Public Health England (PHE) publish annual Sexual and Reproductive Health Profiles for each area of England. The latest for Somerset was published in March 2016 (see below). The profile provides a snapshot of sexual and reproductive health across a range of topics including teenage pregnancy, abortions, contraception, HIV and sexually transmitted infections. Wider influences on sexual health such as alcohol use, and other topics relating to teenage pregnancy such as education and deprivation level, are also included.
. Indicators are updated throughout the year and are available on the PHE interactive profile tool
Key Messages for Somerset
- Teenage motherhood often has long-term negative effects on women's wellbeing, and the child is up to three times more likely to become a teenage parent themselves.
- According to 2013 data (published in February 2015) from the Centre for Sexual Health Research, there were 218 conceptions amongst under-18s recorded in Somerset.
- The under-18 conception rate in Somerset of 22.1 per 1000 women aged 15-17 has fallen for six consecutive years and is at its lowest since at least 1992. However there are a number of wards with teenage pregnancy rates significantly higher than the England average.
- Between 2011 and 2013, there were 148 conceptions to girls aged 13-15, a rate of 5.1 per 1,000. 62% of these conceptions led to abortion.
- Abortion rates amongst under-18s have almost halved since 2008
- The proportion of abortions in Somerset carried out within a 10-week gestation period has more than doubled since 2006
- Prevalence or diagnosis rates for sexually transmitted infections (STIs) in Somerset are below national and regional averages
- The chlamydia detection rate for young people aged 15-24 is the second lowest in the region and the coverage of tests is also the lowest it has been for a number of years.
- The percentage of late diagnoses of HIV has increased and is higher than the regional and national average.
- There are an estimated 54 women living in Somerset with Female Genital Mutilation (FGM), and between 2005 and 2013, an estimated 16 girls have been born to women with FGM.
- From May 2016, a new service known as the Somerset Wide Integrated Sexual Health Service (SWISH) was launched. This provides a ‘one stop shop’ offering free and open access to contraceptive and sexual health services to support healthy sexual and reproductive choices.
Teenage conceptions and pregnancy
Teenage pregnancy is strongly associated with the most deprived and socially excluded young people. Difficulties in young people’s lives such as poor family relationships, low self-esteem and unhappiness at school also put them at greater risk. Rates of teenage pregnancy are far higher among deprived communities, so the negative consequences of teenage pregnancy are disproportionately concentrated among those that are already disadvantaged.
The poorer outcomes associated with teenage motherhood also mean the effects of deprivation and social exclusion are passed from one generation to the next. Evidence shows that having children at a young age can damage young women’s health and wellbeing and severely limit their education and career prospects. Whilst young people can be competent parents, longitudinal studies show that children born to teenagers are more likely to experience a range of negative outcomes in later life and are up to three times more likely to become a teenage parent themselves.
At age 30, women who are teenage mothers are 22% more likely to be living in poverty than mothers giving birth aged 24 or over, much less likely to be employed or living with a partner and 20% are more likely to have no qualifications.
Teenage mothers have three times the rate of post-natal depression of older mothers and a higher risk of poor mental health for three years after the birth. The infant mortality rate for babies born to teenage mothers is 60% higher than for babies born to older mothers. Teenage mothers are more likely to smoke during pregnancy and less likely to breastfeed, both of which can affect the health outcomes of their babies.
On 21st May 2013, the Department for Education published a research report: Teenage Pregnancy in England (Centre for Analysis of Youth Transitions, CAYT). The study aimed to identify risk factors associated with teenage pregnancy, and provides some useful insights to inform the targeting of prevention strategies at individual, school and area levels:
- Eligibility for free school meals and being persistently absent from school are the most strongly individual characteristics associated with teenage conceptions and the decision to continue with a pregnancy.
- Low prior educational attainment is also associated with a higher risk of conceiving as a teenager and of deciding to continue with a pregnancy. Deterioration in academic performance between Key Stages 2 and 3 (ages 11 and 14) is a strong risk factor.
- Multiple maternities are more common amongst girls who are eligible for free school meals.
- Girls who attend higher performing schools are less likely to conceive and more likely to have an abortion if they do conceive.
- Girls who conceive achieve fewer GCSE passes and are less likely to continue in post-compulsory education (at a sixth form attached to a school) than those who do not. This relationship is stronger for girls who continue with their pregnancy, but those who conceive and have an abortion also have significantly fewer GCSE passes and are substantially less likely to stay in education than girls who do not conceive.
- Teenage conception and maternity rates are higher in deprived areas even after accounting for the characteristics of the girls themselves and the schools they attend.
- Girls living in deprived areas are also disproportionately more likely to have more than one conception before the ageof 18 that results in a maternity.
Key Facts for Somerset
Teenage pregnancy rates in Somerset have continued to reduce and remain below the national and regional averages. Main areas of progress include:
- The majority of secondary schools now have some form of school nurse led health service;
- The number of health services accredited as ‘Young People Friendly’ has doubled, with the majority of school clinics engaged and the main Contraceptive and Sexual Health clinics accredited;
- Prescribing rates in general practice for Long Acting Reversible Contraception are now amongst the highest in the South West region;
- The Targeted Youth Support team have integrated sexual health support across programmes with social care, Youth Offending Team and other vulnerable groups.
- 2 in 3 Secondary school pupils said they had learned about contraception in school lessons, and 42% of secondary pupils responded that they know where they can get condoms free of charge (Somerset Children and Young People Survey 2016).
In particular, the data published by the Office for National Statistics (ONS) show that:-
- There were 746 conceptions amongst 15-17 year-old females recorded in Somerset in the three year-period 2011-13;
- The conception rate was 24.8 per 1000 females in the age group, below the England average and in line with the South West norm;
- Since 2008, there has been a steady decrease in teenage conception rates in Somerset and nationally (see Figure 1 below);
- In terms of 2011-13, the largest percentage fall since 2008-10 within Somerset occurred in Taunton Deane
- In 2013, the maternity rate per 1000 women in Somerset was 10.9, slightly below the England average of 11.9;
- The abortion rate was 11.1, below the national figure of 12.9;
- 51% of conceptions lead to abortion, in line with the regional and national proportions but slightly higher than in recent years.
Figure 1 Trends in Teenage Conception rates since 1992
The 2012-13 data published in the 2014 Child Health profiles show that 1.5% of all mothers (defined as delivery episodes in this period) in Somerset were aged under 18, above the national average of 1.2%.
- There were 15,155 under 16 conceptions in England in the three year period 2011 to 2013, equating to a rate of 5.5 conceptions per 1,000 girls aged 13-15.
- The number of conceptions int his age group has fallen by 25% since the 2008-10 period.
- The proportion of under 16 conceptions leading to abortion was 61%.
- In Somerset, there were 148 conceptions to girls aged 13-15 between 2011 and 2013 (a rate of 5.1 per 1,000). 62% of these conceptions led to abortion.
- As in England generally, the number of under-16 conceptions has fallen in the county in recent years, but not in Sedgemoor.
The earlier abortions are performed the lower the risk of complications. Prompt access to abortion, enabling provision under 10 weeks gestation, is also cost-effective and an indicator of service quality. In particular, an increased proportion of abortions carried out within 10 weeks gestation demonstrates improved access to abortion services.
Furthermore, all women should have a choice of suitable procedure, whether medical or surgical, and this is most likely achieved if the abortion pathway has minimal delays.
- Whilst the number of abortions in Somerset was higher in 2014 at 1,244, the crude rate shows an actual downward trend in the past decade (see Figure 2). The county figure of 13.7 per thousand women aged 15-44 is in line with the regional average (13.6) and below the national average (16.5)
Figure 2 Trends in Abortion Rates amongst women aged 15-44
- Amongst under-18s, the abortion rate has decreased notably from 16.0 per thousand women in 2008 to 8.6 per thousand in 2014 (see Figure 3).
Figure 3 Trends in Abortion Rates amongst women aged under 18
- With the introduction of a Central Booking Service, self-referral and the commissioning of a range of abortion services accessible from all parts of the county Somerset has experienced a significant improvement in the proportion of women accessing abortion within 10 weeks gestation. It has more than doubled from 40% in 2006 to 84 % in 2014 (see Figure 4), taking Somerset from the second lowest in England to one of the highest.
Figure 4 Trends in % of Abortions where Gestation under 10 weeks
- Repeat abortion rates amongst women aged under 25 are fairly stable locally as well as nationally.
- The percentage of abortions carried out by medical procedure has significantly improved in Somerset from only 20% in 2009 to 44% in 2014. This is due to improved access to services including early medical abortion. As women should always have the choice of preferred method, there will always be a balance of medical versus surgical procedures.
Source: Department of Health. Next update: June 2016
Sexually Transmitted Infections
Chlamydia is the most common bacterial sexually transmitted infection in England, with rates substantially higher in young adults than any other age group.
- The chlamydia detection rate for Somerset in 2013 was under 1,450 per 100,000 15-24 year olds, and was the second lowest in the region after the Isles of Scilly, and lower than the national rate of 2,016 per 100,000.
- In Somerset in 2013, the proportion of population aged 15 to 24 screened for chlamydia, measured separately in GUM and non-GUM settings, is 19.7%, significantly below the national average of 24.7%.
Gonorrhoea is used as a marker for rates of unsafe sexual activity. This is because the majority of cases are diagnosed in GUM settings, and consequently the number of cases may be a measure of access to STI treatment. Infections with gonorrhoea are also more likely than chlamydia to result in symptoms.
- The diagnosis rate per 100,000 population in Somerset in 2013 is 10.8, well below the national and regional averages of 52.9 and 21.4, respectively.
Syphilis is an important public health issue in men who have sex with men (MSM) among whom incidence has increased over the past decade. Syphilis is primarily diagnosed in GUM clinics.
- In 2013, the number of diagnoses in Somerset was less than five, with a rate per 100,000 population of 0.7, well below the national and regional averages of 5.9 and 2.8, respectively.
Genital Warts and Herpes
Genital warts are the second most commonly diagnosed STI in the UK and are caused by infection with specific subtypes of human papillomavirus (HPV). Recurrent infections are common with patients returning for treatment.
- The first episode diagnosis rate per 100,000 population in Somerset in 2013 is 118.3, below the national and regional averages of 133.4 and 131.8, respectively.
See also Cancer
Genital herpes is the most common ulcerative sexually transmitted infection seen in England. Infections are frequently due to herpes simplex virus (HSV) type 2, although HSV-1 infection is also seen. Recurrent infections are common with patients returning for treatment.
- The first episode diagnosis rate per 100,000 population in Somerset in 2013 is 28.4, below the national and regional averages of 58.8 and 26.9, respectively.
Knowledge of local diagnosed HIV prevalence and identification of local risk groups can be used to help direct resources for HIV prevention and treatment.
- The prevalence of diagnosed HIV infection per 1,000 persons aged 15 to 59 years in Somerset (at 31st December 2015) is 0.73, well below the national average of 2.26, and one of the lowest rates of any upper-tier authority in the South West.
- The rate in each of the five Somerset districts is below 1 per 1,000 (see table below).
- The number of diagnosed individuals living in Somerset has risen from 171 in 2013 to 212 in 2015.
Diagnosed HIV Prevalence in Somerset (as at 31st December 2015)
||Residents accessing HIV related care
||Diagnosed HIV prevalence per 1,000 aged 15 to 59
HIV testing is integral to the treatment and management of HIV. Knowledge of HIV status increases survival rates, improves quality of life and reduces the risk of HIV transmission.
- In 2013, the proportions of Eligible new GUM clinic attendees (defined as a patient attending a GUM clinic at least once during a calendar year, excluding those known to be HIV positive, or for whom a HIV test was not appropriate) in whom a HIV test was accepted were 82.8% for Men who have sex with men, 77.8% for all men and 71.2% for women.
- The comparative England figures are 86.1%, 77.5% and 65.6%, respectively.
Late diagnoses of HIV is one of the Public Health Indicators and is the most important predictor of morbidity and mortality of those living with the HIV infection. It is essential in evaluating the success of access to HIV testing. Late diagnoses data are for those aged 15 years and over and is presented as 3 year combined data due to the small numbers in individual years.
- In Somerset the percentage of late diagnoses of those newly diagnosed with HIV in the period 2011-13 was 61.3%, higher than the South West at 46.7% and England at 45%.
- It also represents a rise in the Somerset figure compared with the period 2010-12 (50.3%).
HIV Support and treatment services in Somerset
As part of the new Somerset-wide Integrated Sexual Health service (SWISH), The Eddystone Trust has been awarded the contract to provide HIV prevention, targeted sexual health promotion and outreach services and condom distribution schemes in addition to the support services they already provide in Somerset for people living with HIV. This will include the promotion of early HIV testing and delivery of HIV rapid results point of care testing in the community.
HIV treatment services commissioned by NHS England currently remain at Musgrove Park and Yeovil District Hospitals whilst SWISH will provide sexual health and HIV support services for people living with HIV.
Female Genital Mutilation (FGM)
Female genital mutilation (FGM) comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.
Procedures are mostly carried out on young girls sometime between infancy and age 15, and occasionally on adult women. The practice is most common in much of northern Africa, some countries in Asia and the Middle East, and among migrants from these areas. In Africa alone, more than three million girls have been estimated to be at risk for FGM annually and more than 125 million girls and women alive today have undergone FGM in the 29 countries in Africa and Middle East where it is concentrated.
In July 2015, City University London published a report entitled Prevalence of Female Genital Mutilation in England and Wales. This builds on an interim report (published 2014) which estimates the number of women and children in England and Wales living with the consequences of FGM to be 137,000, with a further 60,000 born to mothers who have undergone FGM. This assumes that the women who have migrated are typical of women in their country as a whole.
In Somerset, there are an estimated:-
- 644 women permanently resident in Somerset (at the time of the 2011 Census) born in FGM-practising countries
- 54 women in Somerset with FGM
- 28 ‘maternities’ in the period 2005-13 to women with FGM, Of these maternities, 16 were girls.
Since September 2014, acute hospital providers in England must now provide monthly data on the incidence of FGM including women who have been previously identified and are currently being treated (for FGM related or non-FGM related conditions as at the end of the month) and newly identified women within the reporting period.
- The active caseload for the whole of the South of England is currently 247 (at March 2015). There are no reported cases by either of the two hospital trusts within Somerset but there may be instances not known to either the police or NHS.
- More details about the new Enhanced FGM dataset are available on the Health and Social Care Information Centre (HSCIC) website. Quarterly data will be published, starting in September 2015.
See also our section on Safeguarding Children.
Sex and Relationship Education
The UK Youth Parliament Advisory Group (April 2013) believes that early sex and relationship education would help children understand themselves, their development, prepare them for growth and help them form positive identities. In turn, this will help protect them better and enable them to make better choices. This could be implemented through school, but should also be done at home and supported in the wider community too. In addition, secondary schools need to have much better and more consistent/effective sex and relationship education, support and advice available.
Somerset-wide Integrated Sexual Health service (SWISH)
‘SWISH’, a new service aimed at improving sexual and reproductive health in Somerset launched in May 2016.
Somerset Partnership NHS Foundation Trust has been awarded the contract and will be providing a range of services including all forms of contraception and emergency contraception, pregnancy testing, diagnosis and treatment of sexually transmitted infections, HIV testing, chlamydia screening and advice on sexual abuse and abortion services.
The Eddystone Trust has been awarded the contract to provide HIV prevention, targeted sexual health promotion and outreach services and condom distribution schemes in addition to the support services they already provide in Somerset for people living with HIV. This will include the promotion of early HIV testing and delivery of HIV rapid results point of care testing in the community.
A new sexual health website has been developed for Somerset which provides information on contraception and sexual health as well as details on clinics and opening times across Somerset. It will enable users to access it from any device and includes smart features like being able to call the service direct from the site if using a smart phone and will include the ability use Google maps and Google translate.