2. Prevention of teenage pregnancies, best practice from the Netherlands Ineke van der Vlugt Programme coordinator Rutgers Nisso Groep

3. Presentation 1.Teenage pregnancies in the Dutch context 2.Facts and figures 3.Key determinants of teenage motherhood 4.Prevention of teenage pregnancies 5.Relative factors of success 6.Improvement strategies in the last years

4. 1. Teenage pregnancies in the Dutch context -Social democratic Christian government -Liberal pragmatic attitude towards sexuality of youth -Good access to contraceptives and abortion -Sexual youth services for under 24s (Sense) -Under 21 the morning-after pill is free -Positive attitude to family planning (average age is 28) -High contraceptive use (double Dutch) -Long history of sexuality education -Since 2006 prevention of teenage pregnancies topic in Dutch policy

5. Birth and abortion rate 1980-2007 per 1,000 girls 15-19 years Source: LAR 2007

6. Teenage pregnancies and abortions per 1,000 girls ≤19 yrs van Lee & Wijsen (2008)

7. Ethnic differences in teenage abortion ratio per 1,000 girls ≤19 yrs van Lee & Wijsen (2008)

8. Changes in contraceptive use first intercourse highschool youth 12-17 yrs de Graaf, Meijer, Poelman, & Vanwesenbeeck, 2005 Brugman, Goedhart, Vogels & van Zessen, 1995

9. 3. Key determinants of teenage pregnancies Aspects of personal lifestyle and sexual development: -Lack of aims or perspective -External locus of control -Lack of adequate sexuality education -Traditional gender roles -Conflicting messages -Ineffective contraceptive use (including emergency pill) -Unplanned sex Indirect determinants: -Lack of warmth or abundance of problems at home -Intergenerational transference -Latent desire, ambivalence

10. Conclusion Prevention of teenage pregnancies is Difficult or Not important !

11. 4. Preventative interventions in response Sexuality education in the Netherlands -Comprehensive and starting at an early age -Relationship & Sexuality in primary school -Long Live Love in secondary school -Integrated sexual health in vocational training -Contraceptive support in youth friendly services, in school and youth welfare In cooperation with public health centres

12. Comprehensive approach: Six domains of sexuality education Safe Sex Sexuality Relation- ships Sexual violence Reproduction pregnancy Physical, social and emotional development Sexuality education

13. Comprehensive approach: stakeholders Sexual health care services Media Others School teachers Parents Youth/ RAP Youth sexual health

14. Specific interventions Girls’ Choice, attractive game for girls (10-15 year old girls) Girls’ Talk, gender specific counselling programme (14- 18 year old girls) Your life, your choice! Gender specific counselling programme 18 – 24 year old adolescents) Contraceptive suitcase and materials

15. 5. Relative factors of success (content based): -Focus on sexual and reproductive health (not only on risks) -Different levels: knowledge, attitude, emotions, intentions, interaction, skills -Respecting gender- and cultural diversity -Personal fit (aims, barriers, doubts, risks) -Contraceptive choices, advantages and disadvantages, use and customary behaviour, help after failure (emergency pill) -Familial planning, responsibility when getting a child (motherhood and fatherhood)

16. 6. Improvement strategies in the last years -Monitoring Sex under 25 -Special programme Sexual Health of Young People (government funding) -Research on determinants of teenage pregnancies -Developing evidence based programmes -Cooperation with public health centres -Youth participation -Starting media campaigns -Focus on implementation monitors -Building up an integrated programme for young people in their different stages of life

18. Thanks a lot for your attention ! i.vandervlugt@rng.nl