Teenage Pregnancy: great progress but more to do Alison Hadley, Director, Teenage Pregnancy Knowledge Exchange, University of Bedfordshire
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Teenage Pregnancy: great progress but more to do
Alison Hadley, Director, Teenage Pregnancy Knowledge Exchange, University of Bedfordshire
A reminder of the reasons for a Teenage Pregnancy Strategy
• Poor outcomes for young parents and their children
• 50% under 18 conceptions end in abortion
• A key public health issue of health and educational inequalities
• Historically high rates compared with similar Western European countries and no sustained downward trend
Teenage Pregnancy Strategy:the goals
Halve the under 18 conception rate from 1998-2010 to bring the rate in line with Western European countries
Improve outcomes for teenage parents and their children, measured by increasing proportion of 16-19 mothers in education, employment or training
10 year strategies in each of the 150 local government areas with a local 2010 reduction target. If all areas met the target the 50% national goal would be achieved
Progress on reducing teenage pregnancy - and trends in chlamydia diagnosis
England progress: 1998-2012
41% reduction in under 18 conception rate – from 46.6/1000 15-17s in 1998 to 27.7/1000 in 2012.
Lowest rate since 1969 when conception data collection began
Both maternity and abortion rates now declining but steeper overall reduction in births of 46%
..but still higher than levels experienced by young people in comparable Western European countries
Under 18 conception rate | 1998-2012
6
0
5
10
15
20
25
30
35
40
45
50
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Rate per 1,000 females
aged 15-17
Year
Conception rate
Maternity rate
Abortion rate
Cen
tral
Bed
ford
shir
e, -
28.2
%
Luto
n, -
32.1
%N
orth
ampt
onsh
ire,
-32
.9%
Bed
ford
, -3
8.7%
Her
tfor
dshi
re, -
45.7
%
Milt
on K
eyne
s, -
50.2
%
-70
-60
-50
-40
-30
-20
-10
0
10
20
Pe
rce
nta
ge
ch
an
ge
in r
ate
, 19
98
to
20
12
Top-Tier Local Authorities
England, -40.6%
Per
cen
tag
e ch
ang
e in
und
er 1
8 c
once
ptio
n r
ate
199
8-20
12
Variation in local authority reductions: 1998-2012Progress of LAs in South Midlands and Herts Public Health England Centre
Under 18 conception rates* 2012and % reduction since 1998
England 27.7 -41%
Milton Keynes 25.5 -50%
…but 2012 data showed an increase from 2011 and and Q1 2013 data also showing an increase
*Number of conceptions per 1000 females aged 15/17
Number of under 18 conceptions, % ending in abortion and number of maternities: 2012
Number % abortion no. of maternities
England 26,157 49% 13,340
Milton Keynes 115 50% 57
‘Hidden’ high rate wards in Milton Keynes (2009-11 data) Woughton 63/1000
Campbell Park 60/1000
Eaton Manor 55/1000
Denbigh 49/1000
Stantonbury 41/1000
Stony Stratford 41/1000
*Latest ward data is for 2009-11
Chlamydia: aims of the NationalChlamydia Screening Programme
- A high level of diagnosis: 2,300 per 100,000 15-24 year olds
- Universal screening to reach large numbers of sexually active 15-24 year olds
15-24 year olds screened annually or on change of partner -
including young parents
- Recent NATSAL data found two thirds of young people with chlamydia only had one partner in the last year
- -
Local chlamydia data:diagnostic rate 2013
Aim: 2,300 positive tests per 100,1000 15-24s
2013 data (published 17 June)
England: 2,016 positive tests per 100,000 15-24 year olds
Milton Keynes: 2,700 positive tests per 100,000 15-24s
- -
Reducing teenage pregnancy: a reminder of the evidence
Provision of high quality SRE, (Kirby 2007) and improved use of contraception (Santelli 2008) are areas where strongest empirical evidence exists on impact on teenage pregnancy rates
Universal and targeted. SRE and contraception provision for all, with more intensive support for young people at risk, combined with additional motivation to delay early pregnancy – ‘means and motivation’
No evidence that alternative approaches (e.g abstinence-only education or benefit conditionality) are effective
Translating evidence into a ‘whole systems’ approach: ten factors for an effective local strategy
Why the work needs to continue
Rates remain higher than levels experienced by young people in similar Western European countries
Progress varies significantly between – and within – Local Authorities
Outcomes for young parents and their children are improving but remain disproportionately poor
A continuing priority: the national policy context
▪ A Framework for Sexual Health Improvement in England:
- continue to reduce the rate of under 16 and under 18 conceptions one of four priorities
Child Poverty Strategy:
- under 18 conception rate a measure of national and local progress
Troubled Families: overlapping risk factors for teenage pregnancy
Raising the Participation Age:
- from 2013 all 17 year olds in education, training or work based learning and all 18 year olds – until their 18th birthday - from 2015
Healthy Child Programme and School Nurse Development Programme
Safeguarding and Child Sexual Exploitation
Children’s Centres core purpose
Public Health Outcomes Framework:
- under 18 conception rate + other indicators disproportionately affecting teenage parents and their children
The pregnancy pathway and improving support for young parents
Poor child health outcomes
• 21% higher risk of preterm birth and 93% higher risk for second pregnancies
• 25% higher risk of low birth weight
• 41% higher rates of infant mortality (reduced from 60% in 2000)
Affected by …
• Late booking for antenatal care (on average 16 weeks)
• Three times higher rate of smoking during pregnancy
• A third lower rate of breastfeeding
• Poor maternal nutrition
Poor emotional health and well being
• Three times the rate of post-natal depression of older mothers
• Higher rates of poor mental health for up to 3 years after the birth
• Higher risk of partnership breakdown and isolation
• More likely to live in poor quality housing
Affecting the well being of their children and contributing to:
• Higher accident rates - such as from falls and swallowing substances
• More behavioural problems - conduct, emotional and hyperactivity problems
Poor economic well being
• 21% of estimated number of 16-18 year old young women not in education, training or employment are teenage mothers
• By age 30, 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
• Young fathers twice as likely to be unemployed at age 30 – even after taking account of deprivation
Which also affects the economic well being of their children who have:
• 63% higher risk of living in child poverty
• Lower academic attainment
• A higher risk of unemployment and low income in later life
Fingertips Sexual and Reproductive Health Profilesand LA Child Health Profiles:
Children in poverty
(63% higher risk for children born to women under 20)(1)
Rates of adolescents not in education, employment or training (NEET)
(21% of the estimated number of female NEETs 16-18 are teenage mothers)(2)
Infant mortality rate
(41% higher risk for babies born to women under 20)(3)
Incidence of low birth weight of term babies
(25% higher risk for babies born to women under 20) (4)
Maternal smoking prevalence (including during pregnancy)
(Mothers under 20 are twice as likely to smoke before and during pregnancy and three times more likely to smoke throughout pregnancy)(5)
Breastfeeding initiation and prevalence at 6-8 weeks
(Mothers under 20 are third less likely to initiate breastfeeding and half as likely to be breastfeeding at 6-8 weeks)(6)
..but poor outcomes are not inevitable withthe right support in place
Family Nurse Partnership: intensive support for young parents from family nurse, from no later than 28 weeks of pregnancy until child reaches two. Randomised controlled trial reporting in 2014
Evidence from Sure Start Plus programme found key ingredients of effective support are: early identification in the antenatal period, dedicated support from a lead professional – coordinating and drawing in specialist services as necessary from education, social care, housing voluntary sector – and health services
Provided in a young people friendly, non-judgemental and supportive environment – to address young parents’ waryness of professional support and fears that asking for advice makes them a bad parent.
•.
The importance of involvingyoung fathers
75% of babies to teenage mothers are jointly registered with the father; only 20% are sole registrations
Young fathers have a strong influence over young mothers’ attitudes and decisions about smoking and breastfeeding
A good relationship with the baby’s father and supportive behaviour by him is a protective factor for postnatal depression
•Highly involved fathers (even if the couple don’t remain together) is associated with better outcomes for the child - emotional, behavioural and educational
•
The importance of partnership work: recommendations from Ofsted
“’In too many cases: there had been insufficient support for young parents‘
Young teenage parents need to be supported in an environment in which they feel comfortable and supported. Adult centred services may not achieve this without additional teenage focused services
Both parents need to be supported. The father is as important as the mother and they need support to help them become good parents
There should be a joined up (multi-agency) approach to teenage pregnancy and teenage parents with every agency understanding their role within it.
Planned and coordinated transfer of care between midwifery services, health visitors and GPs is critical
Is there a joined up care pathway in your area?
Free well publicised pregnancy testing and unbiased* advice on pregnancy options
If abortion is the chosen option
Swift referral to accessible NHS funded abortion service
Pre-abortion: access to accurate, unbiased information and a trained counsellor if required, chlamydia screening and support with post abortion contraception
Post abortion: access to trained counsellor if required, follow up support on contraception
* Education for Choice and Telegraph reports on Pregnancy Crisis Centres
Is there a joined up care pathway in your area?
If continuing the pregnancy is the chosen option -
Swift referral to antenatal booking + information to support healthy early pregnancy - folic acid & healthy start
Careful pre-birth assessment in maternity services to identify and address any problems early
Tailored antenatal care and preparation for parenthood for teenage mothers and young fathers, including contraception and sexual health advice – including chlamydia screening
Is there a joined up care pathway in your area?
Clear referral pathway between maternity services and children’s centres, HVs and general practice
Dedicated adviser, co-ordinating support on health, education, housing, benefits and parenting – with more intensive help for the most vulnerable, and inclusive of young fathers
Personal development plans – for both parents building aspirations and skills, promoting Care to Learn childcare funding, linked to RPA programme, local workforce development, employment and regeneration plans – and gender neutral!
Strengthening the prevention pathway for young people
What’s working well?
Are there any gaps?
Strengthening the support pathway for young mothers – and young fathers
What’s working well?
Are there any gaps?
Would your children’s centre/service feel friendly and accessible to young parents – mothers and fathers?
Do young parents – mothers and fathers – know about all the support services available?
Do practitioners and agencies work well together?
Are there any quick wins to improve support for young parents?
Small group discussion
References: support
Ages of Concern: Ofsted Serious Case Reviews
http://www.ofsted.gov.uk/resources/ages-of-concern-learning-lessons-serious-case-reviews
Are we nearly there yet, dad?
http://www.barnardos.org.uk/what_we_do/policy_research_unit/research_and_publications/are-we-nearly-there-yet-dad/publication-view.jsp?pid=PUB-1900
Statutory guidance on the participation of young people in education, employment or training
http://www.education.gov.uk/childrenandyoungpeople/youngpeople/participation/g00222993/stat-guide-young-people-edu-employ-train
Care to Learn – childcare funding for teenage parents
https://www.gov.uk/care-to-learn/overview
References: prevention
Your local teenage pregnancy statistics
www.beds.ac.uk/knowledgeexchange
A Framework for Sexual Health in England (DH) (2013)
www.gov.uk/government/publications/a-framework-for-sexual-health-improvement-in-england
Not yet good enough: Ofsted report on PSHE (2013)
http://www.ofsted.gov.uk/resources/not-yet-good-enough-personal-social-health-and-economic-education-schools
SRE for the 21st Century: supplementary advice
http://www.sexeducationforum.org.uk/resources/sre-advice-for-schools.aspx
NICE public health guidance: contraceptive services for young people up to 25
http://publications.nice.org.uk/contraceptive-services-with-a-focus-on-young-people-up-to-the-age-of-25-ph51
Ages of Concern: Ofsted Serious Case Reviews
http://www.ofsted.gov.uk/resources/ages-of-concern-learning-lessons-serious-case-reviews
Are we nearly there yet, dad?
http://www.barnardos.org.uk/what_we_do/policy_research_unit/research_and_publications/are-we-nearly-there-yet-dad/publication-view.jsp?pid=PUB-1900
Statutory guidance on the participation of young people in education, employment or training
http://www.education.gov.uk/childrenandyoungpeople/youngpeople/participation/g00222993/stat-guide-young-people-edu-employ-train
For more information:
Teenage Pregnancy Knowledge Exchange
www.beds.ac.uk/knowledgeexchange
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