 0.69–0.75), and progesterone-only injection (RR 0.35;95 %CI 0.34–0.36). Interpretation: Healthcare resource use differs between migrant and non-migrant women of reproductive age. Opportunities identified for tailored interventions include access to primary care, LARCs, emergency contraception and cervical screening. An inclusive approach to examining health needs is essential to actualise sexual and reproductive health as a human right.

Published
2024
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2. Changes in conceptions in women younger than 18 years and the circumstances of young mothers in England in 2000-12: an observational study

Author

Rebecca S Geary, Kaye Wellings, Andrew Copas, Lorna Gibson, Anna Glasier, Clare Tanton, Rachel H. Scott, Kyle G Jones, Paul Wilkinson, Catherine H Mercer, Bob Erens, Anne M Johnson, Rebecca S French, Melissa J Palmer, Jessica Datta, and Wendy Macdowall

Subjects
Gerontology, Adolescent, Sex Education, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Humans, Medicine, 030212 general & internal medicine, 10. No inequality, Socioeconomic status, Medicine(all), Teenage pregnancy, 030505 public health, business.industry, 1. No poverty, Articles, General Medicine, Young parents, medicine.disease, 3. Good health, Social research, Pregnancy rate, England, Pregnancy in Adolescence, Female, Observational study, Social exclusion, 0305 other medical science, business
Abstract

Summary Background In 2000, a 10-year Teenage Pregnancy Strategy was launched in England to reduce conceptions in women younger than 18 years and social exclusion in young parents. We used routinely collected data and data from Britain's National Surveys of Sexual Attitudes and Lifestyles (Natsal) to examine progress towards these goals. Methods In this observational study, we used random-effects meta-regression to analyse the change in conception rates from 1994–98 to 2009–13 by top-tier local authorities in England, in relation to Teenage Pregnancy Strategy-related expenditure per head, socioeconomic deprivation, and region. Data from similar probability sample surveys: Natsal-1 (1990–91), Natsal-2 (1999–2001), and Natsal-3 (2010–12) were used to assess the prevalence of risk factors and their association with conception in women younger than 18 years in women aged 18–24 years; and the prevalence of participation in education, work, and training in young mothers. Findings Conception rates in women younger than 18 years declined steadily from their peak in 1996–98 and more rapidly from 2007 onwards. More deprived areas and those receiving greater Teenage Pregnancy Strategy-related investment had higher rates of conception in 1994–98 and had greater declines to 2009–13. Regression analyses assessing the association between Teenage Pregnancy Strategy funding and decline in conception rates in women younger than 18 years showed an estimated reduction in the conception rate of 11·4 conceptions (95% CI 9·6–13·2; p

Published
2016
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