PROTOTYPE - AUGUST 2006 Vision To reduce the rate of unintended teenage pregnancies in Britain and to tackle social exclusion among young parents and their families. Audience Directors of Children’s Services, Senior officers in the Local Authority Children’s Services Directorates, Children’s Service Leads in PCT’s, Children’s Service Commissioners. Introduction Since the early 1970s, the UK has had the highest under-20 birth rate in Western Europe with a rate in 2002 around four times higher than the Netherlands, three times higher than France and twice as Germany (1). Until the mid 1970s, under-20 birth rates in the UK were similar to rates in many other Western European countries. However, whereas rates in other Western European countries continued to fall throughout the 1970s and 1980s, rates in the UK from mid 1970s onwards have remained relatively static. Teenage parents tend to have poor ante-natal health, lower birth weight babies and higher infant mortality rates. Their own health and their children’s health is worse than average with higher levels of post natal depression. Teenage parents tend to remain poor, live in poorer quality housing and disproportionately likely to suffer relationship breakdown. Their daughters are more likely to become teenage mothers themselves (2). Groups at risk from teenage pregnancy:  Those experiencing deprivation  Children of teenage mothers  Care leavers and those in care  Young people with mental health problems  Young people who have been sexually abused  Young offenders  Caribbean, Pakistani and Bangladeshi Women  Young people with low self esteem  Young people with low educational attainment (3) The 1999 Social Exclusion report on teenage pregnancy found evidence that young women who experienced multiple risk factors had a 56% chance of becoming a teenage mother, compared with a 3% chance for young women experiencing none of the risk factors. South East Regional Public Health Group Information Series 4 Teenage Pregnancy PROTOTYPE – AUGUST 2006 This information series has been compiled by the Regional Public Health Group based in the Government Office of the South East. They aim to summarise key public health issues based upon evidence, in order to facilitate good practice and improve health at local and regional levels. They are NOT policy documents.

National Drivers The National Teenage Pregnancy Strategy is set out in the Social Exclusion Unit report on Teenage Pregnancy, launched by the Prime Minister in June The two national targets are to:  Halve the under 18 conception rate in England by 2010 (with an interim reduction target of 15% by 2004) (included within the Department of Health’s Public Service Agreement (PSA), published as one of the 2001/02 NHS Performance indicators for the primary care organisations, a National PSA for Local Government and one of tow cross-cutting indicators in the Local Government Best Value Performance Indicator Set);  Increase the participation of teenage mothers in education, training or work to 60% by 2010 to reduce the risk of long term social exclusion. Reducing rates of teenage pregnancies/Sexually Transmitted Infections remain a Government priority. This was reinforced in the Public Health White Paper and is a key focus within the National Healthy Schools Programme. Consequently, the outcome framework for Children, Young People and Maternity Services include clear outcomes for young people in relations to their sexual health. At a local level, alongside annual performance assessment, Joint Area Reviews (JARs) of Local Authorities will inspect how Children’s Services are working together to improve outcomes. The evidence and judgements used to assess progress against the 5 outcomes will cover the full breadth of the teenage pregnancy strategy. As well as covering progress on reducing under-18 conceptions, JARs can examine the extent to which:  Children and young people receive sex and relationship education and access to impartial and confidential advice and guidance;  Young people are educated about sexual health risks and how to protect themselves;  Teenage mothers receive education suitable to their needs;  The proportion of expectant mothers smoking during their pregnancy decreases;  The proportion of teenage parents aged who are in education, employment or training (EET);  Recruitment strategies for post-16 education and training are being targeted at under-represented groups, of which teenage parents are one;  The proportion of teenage mothers who are in supported accommodation;  Care leavers (a group at particular risk of teenage pregnancy) have access to advice and guidance on health issues. Work to reduce teenage pregnancies and to support teenage parents can contribute to other PCT targets, in particular on reducing infant mortality (a DHPSA target), smoking cessation and breastfeeding (including its role in protecting against childhood obesity, juvenile diabetes and coronary heart disease). References 1. Eurostat: OECD demographic report 2. Social Exclusion Unit (1999) Teenage Pregnancy 3. Catherine Dennison (2004) Teenage pregnancy: an overview of the research evidence HAD/TPU 4. Harden A, Brunton G, Fletcher A, Oakley A, Burchett H, Backams M (2006) Young People, Pregnancy and Social exclusion; A systematic synthesis of research evidence to identify effective, appropriate and promising approaches for prevention and support LONDON: EPPI- Centre 5. Teenage Pregnancy Unit website

Current Situation Personal, social, economic and environmental risk factors associated with teenage pregnancy are ultimately mediated through sexual activity and contraceptive use. Therefore, understanding how these risk factors are manifested through sexual behaviour is crucial to understanding factors associated with teenage pregnancy. Factors related to teenage pregnancy have been categorised as operating at the following levels:  Individual (e.g. knowledge, self esteem, low aspirations, age at first intercourse, poor contraceptive use)  Family (e.g. parent/child communication, family structure history of mother or sister being pregnant as a teenager, children in care)  Education (e.g. provision of sex education, truancy and poor attendance at school, lack of qualifications)  Community (e.g. social norms related to sexual activity, peer and media influences)  Social (e.g. experience of childhood poverty, employment prospects and housing and social conditions) (4) The following figure shows overall percentage change in rates of under 18 conceptions between in the South East. What Works As there appears to be a good understanding of some of the factors that cause teenage pregnancy, initiatives that address these will help to reduce under 18 conception rates. In particular, following an in-depth review into the Teenage Pregnancy strategy in Autumn 2005 the following is a list of the strategy related initiatives which have been found to contribute most to areas declining under 18 conception rates:  The existence of a discrete, credible, highly visible, young-people friendly sexual health promotion as well as reactive services;  Strong delivery of sex and relationship Education / Personal, social and Health Education by schools;  Targeted work with at risk groups of young people, in particular Looked after Children;  Workforce training on sex and relationship issues within mainstream partner agencies;  A well resourced Youth Service, with a clear remit to tackle big social issues, such as young people’s sexual health. It was also noted that progress was greatest where all aspects of key strategy were being delivered effectively with engagement by the four key agencies – PCT’s, Education, Social Services and Youth Services and that the seniority and commitment of the chair of local teenage Pregnancy partnership Boards was critical to effective delivery of the strategy, locally. (5)

Ways Forward There are a range of other initiatives for which the primary focus will not be reducing teenage pregnancy rates, but nevertheless have an indirect influence on conception rates. These include:  Improved support for parents to help develop more positive parenting skills;  Providing more things to do and places to go for young people;  Urban regeneration/neighbourhood renewal strategies;  Tax credits and wider measures to reduce unemployment. Young people need the means and the motivation to avoid early pregnancy. Based on the evidence the following areas need to be developed in addition to the findings from the in- depth analysis:  Maximise schools contribution to Sex and Relationship Education;  Support parents;  Improving messages to young people on the benefits of delay;  Maximise the contribution of the Further Education sector;  Development of workforce training;  Work around second pregnancies;  Work with certain BME groups;  Work with boys and young men;  Early intervention work;  Continuing the focus on supporting parents to achieve better education and health outcomes;  Links to alcohol. Local Area Agreement Indicators proposed in guidance and areas to consider Mandatory where teenage pregnancy grant is received  Reduction in the under 18 conception rate  Number of re-registrations on child protection register*  Number of children of families placed in temporary accommodation by local authorities under the homelessness legislation, who are on the child protection register  Percentage of under 16s who have been looked after for 2.5 or more years living in the same placement for at least 2 years or are placed for adoption  Percentage of young people drinking alcohol  Percentage of young people taking illegal drugs in the last month  Proportion of under 18 year olds in drug treatment with young people’s services  Percentage of year 11 pupils achieving the equivalent of five GCSE Grades A* to C including English and maths  Percentage of 14 year olds achieving at least level five in English, Maths, Science and ICT at Key Stage Three  Educational achievement of 14 year old looked after children compared to their peers  Percentage of 16 year olds achieving equivalent of five A*-C GCSEs  Educational achievement of 16 year old looked after children compared to their peers  Percentage of year olds not in education, employment or training Other Possible Indicators  Percentage of 19 year olds achieving level two or equivalent  Number of young offenders in education, training and employment  Reduce the proportion of young offenders who re-offend  Permanent and fixed period exclusions from school  Percentage of year olds admitting to a) bullying another pupil, and b) attacking, threatening or being rude due to skin colour, race or religion  Developing self confidence and successfully dealing with significant life changes  and challenges (measure to be identified from Children’s Perception Survey) For further information please contact: For additional copies of the Information Series please visit