evidence: The rates of teenage pregnancy may vary widely within a country. For instance, in the United Kingdom, the rate of adolescent pregnancy in 2002 was as high as 100.4 per 1000 among young women living in the London Borough of Lambeth, and as low as 20.2 per 1000 among residents in the Midlands local authority area of Rutland. Teenage birth is often associated with economic and social issues such as alcohol and drug misuse. In 2001, across 13 nations in the European Union, women who gave birth as teenagers were twice as likely to be living in poverty, compared with those who first gave birth when they were over 20.[14] Bulgaria and Romania [edit]Romania and Bulgaria have some of the highest teenage birth rates in Europe. In 2015, Bulgaria had a birth rate of 37 per 1,000 women aged 15–19. Romania had a teen birth rate of 34 per 1,000 women aged 15–19.[15] Both countries also have very large Romani populations, who have an occurrence of teenage pregnancies well above the local average.[16][17][18]