Alison Hadley Teenage Pregnancy Unit The Teenage Pregnancy Strategy What we did and what we learned

The journey of the Strategy

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

Joined Up Action Establishing clear goals

National and local targets «National target: - 50% reduction in under 18 conception rate by 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 The Structures

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

Joined Up Action 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

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 «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

Strategic leadership & accountability SRE in schools and colleges Young people friendly contraceptive & SH services Clear and consistent messages to young people, parents and practitioners Workforce training on SRE SRE & access to contraception in youth services Targeted SRE and contraception/SH support for young people at risk Strong use of data for commissioning & Local performance management Dedicated support for teenage parents – including SRE and contraception Supporting parents to discuss sex & relationships New more prescriptive guidance: the ten key factors for effective delivery

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 «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 – 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 s → 35.4 per s «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