Trends in teenage delivery and abortion rates in Estonia over more than two decades: a nationwide register-based study.

Background: In the last 30 years, Estonia has undergone major socio-economic changes, including profound educational and healthcare reforms. The study aimed to analyse trends in teenage delivery and induced abortion rates among younger and older teens, including Estonians and non-Estonians, and to study trends in repeat teenage pregnancies in more detail.

Methods: The register-based study included data on 29 818 deliveries (1992-2019) and 25 865 (1996-2019) induced abortions among 15-19-year-old girls. Delivery and abortion rates per 1000 girls were calculated by age group, ethnicity and reproductive history. Poisson regression models were applied to estimate average annual percentage changes in delivery and abortion rates over the whole period and in two sub-periods with change points in the trend in 2007.

Results: The delivery rate decreased by 5.3% per year, from 49.9 in 1992 to 8.4 in 2019; the abortion rate decreased by 6.0% per year, from 42.4 in 1996 to 8.6 in 2019. A faster decline in delivery rates took place among Estonians than non-Estonians, but the opposite trend occurred in abortion rates. Delivery rates for first and repeat pregnancies decreased nearly at the same pace, while abortion rates for repeat pregnancies decreased faster than those for first pregnancies.

Conclusions: A decreasing trend in teenage births is evident in parallel with society becoming wealthier. A remarkable decline in teenage abortions occurs when young people's rights to safe abortion, contraception, mandatory sexuality education and youth-friendly services are ensured. There always remains a small group of adolescents who repeatedly become pregnant.