alison hadley teenage pregnancy unit 2000-2012 the teenage pregnancy strategy what we did and what...
TRANSCRIPT
Alison HadleyTeenage Pregnancy Unit 2000-2012
The Teenage Pregnancy Strategy
What we did and what we learned
Why a teenage pregnancy strategy?
15% of all young people not in education , training or employments are teenage mothers or pregnant teenagers
20% more likely to have no qualifications at age 30
22% more likely to be living in poverty at 30, and much less likely to be employed or living with a partner
3 times the rate of post-natal depression and a higher risk of poor mental health for 3 years after the birth
Children of teenage mothers have a 63% increased risk of being born into poverty and are more likely to have accidents and behavioural problems
The infant mortality rate for babies born to teenage mothers is 60% higher
3 times more likely to smoke throughout their pregnancy, and 50% less likely to breastfeed, with negative health consequences for the child
▪ England’s teenage pregnancy rate was significantly higher than comparable European countries and had remained static since 1980s
The start of the Strategy
Social Exclusion Unit Teenage Pregnancy Report published 1999
International review of evidence
National target set of 50% reduction in under 18 conception rate by 2010
Supporting teenage parents into education and training
30 point action plan for 10 year strategy
The four themes of the Strategy
Joined up action
Better prevention: improving sex and relationships education and access to contraception
National campaign to reach young people and parents
Better support for teenage parents
National and local targets
National target: - 50% reduction in under 18 conception rate by 2010 - Interim target of 15% reduction by 2004
Local targets for every Local Authority area:
- 60% reduction in high rate areas - 50% reduction in average rate areas - 40% reduction in low rate areas
Achievement of all local targets = 50% national reduction
Joined up action: nationally
Teenage Pregnancy Unit
- cross departmental funding - combined skills of external experts and civil servants
Inter-departmental Teenage Pregnancy Board
Teenage Pregnancy Independent Advisory Group
- monitor implementation of Strategy and advise Ministers - external experts on young people, contraception/sexual health, sex
and relationships education, parenting, housing, local government and research
Joined up action: regionally and locally
Regional Government Offices (9)
Regional Teenage Pregnancy Coordinators - leading cross-cutting panels to link teenage pregnancy with relevant
health, education, youth services, parenting support programmes
Local Authority (150)
Local Teenage Pregnancy Coordinator Local Teenage Pregnancy Partnership Boards - with representation from health, education, housing, social services,
youth services and relevant NGOs
Funding
Local Implementation Grant for every local area: £25M per year
Size of grant: determined by size of population and degree of challenge (150K-600K per annum)
Ring fenced with conditions for spend: - appointment of local Teenage Pregnancy Coordinator - Teenage Pregnancy Partnership Board - Annual report on local progress
Central government funding to support national campaign and other strategy activity: £7M
Developing local teenage pregnancy strategies
National guidance on developing local strategies
Local strategy developed by Teenage Pregnancy Partnership Board
Each strategy assessed by Regional Teenage Pregnancy Coordinator and Teenage Pregnancy Unit
Annual report on progress submitted by each Partnership Board and assessed by RTPCs and TPU
National activity to support local strategies
Maintaining the priority across Government: - Teenage pregnancy target included in joint Public Service
Agreement between education - Target included in relevant health, education and social
care programmes
Leadership and communications: - Quarterly meetings with Regional TPCs to support policy
delivery and understand and address challenges - Annual conferences for Local TPCs
Providing national guidance and frameworks
National activity to support local strategies: improving sex and relationships education
New Government guidance for schools on Sex and Relationships Education – statutory requirement for schools to pay regard to guidance
Non-statutory framework for Personal Social and Health Education (PSHE)
Professional development programme for teachers to improve skills on SRE and Personal Social and Health Education – with funding for participation
Funding support for the Sex Education Forum to promote evidence based briefings and practical advice to schools and local areas
National activity to support local strategies: improving access to contraception
Guidance on young people friendly contraceptive services Guidance for youth workers and social workers to support
young people to use contraceptive services
Guidance on increasing contraception and condom use by boys and young men
Guidance on reaching young people from black and minority ethnic communities
Guidance on establishing contraception and sexual health services in schools and colleges
Quality criteria for young people friendly services
Accessibility: in the right place, open at the right time
Publicity
Confidentiality and consent
Youth friendly service environment
Staff training, skills, attitudes and values
Joined up working with other young people’s services
Monitoring, evaluation and involvement of young people – ‘mystery shopping’ of services
National activity to support local strategies: National Campaign
Universal campaign for under 18s (boys and girls) Sex. Are you thinking about it enough?:
Headline messages:- Resisting peer pressure- Awareness of risk of pregnancy and STIs- Condom use
- National radio and magazine adverts - Leaflets and posters for local use
- Supported by website and free national helpline
National activity to support local strategies: National Campaign
Parents campaign: Time to Talk
Headline messages:- Parents talking their children about sex and relationships helps prevent teenage
pregnancy- Practical tips on having conversations- Up to date information about contraception and sexual health
Leaflets and posters for local areas
Supported by NGO parenting support free helpline and fpa Speakeasy
- National radio and magazine adverts - Leaflets and posters for local use
- Supported by website and free national helpline
Mid-strategy review: confirmation of the evidence
Vast majority of teenage pregnancies are unplanned
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
No evidence that alternative approaches (e.g abstinence-only/benefit conditionality) are effective
Mid-Strategy Review 2005-07
Steady decline in national rate but wide variation in progress between local areas
Prime Minister Delivery Unit review comparing similar areas showing different rates of progress
- progress determined by action not funding - high rates not inevitable even in deprived areas
Further analysis of data: high rate wards, characteristics of young people most at risk, 80% of conceptions to 16-17s, repeat conceptions...
Review of campaign → new ruthinking for under 16s, Want Respect Use a Condom for 16+
New guidance and Ministerial focus
More prescriptive guidance for local areas
Self assessment toolkit to help local areas monitor their actions
New Ministerial focus on areas with high and increasing rates: - annual meetings with senior leaders - six monthly progress reports with ministerial feedback to Chief
Execs and Elected Members
Additional support from Regional Teenage Pregnancy Coordinators and Department of Health National Support Team
Good local delivery brings down rates:
The 10 key characteristics of successful programmes Strategic: senior champions within council and PCT, engagement
from all partner agencies and accountability to Partnership Board
Data: local data and population knowledge used to inform commissioning of services and to monitor progress
Strong delivery of sex and relationships education (SRE) within PSHE by all schools
Support for parents and carers to encourage early discussion on sex and relationships with their children
Young people focused contraception/sexual health services, trusted by teenagers and well known by professionals working with them – 86% of decline in US rates due to improved contraceptive use
Good local delivery brings down rates:
The 10 key characteristics of successful programmes Targeted SRE and sexual health advice for at risk groups of young
people: e.g. Young people with low education attainment, not in training or employment, Children in Government care, young people in homeless units and supported housing, teenage parents
Workforce training on sex and relationships for practitioners working with young people – e.g. Youth workers, social workers
Well resourced statutory and voluntary sector youth service tackling teenage pregnancy and other social and health issues
Communications: clear and consistent messages to young people and parents, internal stakeholders and the local media
Dedicated coordinated support for teenage parents including SRE and contraception to reduce repeat pregnancies
Additional focus on improving awareness and use of effective contraception
Additional Department of Health funding to expand access to contraception and Long Acting Reversible Contraceptive methods
Review of national campaign and key role of communications identified:
- normalising conversations about contraception and sexual health between young people, with parents and with professionals
- raising awareness of effective contraception
Approaching 2010...
Strong and visible partnership between Departments of Health and Education Ministers
High rate areas under Ministerial focus start to see rates decline First TV advertising of contraception – with no complaints! Big expansion in access to contraception and LARC Broad consensus between young people and parents on age of first
sex, sex and relationships education and access to contraception
Broad consensus among young people and parents
Age of first sex Young people and parents agree on right sort of age for first
sex – 16.5-17 years
Sex and relationships education (SRE) Young people (96%) and parents (86%) support school SRE 86% of parents believe there would be fewer teenage
pregnancies if parents talked more to their children about sex and relationships
Access to contraception 75% of parents agree young people, including under 16s,
should have access to confidential contraceptive services
and the final 2010 data...
25% reduction in under 18 conception rate: 46.2 per 1000 15-17s → 35.4 per 1000 15-17s
35% reduction in conceptions leading to birth
Lowest rate since 1969 – over 40 years
60,000 conceptions saved – if conception rate had stayed the same as 1998
Lessons learned
A clear goal is vital but targets needs to be realistic
Concerted effort makes a difference – high teenage pregnancy rates are not inevitable
We know what works and how to translate evidence into local actions
Senior leadership and partnership work is vital – at national and local level
Building and highlighting consensus is key