Transcript Document

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
50
45
40
35
30
Rate per
25
1,000 females
aged 15-17
Conception rate
Maternity rate
Abortion rate
20
15
10
5
0
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Year
6
Percentage change in under 18 conception rate
1998-2012
in rate, 1998 to 2012
Percentage change
-30
-40
-50
-70
Luton, -32.1%
Northamptonshire, -32.9%
Central Bedfordshire, -28.2%
England, -40.6%
-60
Top-Tier Local Authorities
Milton Keynes, -50.2%
Hertfordshire, -45.7%
Bedford, -38.7%
Variation in local authority reductions: 1998-2012
Progress of LAs in South Midlands and Herts
Public Health England Centre
20
10
0
-10
-20
Under 18 conception rates* 2012
and % 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
England
Milton Keynes
% abortion
no. of maternities
26,157
49%
13,340
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
Chlamydia: aims of the National
Chlamydia 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 abstinenceonly education or benefit conditionality) are effective
Translating evidence into a ‘whole systems’
approach: ten factors for an effective local strategy
SRE in schools
and colleges
Strong use of
data for
commissioning
and monitoring of
progress
Dedicated support
for teenage
parents –
including SRE
and contraception
Youth friendly
contraceptive/SH
services and
condom schemes
Strategic
leadership
&
accountability
Consistent
messages to
young people,
parents and
practitioners
Targeted
prevention for
young people at
risk
Support for
parents to discuss
relationships and
sexual health
Advice and
access to
contraception in
non-health youth
settings
Training on
relationships and
sexual health for
health and nonhealth
professionals
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 Profiles
and 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 with
the 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 involving
young 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!
Small group discussion
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?
References: support
Ages of Concern: Ofsted Serious Case Reviews
http://www.ofsted.gov.uk/resources/ages-of-concern-learning-lessons-serious-casereviews
Are we nearly there yet, dad?
http://www.barnardos.org.uk/what_we_do/policy_research_unit/research_and_publicat
ions/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/g002
22993/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-inengland
Not yet good enough: Ofsted report on PSHE (2013)
http://www.ofsted.gov.uk/resources/not-yet-good-enough-personal-social-health-andeconomic-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-youngpeople-up-to-the-age-of-25-ph51
For more information:
Teenage Pregnancy Knowledge Exchange
www.beds.ac.uk/knowledgeexchange
If you would like to receive free updates from the
Teenage Pregnancy Knowledge Exchange, please
contact me at:
[email protected]