For two decades, teenage conception rates were falling. But across the Tees Valley, that story is beginning to change. Rates are rising again in Hartlepool and Stockton and remain high in Middlesbrough. Redcar and Cleveland has seen a sharp decline, while Darlington continues to make progress. So why are places just a few miles apart now heading in such different directions?
Too early to start a family
Teenage pregnancy was once one of Britain’s most persistent public-health problems. But better access to contraception, relationship advice and sex education, youth-friendly services and targeted support helped drive conception rates among under-18s down.
Public Health England’s teenage pregnancy framework describes the successful approach as a whole system: education, contraception, health services, safeguarding, trained professionals and targeted support working together.
In other words, the fall was never achieved by one policy or one service. It was built from a safety net around young people, with several different strands designed to catch problems before they became crises.
Progress has stalled
That long-term decline, however, is no longer being seen consistently across the Tees Valley. The latest Office for National Statistics (ONS) figures over a five year period show an increasingly complicated picture. And this is where they start to tell very different stories.
North Tees v South Tees
Hartlepool’s rate has risen every year since 2020, while Stockton’s has climbed sharply since 2021 and is now higher than it was before the pandemic.
Middlesbrough remains the region’s biggest concern. Its rate has fluctuated rather than consistently risen, but in 2023 it stood at 30.7 conceptions per 1,000 girls aged 15-17 – more than twice the England rate of 13.5.
Elsewhere, the picture is very different. Darlington’s rate has continued to fall, reaching 12.5 in 2023 and actually managing to drop below the England average. Redcar and Cleveland also recorded a sharp fall in 2023, although its figures have moved considerably from year to year, making it too early to know whether this represents a lasting change.
Put simply, neighbouring areas that once broadly shared the same downward direction are now beginning to diverge. Why?
Pregnancy does not necessarily mean motherhood
There is another important part of the ONS data which changes how these figures should be understood. A conception statistic is not a birth statistic. The ONS counts pregnancies ending in either maternity or legal abortion; miscarriages are unfortunately not included. And in 2023, the outcomes differed markedly across the Tees Valley.
A significant variation in outcomes
In Stockton, 63.2% of under-18 conceptions ended in abortion, slightly above England’s 61.5%. In Hartlepool it was 55.6%, and in Redcar and Cleveland 54.5%.
Middlesbrough was very different, only 41.2% ended in abortion, meaning 58.8% resulted in maternity. In Darlington, where the numbers are small enough for the ONS to flag the outcome measure as less reliable, the split was 40% abortion and 60% maternity.
Stockton’s rising conception rate cannot simply be described as a surge in teenagers becoming mothers. The data instead point towards a wider question about unintended conception and prevention. And Stockton Council appears to know it has a problem.
Its own Joint Strategic Needs Assessment (JSNA) says teenage conceptions remain an “area of concern”. It identifies low condom use, reliance on emergency hormonal contraception and unplanned pregnancy among the issues facing the borough, and says a Teenage Pregnancy Strategy and Working Group is being established.
It takes more than a biology lesson
Relationships and sex education (RSE) has been compulsory in English secondary schools since 2020, but putting RSE on the timetable is not the same thing as creating an effective prevention system.
Government evidence says comprehensive RSE has substantial social, emotional and physical benefits, while young people report that some subjects are taught too late or in too little depth. Effective prevention also requires somewhere for teenagers to go afterwards.
Outside of the classroom, a quiet word
And what happens in the classroom is also only part of the picture. Young people also need confidential advice and reliable access to contraception, from condoms and emergency contraception to longer-acting methods, alongside professionals they can trust and services capable of reaching those who may never walk through the door of a sexual-health clinic.
Hartlepool is on a learning curve
Hartlepool’s own assessment suggests the borough knows there are gaps to bridge. With its under-18 conception rate now having risen for three consecutive years, the council says bringing it down requires health, education, youth services and local government to work together. It also identifies a need for better integration between GPs and sexual and reproductive-health services.
Perhaps more tellingly, when Hartlepool Youth Voices asked young people about relationships and sexual-health education, one response was brutally simple:
“I don’t remember being taught anything in school.”
This is not indicative of an entire borough but when the council itself acknowledges that more needs to be done it is difficult to dismiss.
The Darlington question
Darlington makes the comparison particularly interesting because deprivation alone cannot explain everything. This is not an affluent southern enclave dropped accidentally into the North East. Darlington Council reports that nine of its wards are among England’s most deprived 20%, while almost a quarter of children aged under 16 live in poverty. Yet its teenage conception rate has continued falling.
Darlington’s Director of Public Health describes its approach to teenage pregnancy explicitly as “whole systems”, building young people’s knowledge, skills, resilience and aspirations while making services easier to access, supporting healthy consensual relationships and contraception use.
One to one conversations
That philosophy is visible in its school-age health service. Every school has a named school nurse. Young people can receive advice about relationships, sexual health and pregnancy, and regular health drop-ins operate in secondary schools.
Darlington’s latest Healthy Lifestyle Survey also found 94% of participating young people said they understood consent, 86% understood factors affecting someone’s capacity to consent, and 94% agreed that discussing and accessing contraception within a relationship was a shared responsibility.
Structured interventions are effective
None of that proves these services caused Darlington’s falling conception rate. But deprivation does not appear to have made that progress impossible either. While neighbouring areas have stalled or begun moving backwards, Darlington has kept going in the other direction. It offers a local example of what a more joined-up safety net can look like.
Contraception is only useful if you can use it
There is another danger in treating teenage pregnancy solely as a matter of contraceptive choice. Not every young person has the same freedom or safety in which to make those choices. Rape, sexual coercion, abusive relationships and exploitation can profoundly undermine a young person’s control over their own body, including decisions around contraception.
That is why national teenage-pregnancy guidance links prevention with healthy relationships, safeguarding and child sexual exploitation, rather than treating pregnancy as a health issue in isolation. A safety net that stops at contraception is therefore not much of a safety net at all.
School exclusions have a lasting impact
It also makes school absence and exclusion relevant. The teenagers most vulnerable to exploitation, deprivation and unstable circumstances may also be those least consistently reached by classroom-based RSE. A brilliant lesson on consent is of limited use to the child who is rarely there to hear it. Prevention therefore has to follow young people beyond the school gate. School nurses, youth workers, pharmacies, social workers, sexual-health clinics and services working with vulnerable children all become part of the same safety net.
The warning lights are already flashing
Five years of data is not enough to declare that Teesside is experiencing a new teenage-pregnancy epidemic. The pandemic makes the period particularly difficult to interpret, and relatively small numbers mean local rates can move sharply from one year to another.
But neither should the latest figures be shrugged off. Hartlepool has risen for three successive years. Stockton has climbed substantially from its 2021 low and is now above its 2019 rate. Middlesbrough remains at more than twice the national rate.
A change in behaviour?
Crucially, councils themselves are identifying some of the same warning signs. Stockton says teenage conception is an area of concern and wants greater condom and Long-Acting Reversible Contraception (LARC) use. Hartlepool says its high under-18 conception and birth rates require a whole-system response. Meanwhile, Darlington has continued in precisely the opposite direction.
The lesson from Britain’s extraordinary reduction in teenage pregnancy was never simply to tell teenagers not to get pregnant. It was to make avoiding an unwanted pregnancy possible.
Teach your children
That means teaching young people about sex, relationships and consent before they need that knowledge. It means contraception they can actually obtain. It means confidential adults they can trust. It means reaching children who are absent from school, excluded, in care, disabled or otherwise vulnerable. And it means recognising that not every sexual encounter is freely chosen.
The latest figures cannot tell us exactly why neighbouring areas are now following such different paths, and they certainly cannot prove that any single service or intervention is responsible. What they do show is that deprivation alone cannot explain the difference, nor are rising teenage conception rates inevitable.
Best practice
Darlington has continued to make progress while other parts of the Tees Valley have stalled or moved backwards. Its experience does not provide a simple blueprint, but it does reinforce something public-health experts have argued for years that preventing unintended teenage pregnancy depends on far more than a lesson in school or the availability of contraception. It requires education, accessible services, trusted professionals and safeguarding to work together and to reach the young people who need them.
There’s no time to lose
The five boroughs are now telling very different stories. If parts of that safety net are working better in some places than others, the obvious question is whether that best practice is being shared effectively across the Tees Valley. Finding the gaps, sharing what works and strengthening the safety net where it is weakest could help stop a generation of progress from unravelling.
Thank you to Ray Casey for contributing to this article.
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