Alison Hadley Teenage Pregnancy Consultant

1. Teenage Pregnancy Strategy transferring the lessons from the last 10 years into the new system Alison Hadley Teenage Pregnancy Consultant

2. Why teenage pregnancy matters 11% of 16-18s not in education, employment or training are teenage mothers or pregnant teenagers 22% more likely to be living in poverty at 30, and much less likely to be employed or living with a partner 20% more likely to have no qualifications at age 30 3 times the rate of post-nataldepression 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 The majority of teen pregnancies are unplanned and over half end in abortion And…rates of chlamydia and gonorrhoea are highest in 16-19 women and 20-24 men

3. Teenage Pregnancy Strategy (1999-2010): the ambition Halve the under 18 conception rate by 2010 – bringing the rate in line with Western European countries Improve outcomes for teenage parents and their children, measured by increasing proportion of 16-19 mothers in education, employment or training 10 year strategies in each top tier Local Authority with local 2010 reduction target – adding up to 50% national reduction

4. Lesson 1:Concerted effort makes a difference! 24.3% reduction in under 18 conception rate (63% K&C; 38% H&F; 13.2% Westminster) 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 Concerted and sustained effort makes a difference – but needs to be continued!

5. Local progress: 93% areas (140 out of 150) show reductions Oldham Milton Keynes Tower Hamlets Hackney Swindon

6. Lesson 2 We know what works

7. The evidence • 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. 86% of recent US decline in rates is attributed to better contraceptive use • Universal and targeted. SRE and contraception provision for all, with more intensive support for young people at risk, combined with additional motivation to delay early pregnancy – ‘means and motivation’ • Dedicated coordinated support for teenage parents – with more intensive support for the most vulnerable – Family Nurse Partnership • No evidence that alternative approaches (e.g abstinence-based/benefit conditionality) are effective

8. Lesson 3 Translating evidence into practice: learning from local areas

9. Translating a complex issue … Teenage pregnancy: A complex issue associated with a large range of risk factors…

10. ..into clear actions – with everybody understanding their contribution to the solution

11. The key characteristics of successful programmes • Strategic: senior champions, engagement from all partner agencies and accountability for agreed actions • 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 • Young people focused contraception/sexual health services, in the right place, trusted by teenagers and well known by all local professionals working with them • Workforce training on sex and relationships for youth practitioners, Connexions/IAG providers, social workers/foster carers • Targeted SRE and sexual health advice for at risk groups e.g. pupil referral units, NEETs, Children in care and Care Leavers, young people in homeless units and supported housing, teenage parents

12. Lesson 4 Shifting the culture: the consensus behind the headlines

13. 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 – but both hugely overestimate the % of under 16s having sex Sex and relationships education 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 Pro-choice on pregnancy options >75% in favour of a woman’s right to choose

14. Next steps Maintaining the momentum

15. Why teenage pregnancy still matters 11% of all young people who are not in education, employment or training (NEET)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-nataldepression higher risk of poor mental health for 3 years after the birth Children of teenage mothers have a 63% increased risk of child poverty and are more likely to have childhood accidentsand behavioural problems The infant mortalityrate for babies born to teenage mothers is 60% higher 3 times more likely to smokethroughout their pregnancy, and 50% less likely to breastfeed, with negative health consequences for the child Despite the decline, teenage pregnancy rates remainhigher than comparable western european countries

16. The importance of further progress on teenage pregnancy to achieve key policy priorities ▪ Child Poverty Strategies – under 18 conception rate a national and local measure of progress ▪ Early intervention to improve outcomes for children and young people most at risk ▪ Improving safeguarding of children and young people ▪ Refocused Children’s Centres to reach vulnerable families ▪ Raising the Participation Age – statutory duty on LAs ▪ Health reforms and narrowing health inequalities

17. The key importance of Health and Wellbeing Boards ▪Health and Wellbeing Boards (HWB): HWB in each top tier Local Authority ▪ Statutory requirement on HWB to produce a Joint Strategic Needs Assessment (JSNA) of current and future needs and a Health and Wellbeing Strategy ▪ Health and Wellbeing Strategy informs all commissioning including by Clinical Commissioning Groups HWBs can challenge CCGs if out of line with HWB Strategy. ▪ Public Health England (PHE):Director of Public Health in each LA responsible for public health of their local populations, through a ring fenced public health grant which includes funding for contraception/sexual health services and prevention work ▪ Public Health Outcomes Framework: sets out key indicators for all areas local assessments

18. Public Health Outcomes Framework Sexual health indicators ▪ Under 18 conception rate ▪ Chlamydia diagnosis (15-24) Related indicators disproportionately affected by teenage pregnancy ▪ Children in poverty ▪ Child development at 2-2.5 years ▪ Rates of adolescents not in education, employment or training (NEET) ▪ Proportion of people in long term unemployment ▪ Infant mortality rate ▪ Incidence of low birth weight of term babies ▪ Maternal smoking prevalence (including during pregnancy) ▪ Breastfeeding initiation and prevalence at 6-8 weeks ▪ Hospital admissions caused by unintentional and deliberate injuries to under 5s ▪ Sexual violence

19. Making the most of the Joint Strategic Needs Assessment ▪ Make good use of local data, including high rate wards and repeat abortions ▪ Map schools, colleges and services (statutory and voluntary) young people and teenage parents are in contact with ▪ Hold engagement days with relevant practitioners and young people to map pathways, identify gaps and promote consistent messages and joined up working ▪ Use existing young people groups and the new role of local HealthWatch to advise and monitor improvements

20. To summarise… Build on progress we’ve made – ensure lessons learned are transferred to new strategic leaders and commissioners Champion why teenage pregnancy still matters – and its links to other outcomes Maximise the potential of the JSNA and Health and Wellbeing Strategy to review and strengthen key factors for effective delivery Involve relevant practitioners and young people

21. Useful links DfE teenage pregnancy website: statistics and guidance http://www.education.gov.uk/childrenandyoungpeople/healthandwellbeing/teenagepregnancy Further advice: alisonhadleymail@gmail.com