Teenage Pregnancy Next Steps: Guidance for Local Authorities and Primary Care Trusts on Effective Delivery of Local Strategies

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1 Teenage Pregnancy Next Steps: Guidance for Loca Authorities and Primary Care Trusts on Effective Deivery of Loca Strategies

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3 Contents 1. Executive Summary 2 2. Introduction 5 3. Why teenage pregnancy matters 7 4. Who gets pregnant eary and why? 9 5. What works in reducing teenage pregnancy? Acceerating progress to Support and Chaenge 49 Annex 1 52 Annex 2 57 Annex 3 60

4 1. Executive Summary 1.1 Since the aunch of the Teenage Pregnancy Strategy in 1999, steady progress has been made overa on reducing under-18 and under-16 conception rates, to the point where both are now at their owest eve for 20 years. But UK rates are sti much higher than comparabe EU countries and as set out in the PSA and LDP trajectories we need to acceerate progress if we are to achieve the chaenging target to have the under-18 conception rate by The progress achieved nationay, however, masks significant variation in oca area performance. Those areas which effectivey impemented their strategies with a prompt start are seeing significant reductions. But in other areas, Teenage Pregnancy has not been given sufficient priority either within the area as a whoe or among key parts of the deivery chain. If a areas were performing as we as the top quartie, the nationa reduction woud be 23% more than doube the 11.1% reduction that has actuay been achieved. 1.3 This document states the rationae for the teenage pregnancy strategy, highighting the short and ong-term consequences of eary parenthood in terms of poorer heath and education outcomes for teenage mothers and their chidren. It makes the financia case for investing in measures to prevent eary pregnancy and presents evidence on which young women get pregnant eary and the underying factors that affect both young peope s sexua behaviour and the outcomes that resut from it. Whie confirming the strong ink to deprivation, it demonstrates that a range of other factors in particuar poor educationa attainment and ow aspiration have an impact over and above deprivation eves. 1.4 It sets out in detai what we know about what has worked in areas with decining rates, based on findings from in-depth reviews in a number of areas with both good and poor performance in reducing teenage pregnancies. These deep dive reviews, carried out by the Teenage Pregnancy Unit and members of the Independent Advisory Group on Teenage Pregnancy, ooked at the key features of oca strategies in areas where rates have reduced significanty and compared and contrasted their experience with what was 2 EVERY CHILD MATTERS

5 happening in statisticay simiar areas, where rates were static or increasing. The key factors contributing to success are set out in chapter In summary, successfu oca areas were characterised by the foowing factors, which confirm the evidence base for the strategy: Active engagement of a of the key mainstream deivery partners who have a roe in reducing teenage pregnancies Heath, education, Socia Services and Youth Support Services and the vountary sector; A strong senior champion who was accountabe for and took the ead in driving the oca strategy; The avaiabiity of a we pubicised young peope-centred contraceptive and sexua heath advice service, with a strong remit to undertake heath promotion work, as we as deivering reactive services; A high priority given to PSHE in schoos, with support from the oca authority to deveop comprehensive programmes of sex and reationships education (SRE) in a schoos; A strong focus on targeted interventions with young peope at greatest risk of teenage pregnancy, in particuar with Looked After Chidren; The avaiabiity (and consistent take-up) of SRE training for professionas in partner organisations (such as Connexions Persona Advisers, Youth Workers and Socia Workers) working with the most vunerabe young peope; and A we resourced Youth Service, providing things to do and paces to go for young peope, with a cear focus on addressing key socia issues affecting young peope, such as sexua heath and substance misuse. 1.6 In order to make a asting and positive impact on teenage pregnancy rates, a areas need to ensure a of the above measures are being impemented fuy, and mainstreamed within their Chidren & Young Peope Pans. The key purpose of this document, therefore, is to support and hep oca areas to review their strategies against the deep dive findings. Chapter 6 of this document sets out what arrangements need to be in pace for optima deivery in each area and sets out what support we wi be providing nationay to hep areas to reach this position. A detaied sef-assessment too wi be issued in October to hep areas review their strategies ahead of this autumn s round of Priorities Conversations. In chapter 7, we set out how we wi support and chaenge oca areas, with a focus on turning around performance in areas with high and increasing rates. 1.7 But as the anaysis in chapter 4 makes cear, whie effective deivery of oca strategies is essentia in making further progress, it is not the whoe answer to reducing teenage pregnancy rates down to the eves of our Western European neighbours. The anaysis demonstrates that as we as having the means to avoid eary pregnancy knowedge 3

6 and skis in reation to sex and reationships, easy access to contraceptive and sexua heath advice and support etc some young peope aso need the motivation to pursue further earning or a career, rather than to choose or accept eary parenthood as the ony passport to aduthood. 1.8 The anaysis in chapter 4 provides compeing evidence that a range of underying factors impact on the ikeihood of eary pregnancy. It demonstrates the we known ink between deprivation and teenage pregnancy, but goes on to show that deprivation is not the ony factor. In particuar, it shows the strong inks between eaving schoo at 16 with no quaifications, and eary and risky sexua behaviour which in turn impacts on the ikeihood of eary pregnancy. Chapter 4 aso provides detaied anaysis on other significant underying risk factors. 1.9 This anaysis of underying risk factors is designed to hep oca areas to target their teenage pregnancies on young peope most at risk. But it aso demonstrates that action to tacke the root causes of teenage pregnancy needs further consideration. This document does not set out new measures to improve attainment, attendance at schoo and post-16 participation. We wi, however, be returning to these issues ater this year when we pubish a broader strategy document setting out what action we wi be taking to improve the ife chances of those at risk of teenage pregnancy. 4 EVERY CHILD MATTERS

7 2. Introduction 2.1 The Government s Teenage Pregnancy Strategy, aunched by the Prime Minister in 1999, required a oca authorities to have measures in pace to meet oca reduction targets. The strategy is working the Engand under-18 conception rate has faen steadiy, resuting in an 11.1% decine between 1998 and But individua areas have had contrasting success in reducing rates some have seen impressive reductions of over 40%, whie in other areas rates have increased, in some cases significanty. If a areas had performed as we as the top quartie, the Engand rate woud have faen by 23% more than doube the current rate of decine and we above the trajectory needed to achieve the PSA target. A tabe showing changes in conception rates between 1998 and 2004, for each top-tier oca authority, are provided at annex Whie the strategy has made significant progress both under-18 and under-16 conception rates are now at their owest eves since the mid-1980s we need to acceerate it if we are to achieve the ambitious target to have the under-18 conception rate by Whie the interim target of a 15% reduction in conception rates by 2004 was achieved for under-16s, it was not met for under-18s. 2.3 During the first 6 years of the strategy, we have earnt a great dea about what approaches are effective in reducing teenage pregnancy. We aso have a much better understanding about the wider socia and cutura probems associated with teenage pregnancy and about the ocation and character of teenage pregnancy hotspots. 2.4 This document sets out the essons we have earnt since the strategy began, in particuar, the findings from in-depth reviews carried out by the Teenage Pregnancy Unit in These reviews identified the key things that are happening in successfu areas, which were absent or being deivered ess intensivey in the (statisticay simiar) comparison areas. It demonstrates the importance of focused and sustained deivery of a aspects of the strategy and engagement of a key partners. 5

8 2.5 It aso provides new anaysis on the underying causes of teenage pregnancy, so that areas can in an increasingy sophisticated way target their strategies on those young peope who are at greatest risk. It re-affirms the Government s commitment to the teenage pregnancy strategy and sets out how we wi deveop it further in the ight of the findings from the in-depth reviews, new research and anaysis. 2.6 This document focuses specificay on the action which wi hep LAs and PCTs achieve the 50% conception rate reduction target. However, support to improve outcomes for teenage parents and their chidren wi continue to be an essentia part of the wider teenage pregnancy strategy. We wi set out ater in the year how we wi buid on the current approach to supporting teenage parents, through Chidren s Centres and targeted youth support, and how we wi further deveop the teenage pregnancy strategy. 6 EVERY CHILD MATTERS

9 3. Why teenage pregnancy matters Summary This chapter sets out the rationae for the teenage pregnancy strategy. Loca areas shoud: note the poor outcomes experienced by young mothers and their chidren; ensure that senior managers through to front ine professionas understand that reducing teenage pregnancy is a priority; and recognise that actions to reduce teenage pregnancy represent an important invest to save measure. 3.1 Teenage pregnancy is a serious socia probem. Having chidren at a young age can damage young women s heath and we-being and severey imit their education and career prospects. Whie individua young peope can be competent parents, a the evidence shows that chidren born to teenagers are much more ikey to experience a range of negative outcomes in ater ife. Chidren born to teenage parents are aso much more ikey, in time, to become teenage parents themseves. Whie the negative consequences of teenage pregnancy are fet most by young women and their chidren, it is important that strategies to reduce teenage pregnancy aso impact on young men s attitudes and behaviour. 3.2 Each year, around 39,000 girs under-18 become pregnant in Engand. These pregnancies occur throughout the country athough they are much more ikey to occur in deprived neighbourhoods. Neary every oca authority has at east one hotspot neighbourhood, where more than 6% of girs aged become pregnant every year. The overwheming majority of under-18 conceptions are unintended and around haf ead to an abortion. 7

10 3.3 The facts are stark: Teenage mothers are ess ikey to finish their education, and more ikey to bring up their chid aone and in poverty; The infant mortaity rate for babies born to teenage mothers is 60 per cent higher than for babies born to oder mothers; Teenage mothers are more ikey to smoke during pregnancy and are ess ikey to breastfeed, both of which have negative heath consequences for the chid; Teenage mothers have 3 times the rate of post-nata depression of oder mothers and a higher risk of poor menta heath for 3 years after the birth; Chidren of teenage mothers are generay at increased risk of poverty, ow educationa attainment, poor housing and poor heath, and have ower rates of economic activity in adut ife. Rates of teenage pregnancy are highest among deprived communities, so the negative consequences of teenage pregnancy are disproportionatey concentrated among those who are aready disadvantaged; 3.4 Teenage pregnancy is, therefore, a key inequaity and socia excusion issue. But there is aso a strong economic argument in investing in measures to reduce teenage pregnancy, which paces significant burdens on the NHS and wider pubic services: The cost of teenage pregnancy to the NHS aone is estimated to be 63m a year. Benefit payments to a teenage mother who does not enter empoyment in the three years foowing birth can tota between 19,000 and 25,000 over three years. Teenage mothers wi be much more ikey than oder mothers to require targeted support from a range of oca services, for exampe to hep them access supported housing and/or re-engage in education, empoyment and training. 3.5 Broad estimates suggest that every pound spent on the Strategy saves approximatey 4 to the pubic purse, when assessed over a period of 5 years. 8 EVERY CHILD MATTERS

11 4. Who gets pregnant and why? Summary This chapter presents new anaysis on the characteristics of young peope who are at higher risk of becoming a teenage parent and the factors that contribute to that increased risk. Loca areas shoud: use the anaysis to identify young peope most at risk of eary pregnancy and target deivery of their oca strategy more intensivey on these groups; recognise the overapping risk factors and use this information to inform the targeted support eements within their Chidren and Young Peope Pans; and consider how they can ensure that improvements in performance on these key underying risk factors have maximum impact on those most at risk of teenage pregnancy. Teenage pregnancy rates in context 4.1 The UK has historicay high rates of teenage pregnancy. Figure 1 shows that since the eary 1980s under 20 birth rates 1 in the UK have been consistenty, and markedy, higher than rates in other European countries. 1 Due to differences in coecting and recording data on conceptions, under 20 birth rates are usuay used for internationa comparisons 9

12 Figure1: Under 20 birth rate in seected European countries Under 20 birth rate per UK Ireand Germany France Netherands Sweden 0 Year Source: Eurostat 2006 Note: Due to differences in coecting and recording data on conceptions, under-20 birth sites are usuay used for internationa comparisons. 4.2 Figure 2 shows how teenage conception rates in Engand have moved over the ast 30 years. The chart breaks the figures down between under-18 and under-16 pregnancies. (Conception rates are a measure of births and abortions combined see fuer expanation on how conception statistics are compied in Chapter 7.) 10 EVERY CHILD MATTERS

13 Figure 2: Under-18 and under-16 conception rates for Engand , and target projection 50 Under 18 rate 1998 ba seine 40 Conception rate per Under 16 rate 2010 target Year Sources: ONS and TPU, The graph shows that: high rates of teenage pregnancy are a ong-estabished probem, with the rate of under- 18 conceptions generay at more than 40 per 1000 for over 30 years; there has nevertheess been significant progress in reducing under-18 conception rates since the strategy began in 1998; the greatest progress has been in reducing conceptions among under 16s (15.2% decine); significant further progress is needed if the Government s target to reduce teenage conceptions by 50% by 2010 is to be achieved; under-16 pregnancies make up a reativey sma proportion of a under 18 conceptions 80% are to 16 and 17 year ods (athough this fact shoud not detract from the importance of providing sex and reationships education to under-16s). 4.4 Teenage pregnancy is a compex issue, affected by young peope s knowedge about sex and reationships and their access to advice and support; and infuenced by aspirations, educationa attainment, parenta, cutura and peer infuences and eves of emotiona webeing. 11

14 4.5 Data anaysis identifies strong associations between teenage pregnancy and certain risk factors and provides a compeing case for targeted action on young peope who are exposed to these risk factors, whie maintaining universa provision of PSHE and access to confidentia advice for a young peope. 4.6 It is aso cear that the wide range of persona, socia, economic and environmenta risk factors associated with teenage pregnancy are, utimatey, mediated through sexua activity and contraceptive use. Understanding differences in sexua activity rates and contraceptive usage among teenagers is, therefore, crucia to understanding how teenage pregnancy rates can be reduced. Where you ive matters 4.7 Variations in under-18 conception rates argey mirror the pattern of deprivation across Engand, with haf of a conceptions under 18 occurring in the 20% most deprived wards. However, athough teenage pregnancy is predominatey concentrated in deprived urban areas, figure 3 shows that hotspots, with rates over 60 per 1000 girs aged 15-17, are found in virtuay every oca authority in Engand, incuding some rura areas. 12 EVERY CHILD MATTERS

15 Figure 3: Ward under-18 conception rates in Engand Under 18 conception rates for wards in Engand, Wards under 18 conception rate Over Under 30 _ Carise _ Workington Newcaste Sunderand _ Durham _ Hartepoo Middesbrough Darington _ Scarborough _ Barrow-in-furness _ Lancaster _ Backpoo _ Preston Bradford Leeds _ York Boton Manchester _ Liverpoo _ Barnsey _ Doncaster _ Sheffied _ Grimsby _ Chester _ Chesterfied _ Mansfied _ Lincon _ Nottingham _ Derby _ Boston _ Teford _ Woverhampton _ Leicester _ Peterborough _ Norwich Great Yarmouth _ Dudey Birmingham Coventry Hereford _ Goucester _ Northampton _ Cambridge _ Bedford Stevenage Luton _ Oxford _ Ipswich Cochester Cacton-on-sea _ Taunton _ Bristo _ Bath _ Swindon _ Reading _ Newbury _ Andover _ Winchester _ Maidstone _ Canterbury Ashford Dover _ Fokestone _ Exeter Bournemouth Southampton Portsmouth Brighton _ Hastings _ Eastbourne _ Weymouth Inset for London _ Pymouth _ Torbay _ Truro _ Penzance Sources: ONS under 18 contraception data ONS ward popuation estimates Notes: Rates per 1000 femaes aged Rates under 30 incude wards with suppressed data Census 2001 ward boundaries Produced by Teenage Pregnancy Unit,

16 4.8 Nevertheess, high teenage pregnancy rates are much more ikey to be found in deprived areas. Figure 4 shows the strong association between deprivation and teenage pregnancy with under-18 conception rates more than four times higher in the most deprived 10% of wards in Engand compared with the 10% east deprived. Figure 4: Under-18 conception rates in Engand by deprivation decie, Under 18 conception rate Ward deprivation decie Least deprived Most deprived Sources: ONS, TPU, ODPM Deprivation Index 2004 Notes: Incudes estimated rates for wards with suppressed data But other factors matter too 4.9 The reationship between teenage pregnancy and deprivation is not consistent across the country. Some oca areas have rates markedy higher, or ower, than woud be expected given their eve of deprivation. 1 This variation demonstrates that deprivation is not the whoe story, and that other factors have an important roe to pay in infuencing under-18 conception rates incuding educationa attainment. Educationa Attainment 4.10 It is we understood that the ikeihood of teenage pregnancy is far higher among those with poor educationa attainment. Given that educationa attainment is strongy associated with deprivation and socio-economic status this woud be expected. However, anaysis of new data ceary shows that ow attainment is strongy associated with higher teenage conception rates even after accounting for the effects of deprivation and socio- 14 EVERY CHILD MATTERS

17 economic status. On average, deprived wards with poor eves of educationa attainment have under-18 conception rates twice as high as simiary deprived wards with better eves of educationa attainment. (See figure 5.) Figure 5: Under 18 conception rates and educationa attainment in 20% most deprived wards Under 18 conception rate Poor 1 Average 2 Good 3 Educationa attainment among girs in 20% most deprived wards Source: Teenage Pregnancy Unit, < 40% girs 5+ A-C GCSEs & > 10% no quaification % girs 5+ A-C GCSEs & 6-10% no quaification 3 > 60% girs 5+ A-C GCSEs & <6% no quaification 4.11 Educationa outcomes aso have a strong infuence on the age at which young peope first have sex. Sex under-16 is associated with higher eves of regret among young women, poorer contraceptive use and higher rates of teenage pregnancy. Young men aso report that they regret putting pressure on their partners and that their experiences of sex at an eary age are often negative. 2 Surveys estimate that between a quarter and a third of a young peope have sex before they reach age 16, 3 a proportion that has remained constant since the start of the Strategy. 4 But as figure 6 shows, around 60% of boys and 47% of girs eaving schoo at 16 with no quaifications had sex before 16. For those eaving schoo aged 17 or over with quaifications, the proportion having sex before 16 was around 20% for both maes and femaes. 15

18 Figure 6: Proportion having first sex under-16, by quaifications and schoo eaving age 70% 60% 60% Maes Femaes % sex under 16 50% 40% 30% 20% 47% 46% 41% 19% 20% 10% 0% no quaifications with quaifications Leaving schoo at 16 Leaving schoo at 17+ Source: Nationa Survey of Sexua Attitudes and Lifestyes (NATSAL) Educationa attainment aso has a big impact on contraceptive use. Overa, reported use of condoms at first sex has increased significanty in recent years. In 2000, 83% of maes and 80% of femaes aged reported using condoms the first time they had sex. However, the ikeihood of not using any contraception at first sex is higher in young peope eaving schoo at 16 with no quaifications, as shown in Figure 7 beow. Around a quarter of boys and a third of girs who eft schoo at 16 with no quaifications did not use contraception at first sex, compared to ony 6% of boys and 8% girs who eft schoo at 17 or over, with quaifications. Overa, neary 40% of teenage mothers eave schoo with no quaifications EVERY CHILD MATTERS

19 Figure 7: Rates of non-use of contraception, by quaifications and schoo eaving age % no contraception at 1st sex 40% 30% 20% 10% 28% 34% 12% 11% 6% Maes Femaes 8% 0% no quaifications with quaifications Leaving schoo at 16 Leaving schoo at 17+ Source: Nationa Survey of Sexua Attitudes and Lifestyes (NATSAL) 2000 Other schoo-reated factors 4.13 Poor attendance at schoo is aso associated with higher teenage pregnancy rates. Among the most deprived 20% of oca authorities, areas with higher rates of absenteeism have higher under-18 conception rates. Loca authorities with fewer than 8% of haf days missed averaged an under-18 conception rate of 33.6, compared with a rate of 47.7 in areas where more than 8% of haf days were missed. Teenage Pregnancy Unit funded research shows that disengagement from education often occurred prior to pregnancy, with ess than haf of the young women interviewed attending schoo reguary at the point of conception. Disike of schoo was aso shown to have a strong independent effect on the risk of teenage pregnancy. 6 Other factors that infuence rates 4.14 Our anaysis points to socia deprivation, poor attainment and disengagement at schoo being the key underying factors that affect conception rates. But a range of other factors affecting young peope s ives are important too. 17

20 Ethnicity 4.15 There is evidence that suggests that young peope from some ethnic groups are much more or ess ikey to experience teenage pregnancy than others, even after taking account of the effects of deprivation. For exampe, teenage pregnancy rates vary dramaticay between London boroughs with a simiar eve of deprivation, but a different ethnic composition. In some instances, a Borough s rate is doube that of a simiary deprived Borough with a different ethnic make-up Estabishing the precise impact of ethnicity is difficut because: ethnicity is not recorded at birth registration; BME groups are over-represented in deprived areas where high rates woud be expected; and sexua behaviour, knowedge and attitudes may vary consideraby within BME groups. Nevertheess, the avaiabe evidence does indicate that girs and young women from some ethnic groups are more ikey to become pregnant under Data on mothers giving birth under age 19, identified from the 2001 Census, show rates of teenage motherhood are significanty higher among mothers of Mixed White and Back Caribbean, Other Back and Back Caribbean ethnicity. White British mothers are aso over-represented among teenage mothers, whie a Asian ethnic groups are underrepresented (Whist Asian groups are under-represented among under-19 births, data on under-20 births show high rates of pregnancy among Asian groups, which suggests these groups have higher than average birth rates at age 19) Girs and young women of Back and Back British ethnicity are aso over-represented among abortions under-18. In 2004, Back ethnic groups (which represent around 3% of a femaes aged 15-17) accounted for 9% of a abortions under-18, and in London, which has high rates of repeat abortion, 43% of a under-18 abortions foowing a previous pregnancy were for young women from Back ethnic groups. (Sma numbers do not permit a more detaied disaggregation of Back ethnicity) Variations between ethnic groups in sexua activity and contraceptive use suggest the higher rates of teenage pregnancy among some ethnic groups are at east party attributabe to differences in behaviours and attitudes, and not simpy a resut of deprivation. A survey of adoescents in East London 7 showed the proportion having first sex under 16 was far higher among Back Caribbean men (56%), compared with 30% for Back African, 28% for White and 11% for Indian and Pakistani men. For women, around 30% of both White and Back Caribbean groups had sex under-16, compared with 12% for Back African, and ess than 3% for Indian and Pakistani women. Survey data aso demonstrate variations in contraceptive use by ethnicity. Among year ods surveyed in London, non-use of contraception at first intercourse was most frequenty reported among Back 18 EVERY CHILD MATTERS

21 African maes (32%), Asian femaes (25%), Back African femaes (24%) and Back Caribbean maes (23%) Differences in sexua behaviour and risk of teenage pregnancy between ethnic groups demonstrate the need for oca strategies to deveop cuturay appropriate approaches to reducing teenage pregnancy rates especiay in areas with arge BME popuations. These need to recognise, and address, differences in: norms around discussing sensitive issues within famiies; gender issues; reigion; and accessing mainstream services. Living in Care 4.21 Athough the numbers are ow, young peope who are or have been ooked after are at a significanty higher risk of teenage motherhood. Research has shown that by the age of 20 a quarter of chidren that had been in care were young parents, and four out of ten young women were mothers. 9 Statistics on Looked after Chidren reeased by DfES in November 2005 showed that 4.1% of year od femaes in care were mothers a proportion around three times higher than the prevaence among a girs under-18 in Engand. Associated risk factors 4.22 The daughter of a teenage mother is at increased risk of becoming a teenage mother hersef. Research findings from the 1970 British Birth Cohort dataset showed that being the daughter of a teenage mother was the strongest predictor of teenage motherhood A number of studies have suggested a ink between menta heath probems and teenage pregnancy. A 1991 survey showed that a quarter of teenage parents invoved in the study had a probabe psychiatric disorder. One in ten year ods had a cinicay diagnosed menta heath disorder, with the same proportion of 16-19s experiencing depressive disorders. A further study of young women with conduct disorders showed that a third became pregnant before the age of Studies have aso shown an association between sexua abuse in chidhood and teenage pregnancy, with experience of abuse twice as high among pregnant teenagers, compared to the genera popuation. Researchers attribute this to ow sef esteem and a ack of confidence in resisting pressure to have sex, even years after the origina abuse has taken pace Sex before age 16 and non-use of contraception were higher for those who did not ive with both parents unti age 16. The ikeihood of not using any contraception at first sex is higher in young peope who did not discuss sexua matters with their parents. 2 19

22 4.26 Factors such as ow aspiration, vioence and buying at schoo, poor parenta support, domestic vioence and a ack of things to do and paces to go for young peope a impact upon the ikeihood of teenage pregnancy There is aso an association between invovement in crime and teenage parenthood. The 1958 UK birth cohort identifies that teenage boys and girs who had been in troube with the poice were twice as ikey to become a teenage parent, compared to those who had no contact with the poice Research points to the use of acoho and substance misuse as being a significant factor in young peope s sexua behaviour. Research among south London teenagers found reguar smoking, reguar drinking and experimenting with drugs increased the risk of starting sex under-16 for both young men and women. A study conducted by the oca Teenage Pregnancy Strategy in Rochdae reports that feeing in contro about negotiating consent to sex is seen as very difficut, and made harder by the effects of acoho. Findings from the study show that one in five white young women report going further sexuay than intended because they were drunk. 14 Other studies have found teenagers who report having sex under the infuence of acoho are ess ikey to use contraception and more ikey to regret the experience Where young women experience mutipe risk factors, their ikeihood of teenage parenthood increases exponentiay The 1999 SEU report on teenage pregnancy 16 anaysed the 1958 UK birth cohort which found evidence that young women who experienced mutipe risk factors (incuding having a mother who was a teenage parent, having emotiona probems at age 7 and age 16 and ow educationa attainment at 16) had a 56% chance of becoming a teenage mother, compared with a 3% chance for young women experiencing none of these factors. 17 A simiar and subsequent anaysis of the 1970 British Cohort Study found young women experiencing five seected risk factors (daughter of a teenage mother; father s socia cass IV & V; conduct disorder; socia housing at 10 and poor reading abiity at 10) increased the ikeihood of becoming a mother under 20 by 31% Much of the above anaysis refers to the characteristics of young women who are more ikey to conceive before age 18. Very itte routine data exists on the characteristics of the young men who are the partners of these young women, athough anaysis of the 1970 British Cohort Study found young men experiencing the five seected risk factors mentioned above were 23% more ikey to become a young father (under age 23) than those not experiencing any of the risk factors. 8 Ceary it is important to ensure that boys and young men aso receive the information and skis to enabe them to understand the benefits of deay and use contraception when they become sexuay active, as we 20 EVERY CHILD MATTERS

23 as receiving support to hep them in their roe as young fathers, where appropriate. Motivation and means, therefore, appies to young men as we as young women. What does the anaysis te us about probems and soutions? 4.31 The anaysis points to a number of probems that we need to address in order to acceerate progress on reducing teenage pregnancies: 1) Poor knowedge and skis among young peope in reation to sex, reationships and sexua heath risks; 2) Poor and inconsistent contraceptive use among young peope; 3) Lack of support for parents and professionas on how to engage with young peope on reationships, sex, and sexua heath issues. 4) Disengagement from/disike of schoo among those most at risk; 5) Low attendance/attainment at schoo; 6) Lack of aspiration among young peope in the most disadvantaged communities Chapter 5 of this document sets out what we know about what works in addressing the first 3 of these probems and chapter 6 describes what action areas need to take as a resut. In broad terms, these focus on giving young peope the means to avoid unintended pregnancies and are the core business of oca teenage pregnancy strategies But it is cear that in order to impact on a of the factors that increase the risk of teenage pregnancy, wider action to address the underying causes of teenage pregnancy is aso needed. Tacking these remaining probems wi give young peope at risk of eary pregnancy the choice and motivation to aspire to further education and rewarding careers, eaving the decision to have chidren unti ater when they are better equipped to dea with the demands of parenthood Loca areas can use the above anaysis to hep target their strategies on those most at risk of eary parenthood both boys and girs. In order to put these broad associations between teenage pregnancy and underying risk factors into the context of assessments of individua young peope s persona risk of eary parenthood, a range of assessment toos exist. These range from more generic toos for assessing risk, such as the Common Assessment framework, to the sort of assessment toos used by projects such as Teens & Todders, which identify young peope at specific risk of teenage parenthood. A copy of the assessment too used by Teens & Todders is incuded at annex 3. 21

24 4.35 We wi produce a broader strategy document ater this year. In the meantime, this document focuses on the actions Loca Authorities and PCTs can take to improve their deivery of oca strategies based on the evidence of what works in Chapter 5. The support we wi be providing nationay is set out in Chapter EVERY CHILD MATTERS

25 5. What works in reducing Teenage Pregnancy? Summary This chapter sets out the key findings from the deep dive reviews carried out by the Teenage Pregnancy Unit to identify factors that were responsibe for the significant variation in performance between oca areas, incuding between areas that are statisticay simiar. A areas shoud: Ensure that a stakehoders are aware of the deep dive findings Review their Strategies and Chidren and Young Peope s Pans against the deep dive findings. 5.1 The wide variation in oca performance even when comparing areas with simiar characteristics provides strong evidence that the deivery of oca strategies is criticay important. In addition, the evauation of the first four years of the strategy shows that the rate of decine has been steeper in areas that have received more funding. This positive ink between funding and resuts indicates that effective deivery of oca strategies rather than unreated factors are driving under-18 conception rate reductions. Figure 8 shows the extent of this variation in performance, with at one end of the spectrum rates faing by 42%, whie at the other rates increasing by 43%. 23

26 Figure 8: Percentage change in under 18 conception rates for top-tier Loca Authorities, % 40% Percentage change in rate % 20% 10% 0% 10% 20% 30% 40% 50% Top-tier LAs Source: Teenage Pregnancy Unit, In-depth reviews carried out by the Teenage Pregnancy Unit in 2005 (in 3 high performing oca authorities and 3 statistica neighbours with static or increasing rates), sought to expain this variation by identifying factors that were evident in successfu areas, but absent in those where rates were increasing. The key factors identified in the Deep Dive review were: Senior oca sponsorship and engagement of a key partners. In high-performing areas the seniority and persona commitment of key post-hoders such as the chair of the Teenage Pregnancy Partnership Board, oca Teenage Pregnancy Co-ordinator and senior personne within key partner agencies, were seen as of critica importance. Conversey, in comparison areas, a ack of commitment by key payers was seen as one of the main factors that expained the area s ack of success. This ack of commitment might, for exampe, manifest itsef in the form of acceptance that eary parenthood in some communities was impossibe to infuence. There was further evidence that progress was greatest in areas where a aspects of the strategy were being deivered effectivey. In particuar, there needed to be engagement of the 4 key mainstream agencies invoved in deivering the strategy PCT, Education, Socia Services and Youth Services/Connexions and the vountary sector. 24 EVERY CHILD MATTERS

27 Case Study Thurrock: Senior oca sponsorship and engagement of a key partners Thurrock s teenage pregnancy rate has faen by 30.7% between1998 to Thurrock Teenage Pregnancy Partnership Board and its reationship with the Chidren and Young Peope s Strategic Partnership (CYPSP) has changed over recent years with the advent of the first Chidren and Young Peope s pan and the reconfiguration of the oca CYPSP. As a unitary authority there is a singe Director of Chidren s Services and an amagamated Directorate of Chidren s, Education and Famiies (CEF) that takes account of the previous separate directorates of education and socia care. The CYPSP currenty works with the coterminous Primary Care Trust (PCT) to effect panning and impementation for chidren and young peope s services. The oca Teenage Pregnancy Coordinator is empoyed and hosted through the PCT and directy reports through the pubic heath team, with dua reporting to the Strategic Lead for Targeted Services within CEF. This arrangement ensures that both key statutory partners are fuy invoved in the panning process and ownership of the strategy. The CYPSP had adopted an age-based framework for channeing a areas of panning and commissioning. This meant that the Teenage Pregnancy Action Pans and monitoring process were reported through the Executive Board of the CYPSP. Whist this did not account for a the activity within the pans, it made for a substantia home for the teenage pregnancy agenda over the ast five years. However this changed in June 2006 to take account of the Every Chid Matters Five Outcomes Framework approach. For the future, the issues of teenage pregnancy and young peope s substance misuse wi have much greater union and common themes within each of these areas wi be jointy addressed. This shoud ead to a greater emphasis on prevention and education and a sharing of resources. These wi be addressed through a high risk behaviour interest group, taking on board some of the previous functions and panning of the Teenage Pregnancy Partnership Board, with the commissioning functions fufied by the Be Heathy CYPSP Executive Board. For further information contact Meody Wiiams on or meody.wiiams@thurrock-pct.nhs.uk 25

28 Provision of young peope focused contraception/sexua heath services, trusted by teenagers and we known by professionas working with them. This was the factor most commony cited as having the biggest impact on conception rate reductions in the high performing areas. Features of successfu services refected the Best practice guidance on the provision of effective contraception and advice services for young peope, issued by the Teenage Pregnancy Unit in 2000: easy accessibiity in the right ocation with opening hours convenient to young peope; provision of the fu range of contraceptive methods, incuding ong acting methods; a strong focus on sexua heath promotion (as we as reactive services) through, for exampe, outreach work in schoos, work with professionas to improve their abiity to engage with young peope on sexua heath issues; and through highy visibe pubicity. Effective services aso had a strong focus on meeting the specific needs of young men. A high-performing areas aso had condom distribution schemes invoving a wide range of oca agencies and/or access to emergency contraception in non-cinica settings. Case Study Liverpoo: Brook/Abacus + So to Speak outreach Liverpoo s teenage pregnancy rate has faen by 24.7% between1998 to Liverpoo provides strong services through two discrete, highy visibe, and young peope friendy sexua heath/contraceptive advice services in the city centre Brook and Abacus. These services are highy accessibe and trusted by young peope. The services are supported by strong outreach work provided by So To Speak, a project which is supported by funding from the Liverpoo and Sefton Teenage Pregnancy Partnerships. So to Speak train professionas to improve their abiity to engage with young peope on sexua heath issues as we as equip young peope with information to make informed choices about their sexua heath. Liverpoo Brook has been providing contraceptive services for young peope for over 30 years. It has been ocated in the city centre for the ast 20 years and, foowing reocation to arger more visibe premises in 2002, has been offering a drop in service, which is open every weekday from 10am to 6pm and on Saturdays from 10am ti 2pm. The service is commissioned by Liverpoo PCTs, and provides a the main methods of contraception, emergency contraception, pregnancy testing, referra for abortion, chamydia screening and sexua heath advice. The centre aso provides a twice weeky fu STI testing service run in partnership with the Roya Liverpoo University Hospita GUM department and 2 Chamydia Treatment Sessions. 26 EVERY CHILD MATTERS

29 Appointments can be made to see the Brook Counseor who is avaiabe one day a week and there is a Mae Information Worker at the centre 5 days a week to provide sexua heath and contraceptive advice to mae cients. Athough Liverpoo Brook does not have an Outreach Team, it is one of the partners in a Heathy Living Centre Heathy Arts Project which aims to address heath issues and probems which affect young peope, through the use of arts and media. As part of this project, for the ast 3 years, Brook Advisors have taken part in a Theatre in Education Project touring oca schoos with pays highighting a different sexua heath theme each year, and has contributed to various other Heathy Arts activities incuding magazines and videos. Abacus cinics for Contraception and Reproductive Heathcare are a mainstream NHS service which provides open access to a methods of reversibe contraception, incuding Long Acting Reversibe Contraception (LARC), emergency contraception, pregnancy testing, referra for abortion, Chamydia screening, and sexua heath advice. The service provides 60 sessions per week, over 6 days per week, across Liverpoo and South Sefton. There are 9 dedicated young-persons sessions across the area, athough a sessions are attended by cients of a ages. The service aso incudes a base in Liverpoo city-centre which is open 6 days per week, in an easiy accessibe, non-nhs buiding. Provision of contraception foowing an abortion is aso a high priority. Women attending for a termination at the Bedford Cinic, Liverpoo Women s Hospita, have immediate access to post-abortion contraception via an Abacus contraceptive nurse or doctor, who attends the cinic on a daiy basis. A cients are activey encouraged to access contraception prior to eaving the service. LARC is aso activey promoted within the cinic. Women who attend for a termination at Merseyside BPAS aso have the opportunity to obtain contraception on-site. For those who want to discuss contraception at a ater date, information is provided about the Merseyside and Wirra Brook Advisory Centres. 27

30 Liverpoo adopts a strong targeted approach to working with at risk groups of young peope, and to providing workforce training on sex and reationship issues within mainstream partner agencies through So To Speak a sexua heath education outreach team, funded through the Liverpoo and Sefton Teenage Pregnancy strategies. The aim of the project is to equip young peope with the information required to make informed choices about their sexua heath; to promote a greater understanding of the broader issues that impact upon sexua heath; and to support agencies that work with young peope to appreciate their roe in tacking those issues and thereby enabing good sexua heath. The team empoys a number of different methods of deivery incuding face-to-face work with sma groups of young peope and parents; outreach; and promotiona campaigns. In order to ensure sustainabiity of this work the team aso deivers staff training and support to agencies that work with vunerabe young peope and hep to tacke inequaities in heath through community deveopment in targeted wards. For further information on Liverpoo Brook contact Sue Ryrie or Jackie Spence on or at sryrie@merseybrook.co.uk For further information on Abacus contact Sue McVicker, Service Manager/Lead Nurse on or at sue.mcvicker@pct.northiverpoo.nhs.uk For further information on So to Speak contact So to Speak on or at info@sotospeak.nwest.nhs.uk Strong deivery of SRE/PSHE by schoos. Key features incuded: systematic deivery of SRE/PSHE in secondary and primary schoos, driven by the LEA; a strong focus on achieving heathy schoos status; use of the DfES SRE guidance (issued in 2000) as a driver for training and support for schoos, incuding panned programmes of training for Governors; LEA support to improve schoos PSHE deivery, incuding the deveopment of exempar esson pans, investment in SRE resources and consutancy support for targeted schoos. Quote: The essons reay heped us tak about things in a way we just don t do when we re hanging around together. I earned that reationships are not a about ooks and sex. You need to ook on the inside not just on the outside Boy, EVERY CHILD MATTERS

31 Case Study Hackney: Puing it Together (Secondary) Christopher Winter Programme (Primary) Hackney s teenage pregnancy rates have faen by 10% between 1998 to An audit of schoos in Hackney, as part of the Hackney Heathy Schoos Programme, drew attention to the need for more consistency in the deivery of PSHE and Citizenship in schoos and for support to further raise the quaity of provision in this area. Therefore in 2000 a Hackney schoos agreed to combine funding from their Standards Fund budgets to deveop PSHE and Citizenship. Schoos received advisory support and guidance known as Puing it Together, which was informed by the DfES guidance on SRE, incuding a scheme of work and esson pans that had been shared and agreed. This has been further deveoped by The Learning Trust and repubished in 2001 with support from teachers. The Learning Trust s guideines on PSHE and Citizenship can be found at This contributes to the achievement of key targets in the Teenage Pregnancy Strategy for Hackney. For further information, contact Nicoa Baboneau, Chair of Hackney & The City s Teenage Pregnancy Partnership Nicoa.baboneau@earningtrust.co.uk. Former Hackney Education, now the Learning Trust and City & Hackney Teaching Primary Care Trust have funded The Christopher Winter Project since The project deivers primary schoo SRE Modeing for teachers. It was devised to compement strategies taken in ine with the key themes of the Nationa Teenage Pregnancy Strategy. The project demonstrates one of the key themes in the recent OFSTED report on SRE, which is to improve the quaity of teaching and earning and is part of the teacher training strategy to provide good continuing professiona deveopment (CPD) in SRE. The project offers teachers professiona support in their own cassroom working with their own pupis. Assistance is given with esson panning and deivery, poicy deveopment, parents and governors meetings. Parents are encouraged in writing to review the programme and have been mosty very supportive with reativey sma numbers of parents withdrawing their chidren from SRE. The project aims to increase teacher confidence in the deivery of SRE. Its objectives are to: Provide mode essons based on schemes of work from The Learning Trust s PSHE Guidance Puing It Together ; Mode methods of deivery which are appropriate to SRE; and Provide team teaching and support to cassroom teachers. 29

32 Initiay ten Heathy Schoos were invited to take part in the piot and ater this was offered to a Hackney schoos. Schoos with up-to-date SRE poicies and programmes in pace were aocated training paces. This system is sti in pace and the project works reguary with 36 primary schoos. A teachers compete a pre and post-evauation form. The data shows that the in-cass training and panning support offered by CWP has resuted in increased confidence in 90% of participating teachers. CWP were fimed with pupis and teachers at Baden Powe Schoo for a nationa training video on SRE for schoo governors (financed by the Department of Heath). The video has been sent to a schoos in Engand. CWP are currenty making a teacher training DVD fimed in Hackney. In 2004 CWP won the FPA Pamea Sheridan Award for SRE. They now run a simiar modeing project with secondary schoos in Hackney. For further information contact Paua Power on power.coeman@virgin.net Targeted work with at risk groups of young peope, in particuar Looked After Chidren. A 3 high performing areas had exampes of Socia Services having a strong focus on sexua heath issues in one area Socia Services had a oca performance target that a Looked After Chidren (LAC) had access to advice on contraception and sexua heath. In the same area, there was aso mandatory SRE training for a socia work managers, famiy support workers, foster carers and reevant socia workers. And in another, Socia Services deivered SRE programmes for young peope in care and the LAC Nurse ran a sexua heath cinic for LAC. Case Study Bradford: Working with Looked After Chidren Bradford s teenage pregnancy rates have faen by 22.9% between1998 to In 1997 the former Bradford District Heath Promotion Service began work with Socia Services and other agencies to deveop sexua heath promotion with ooked after chidren. This group therefore had aready been identified as a priority prior to the deveopment of the Teenage Pregnancy Strategy. Good practice guidance on working on sexua heath issues with young peope was deveoped. 30 EVERY CHILD MATTERS