Prevention of Teenage Pregnancy Policy in the UK

Introduction This essay will discuss the current policies in place to prevent teenage pregnancy in the United Kingdom. Firstly, it will introduce the key concept of teenage pregnancy and discuss it against the context of the problems it creates. The current teenage pregnancy policy will then be presented and critiqued. Finally, a number of recommendations and conclusion will be drawn. Definition and Background According to the World Health Organization (WHO), teenage pregnancy is defined as pregnancy in a woman aged 10 – 19, whilst Unicef (2008) define it as conception occurring in a woman aged 13 – 19 (Unicef, 2008). On the basis of this definition, Unicef calculated that the teenage pregnancy rate in the UK is the highest in Western Europe (Unicef, 2001), and aside from a slight decrease in the birth rate to teenage mothers during the 1970’s it has remained relatively constant since 1969 (DoH, 2003). In 1999, the Labour Government’s Social Exclusion Unit (SEU) presented its report to parliament acknowledging the scope and seriousness of the problem, particularly with reference to damage to the mother’s academic and career progression, and the health of the child. The National Teenage Pregnancy Strategy The SEU implored the Government to commit to reducing teenage conceptions by 50% by 2010, and to address the social exclusion of young mothers. To meet the first aim, the SEU championed improved sexual education, both inside and outside school and better access to contraceptives. To achieve the second, it recommended the implementation of multi-agency government programmes designed to provide support in housing, education and training. To implement the recommendations of the report, the Government set up the Teenage Pregnancy Unit (TPU), which was located in the Department of Health, but required local authorities (LA) to produce their own strategies to reduce teenage conception by 50% by 2010, with an interim target of 15% by 2004. The majority of prevention strategies focused on four key areas; the use of mass media to increase awareness of sexual health, sex and relationship education (SRE) in schools and community settings, easily available services and information on sexual health and better-quality support for young parents to drop social exclusion (DCFS 2009). In 2000, the Department for Children, Schools and Family (DCSF) issued directives to all schools to ensure that SRE in schools aimed to enable young people to make responsible and well-informed choices about their sexual lives and desist from risky behaviours which influence unintended pregnancy (DCSF 2009c). LA gave their strong backing to ensure incl usion of complete SRE programmes into personal and social education lessons in all schools (DfES 2006). The methods of administering SRE differed across LAs. For example, the services of sexual health specialists were stretched outside clinical environment to encompass schools and community settings. Programmes outside of the school environment were implemented to expose teenagers to the realities of parenting and the advantages of sensible sexual choices, and included Choose your Life, Body Tool Kit, Teens and Tots, and the Virtual Doll Plan. The varying needs of culturally diverse communities were measured, and programmes were tailored to meet them. In LA containing the most at-risk teenagers, advanced SRE plans involving parents, teachers, school nurses, teachers and vanguard staff were made. Southwark LA for example, sought to improve the information of young people on early gestations, direct them to making reliable choices and in turn decrease the rate of teenage pregnancies ((NHS Southwark 2007; Fullerton et al 1997). The actions taken were in line with the goals and purposes of the agenda; studies have demonstrated that teenagers value a forum to discuss sex and relationship issues, and such forums are beneficial as they decrease the chances of earlier sexual contact (Allen et al. 2007; Fullerton et al. 1997). Nevertheless, local differences occurred that hampered with the distribution of SRE in the schools in some areas. Not all schools embraced SRE in their teaching syllabus, some of the teachers were uncertain of the degree to teach and were either uncomfortable or awkward about young people’s sexual matters. Some schools had a syllabus that excluded social or emotional topics, which play an important role (Chambers, 2002). Some areas included mixed sex classes; these were less successful as some teenagers, particularly females, felt inhibited (Stephenson et al. 2004). Additionally, some parents refused to support the policy and withdrew their children from SRE classes (Lanek, 2005). I n reaction to these difficulties, the Health & Social Care Scrutiny Sub-Committee (2004) made further recommendations, emphasising the responsibility of schools (particularly faith schools) to include SRE in the curriculum. Post 2010, the policy aims and objectives were to build on the existing strategy, and enable young people to receive the knowledge, advice and support they need from parents, teachers and other specialist to deal with the pressure to have sex, enjoy positive and caring relationships and have good sexual health. Policy Type Birkland (1984) and Lowi et al. (1964) have argued that knowing the type of policy one is dealing with will enable one to predict what may arise after the policy has been implemented. However, Wilson (1973) has criticized categorising policies, as some are too complex to be so simply defined. This is a criticism that can be fiarly levelled at the policy under discussion, which is both preventive and self-regulatory. It aims to reduce and prevent pregancies to bridging health and education inequality gaps that teenage mothers face, reducing child poverty and reducing the cost of teenage pregnancy on public funds. It is both distributive and pragmatic; distributive in that it permits benefit to a particular group (Birkland, 1984), and pragmatic in that it was designed to be practical and workable (Maclure, 2009). The Political Context According to Leichter (1979) contextual factors that can affect policy production can be political, social, economic, cultural, national and international, with some factors becoming major contributors to the policy. Taking the example of international factors, Levine (2003) states that interdependency of nations with the same social problem can affect the policy of the adopting nation takes to solve their problem. In the UK, international influences such as the European Union, WHO and countries facing the same high teenage pregnancy rate have all impacted UK policy on the same issue (Baggott, 2007). As a member state of European Union, the regulation of our national law by the Union takes priority in informing and sharpening our policies (Mclean, 2006). Politically in Britain, the ‘teenage mother’ has come to symbolise social decline. This began with the Conservative government in the 1990’s, who first politicised the single mother by describing her as typifying the prevalent moral standards (particularly amongst the lower social classes) that threatened society (Macvarish, XX). Following the election of the Labour party in 1997, this political perception was altered in line with the New Labour vision; a more optimistic national mood teamed with traditional Labour views on social equality. Under this perspective, issues such as poverty and unemployment were viewed as symptoms of ‘social exclusion’ whereby individuals were unfairly excluded from participating fully in society. Such communities were to be viewed sympathetically instead of being blamed, and it was within this context that the strategy evolved: reducing teenage pregnancy was one way of making the excluded included (Macvarish XX). Against this backdrop of poitical ideology, the UK has a democratic system of government whereby decisions and policies are made based on the influence of the stakeholders. The teenage pregnancy strategy had pluralist influences including the director of public health, consultants in public health, the director of social services, specialist midwifes and parents of teenagers. These contributions were multi-level; nationally, regionally and locally. At a national level, financial support and endorsement was provided by senior ministers, guidance and monitoring was provided at a regional level, and participation by young people and their parents provided the local input. Policy implementation Implementation is the process of turning policy into practice (Buse, 2005). The implementation of the teenage pregnancy policy was two phase: the first launched in 1999 and depended on ‘better’ sex education both in and out of schools, and improved access to contraception. The second phase came 10 years later in 2008 and relied upon different government programs designed to assist teenage mothers with returning to education or training, gaining employment or providing support with other social factors such as housing. The implementation of teenage pregnancy policy was also top-down. The purpose of the policy was to reduce and prevent teenagers from becoming early parents through support and increasing implementation of preventative guidance by the government and to combat social exclusion of teenage mothers. The policy can be seen to be self-regulatory because it was behavioral and aimed to provide the individual with the skills to make informed decisons regarding their sexual health (Bartle & Vass, 1998). There are additional factors that help to facilitate the implementation of policy; actors in policy, and experts in the agenda. Actors generally are individuals with power that can be excercised through influencing policy. They may be lobby or pressure groups and can include politicians, civil servants, and members of an interest group (Buse, 2005). The involvement of experts in the agenda setting was clear from the outset. The National guidance allowed the local areas to enlarge the scope of the policy using guidance. The involvement of local actors and the use of data from the local areas helped to motivate local action. Taking advantage of local knowledge or information facilitates matching policy to the specific needs of the teenagers. Analysis of policy successStrategy implementation related successFollowing the publication of the policy, the earliest the strategy could begin to be implemented was early 2000, but this was highly dependent on the employment of local teenage pregnancy co-ordinators. By the third quarter of 2000, 75% of these posts were staffed, rising to virtually 100% in 2001 (TPSE, 2005). With regards the communication strategy, the percentage of local areas that used media campaigns to reinforce the messages of the national campaign grew steadily from 2% in 2000 to 40% in 2001 (TPSE, 2005). The number of areas with at least one sexual health service dedicated to young people increased consistently from 68% in 2000 to 84% in 2001, while support for young parents with emphasis on reintegration into work and training rose to 70% according to TPSE (2005). Over the course of the strategy, 10,000 teachers, support staff and nurses were trained to deliver Personal, Social and Health Education in schools (TPAIG, 2010).Prevention related successThe original ambition of the teenage pregnancy strategy was to achieve a 15% reduction in under-18 conception by 2004 and 50% reduction by 2010, accompanied by a downward trend in the under-16 conception rate (TPSE 2005). The first phase of the strategy came to an end after a period of ten years without achieving its entire target. In the early part of tits implementation, the policy appeared to have moderate success. By 2002, the conception rate for under-18s had fallen by 9%, reversing the upward trend seen prior to the strategy implementation, and contrary to the relatively static rates observed over the past 30 years (TPSE, 2005). Success varied across the UK, but a steeper decline in conception rates in socio-economically deprived areas suggested that it had targeted the most ‘at-risk’ areas. For example, Hackney council reported a decrease in the rates of repeated abortion from 49% to 27% in under-18s, and they report that the majority of under-16s report not having sex due to understanding of abstinence. How successful the policy had been depended greatly on how robustly it was implemented across various local areas. In general, there was a reduction in areas that have carried out proper implementation, with some areas able to report a 45% decline, while other areas performed poorly due to poor implementation, with no reduction, or in some cases, an increase (TPAIG, 2010). However, the follow-up report ‘Teenage Pregnancy Strategy: Beyond 2010 found that the overall conception rate had fallen by 13.3% since 1998, falling well short of the projected 50% reduction. However the DoH add that births to under-18s had fallen by 25% over this period (DoH, 2010).They also point to the increase in access to sexual health services, information and advice as an additional indicator of success. The new phase goes beyond the original 10-year target, adding more content added to the policy, following an incremental process according to TPSE (2005). Incrementalpolicy according to Lindblom (1993) is a major achievement that is attained as a result of small steps taken which guarded against policy disaster. However, the new phase exists within a climate of austerity. The current downtrend of conception rates in the under-18 age group will be difficult to maintain against a backdrop of disinvestment, which has already led to widespread closure of specialist sexual h ealth services for under-18s.Gaps in the policyIn applying teenage pregnancy policy to the present situation, it can be said that the policy did not really look inward into the situation that the country was facing. It looked at the success rate of other countries without tailoring their measures to curb the problems specific to Britain. The policy is a social policy and as such it focussed on the social aspect of the problem without looking at the health issues that come with teenage pregnancy. Addiitonally, the time frame given to meet its target of a 50% was too short. Teenage pregancy is inextricably linked to both poverty, a social issue too wide to tackle in one decade. It is also strongly related to culture, and specifically the need to foster a culture of openess regarding sexual behaviour and health. This again is too complex to challenge in 10 years. Recommendations In the first instance, the coalition Government must address the shortcomings currently seen in sexual relation education (SRE). The former Government elected to not make SRE part of the compulsory curriculum, and as a result provision of SRE across the country is patchy. The Government should pass legislation ensure good practice such as SRE becomes compulsory. Additionally, refinements to existing SRE need to be made. In particular this should include devising ethnic and faith-based SRE programmes, which will better address the diversity of beliefs held in a modern multi-cultural Britain. Also, the deliberation of same-sex SRE classes should be completed and implemented (Fullerton et al 2001). More use should be made of robust team-working within communities, health sectors and schools in encouraging SRE, and the creative use and further training of more peer-educators to deliver the strategy within schools should be considered. Secondly, an approach which combines measures to prevent teenage conception and support teenage mothers must be in tandem to wider measures to address poverty and social exclusion. The loss of the Education Maintenance Allowance and the closure of many Sure Start centres disproportionately disadvantage the socio-economically deprived, and widen the gap in attainment between the rich and poor. Thirdly, the coalition government must be invested in making reductions to teenage pregnancy rates a priority. Ring-fencing of funds for specialist sexual health services and training in SRE must be guaranteed in order to not lose the small, but significant reductions in teenage pregnancy rates seen to date. Relatedly, strategies to address teenage pregnancy should be integrated into all future policies. Finally, the patchy nature of strategy deliverance across local authorities must be addressed. Areas that neglect to implement the strategy effectively should be identified, and supported according. Sharing of good practice across local authorities should be made routine. Conclusions In conclusion, this essay has outlined the teenage pregnancy strategy devised in 1998, its background and political context. It went on to discuss the outcomes of the first ten-year phase. At this point, it is still too early to say whether the second phase will meet its overall target, especially in the current economic climate, although the strategy focused attention on the problem and provided materials to help local, regional and national implementation of the strategy. As Britain remains a culturally diverse country, addressing this with regards teenage sexual health should remain a priority. In particular, adequate training of all personnel that will help and support teenagers in and out of school, increasing parental involvement in sex and contraception, and ring fencing specialist sexual health services should all be seen as important and complimentary factors in continuing to address pregnancy in UK teenagers. References: Allen, E., Bonell, C., Strange, V., Copas, A., Stephenson, J., Johnson, A.M. & Oakley, A., (2007). Does the UK government’s teenage pregnancy strategy deal with the correct risk factorsFindings from a secondary analysis of data from a randomised trial of sex education and their implications for policy. Journal of epidemiology and community health, 61(1), 20-27. BERTHOUD, R. (2001).Teenage births to ethnic minority women. Population Trends, 6(104):12-17. BONELL, C., ALLEN, E., STRANGE, V., COPAS, A., OAKLEY, A., STEPHENSON, J. and JOHNSON, A. (2005). The effect of dislike of school on risk of teenage pregnancy: testing of hypotheses using longitudinal data from a randomised trial of sex education. Journal of epidemiology and community health, 59(3), 223-230. BONELL, C.P., STRANGE, V.J., STEPHENSON, J.M., OAKLEY, A.R., COPAS, A.J., FORREST, S.P., JOHNSON, A.M. and BLACK, S. (2003). Effect of social exclusion on the risk of teenage pregnancy: development of hypotheses using baseline data from a randomised trial of sex education. Journal of epidemiology and community health, 57(11), 871-876. BOS, R. (2006). Health impact assessment and health promotion. Bulletin of the World Health Organization, 84(11), 914-915. BREEZE, C.H. & LOCK, K., (2001). Health impact assessment as part of strategic environment assessment. Copenhagen: WHO Regional Office for Europe. Buse, K., Mays, N. and Walt, G. (2005) Making health policy. Open University PressOxford English Dictionary. 1989. 2nd ed. Oxford: Clarendon Press. CAMERON, M. (2000).A short guide to health impact assessment. London: NHS Executive London. http://www.londonshealth.gov.uk/pdf/hiaguide/pdf (accessed 1 February 2010). Chambers, R., Boath, E. & Chambers, S. (2002).Young people’s and professionals’ views about ways to reduce teenage pregnancy rates: to agree or not agree. Journal of Family Planning and Reproductive Health Care, 28(2):85-90 DCSF. (2009). Sex and relationship education (SRE). http://www.dcsf.gov.uk/everychildmatters/policy/health/sre/. (accessed January 30, 2010). DCSF. (2009). About Teenage Pregnancy Strategy http://www.dcsf.gov.uk/everychildmatters/healthandwellbeing/teenagepregnancy/about/strategy/ (accessed January 10, 2010). DCSF. (2009). Teenage Conception Statistics for England 1998-2007. http://www.dcsf.gov.uk/everychildmatters/resources-and-practice/IG00200/ (accessed January 17, 2010). DCSF, (2008). Teenage Pregnancy Independent Advisory Group. Annual report 2007-2008. http://www.everychildmatters.gov.uk/health/teenagepregnancy/tpiag (accessed December 27, 2009) DCSF. (2005). Teenage Pregnancy Strategy Evaluation. http://publications.dcsf.gov.uk/eOrderingDownload/RW38.pdf (accessed December 29, 2009). DEPARTMENT OF EDUCATION AND SKILLS. (2006). Teenage pregnancy: Accelerating the strategy to 2010. London: Crown. DEPARTMENT OF EDUCATION AND SKILLS. (2003). Sex and Relationship Education Guidance. DfES 0116/2000, 1-35. Available at http://www.dfes.gov.uk (accessed December 29, 2009). DoH (2010). Teenage Pregnancy Strategy: beyond 2010. http:// http://dera.ioe.ac.uk/11277/1/4287_Teenage%20pregnancy%20strategy_aw8.pdf (accessed July 25th 2012). DoH. (2007). Health impact assessment: questions and guidance for impact assessment.http://www.dh.gov.uk/en/Publicationsandstatistics/Legislation/Healthassessment/Browsable/DH_075622 (accessed January 17, 2010). Fullerton, D., Dickson, R., Eastwood, A.J. & SHELDON, T.A., 1997. Preventing unintended teenage pregnancies and reducing their adverse effects. Quality in Health Care, 6(2):102-8. HOUSTON, A. (2006). Neighbourhood Renewal Fund Strategic Gaps Health Inequalities: Reducing Teenage Pregnancy in Southwark: an evaluation report. UK: Houston Enterprises. KEMM, J., PARRY, J. and PALMER, S. (2004). Health impact assessment. Oxford: Oxford University Press. Joffe, M. & Mindell, J. (2005). Health impact assessment. Occupational and environmental medicine, 62(12), 907-12, 830-5. Joffe, M. & Mindell, J. (2002). A framework for the evidence base to support Health Impact Assessment. Journal of epidemiology and community health, 56(2), 132-138. Lanek, R., (2005). Communities & Outreach Presentation to the Multi-Faith Seminar on Sex & Relationships For Young People in Southwark. LOCK, K. (2000). Health impact assessment. British Medical Journal, 320: 1395-1398. Macvarish, J. (2010). Understanding the significance of the teenage mother in contemporary parenting culture. Sociological Research Online 15 (4). Metcalfe, O., Higgins, C. & Lavin, T. (2009). Health Impact Assessment Guidance. Dublin: The Institute of Public Health in Ireland MINDELL, J., BOAZ, A., JOFFE, M., CURTIS, S. and BIRLEY, M., 2004. Enhancing the evidence base for health impact assessment. Journal of epidemiology and community health, 58(7): 546-551. MINDELL, J., HANSELL, A., MORRISON, D., DOUGLAS, M., JOFFE, M. and QUANTIFIABLE HIA DISCUSSION GROUP. (2001). What do we need for robust, quantitative health impact assessmentJournal of public health medicine, 23(3): 173-178. MINDELL, J. and JOFFE, M. (2003). Health impact assessment in relation to other forms of impact assessment. Journal of public health medicine, 25(2), 107-112. NHS (2007). Southwark Vital Statistics. London, NHS NHS SOUTHWARK. (2009). Southwark Health Profile 2009. http://www.southwarkpct.nhs.uk/documents/5480.pdf. (accessed 28 December 2009) NHS SOUTHWARK, (2007). Southwark Young People’s Sexual Health &Teenage Pregnancy Needs Assessment & Equity Audit. NHS Southwark NHS SOUTHWARK, (2004). Southwark Teenage Pregnancy and Parenthood Action Plan 2003-04. NHS Southwark ONS (2009). Health Statistics Quarterly. London: Crown ONS (2004). Southwark Neighborhood Statistics. Key Figures for 2001 Census: Census Area Statistics. http://neighbourhood.statistics.gov.uk/dissemination/LeadKeyFigures PARRY, J., STEVENS, A. (2001). Prospective health impact assessment: pitfalls, problems, and possible ways forward. British Medical Journal. 323(7322):1177-82. PUBLIC HEALTH INSTITUTE SCOTLAND. (2004). Health Impact Assessment: a guide for local authorities. ROSS, D.A. (2008). Approaches to sex education: peer-led or teacher-ledPLoS medicine, 5(11), 229. SCOTT-SAMUEL A. (1988). Health impact assessment: theory into practice. Journal of epidemiology and community health, 52,704-705. SCOTT-SAMUEL, A., BIRLEY, M., ARDERN, K., (2001). The Merseyside Guidelines for Health Impact Assessment. Second Edition, May 2001. SEAMARK, C.J. and LINGS, P, (2004). Positive experiences of teenage motherhood: a qualitative study. The British journal of general practice: the journal of the Royal College of General Practitioners, 54(508), 813-818. Sexual health charity, FPA. (2010) Teenage pregnancy factsheet: [Online]. Available at: http://www.fpa.org.uk/professionals/Factsheets/teenagepreggnancy (Accessed on 30 May 2012). STEPHENSON, J.M., STRANGE, V., FORREST, S., OAKLEY, A., COPAS, A., ALLEN, E., BABIKER, A., BLACK, S., ALI, M., MONTEIRO, H., JOHNSON, A.M. and RIPPLE STUDY TEAM, (2004). Pupil-led sex education in England (RIPPLE study): cluster-randomized intervention trial. Lancet, 364(9431): 338-346 Teenage Pregnancy Independent Advisory Group (2010). Teenage Pregnancy: Past Successes – Future Challenges. [Online]. Availiable at: https://www.education.gov.uk/publications/eOrderingDownload/Past%20successes%20-%20future%20challenges.pdf (Accessed on 25th July 2012). WHITEHEAD, M. and DAHLGREN, G., 1991. What can be done about inequalities in healthLancet, 338(8774):, 1059-1063. WIGGINS, M., BONELL, C., SAWTELL, M., AUSTERBERRY, H., BURCHETT, H., ALLEN, E. and STRANGE, V. (2009). Health outcomes of youth development programme in England: prospective matched comparison study. BMJ (Clinical research ed.), 339, b2534. World Health Organization (2004) WHO Discussion papers on Adolescence, [Online]. Available at: http://whqlibdoc.who.int/publications/2004/9241591455_eng_pdf (Accessed 30 May 2012). WHO (2002). Technical Briefing Health Impact Assessment: A tool to include health on the agenda of other sectors. EUR/RC52/BD/3. Brussels: European Centre for Health Policy, World Health Organization Regional Office for Europe. World Health Organization (2001). Health impact assessment. Harmonization, mainstreaming and capacity building. Report of an inter-regional meeting on harmonization and mainstreaming of HIA in the World Health Organization and of a partnership meeting on the institutionalization of HIA capacity building in Africa. Geneva: WHO. World Health Organization, 1999. Health impact assessment: main concepts and suggested approach. Brussels: European Centre for Health Policy, World Health Organization Regional Office for Europe. Unicef. (2008). Planning: Teenage pregnancy [online]. Available at: http://www.unicef.org/Malaysia/Teenage pregnancies_overview.pdf young people and Family TAYLOR, L., GOWMAN, N., QUIGLEY, R., 2003. Evaluating health impact assessment. Yorkshire, UK: NHS Health Development Agency. THOROGOOD, M. & COOMBES, Y., 2000. Evaluating health promotion: practice & methods. Oxford: Oxford University Press. WHO, 2010. Health Impact Assessment. http://www.who.int/hia/tools/en/ (accessed 30 January 2010)