1. Teenage pregnancy and young parents: maintaining the focus PHE Conference: 16 September 2015 Alison Hadley, Director, Teenage Pregnancy Knowledge Exchange, University of Bedfordshire and Teenage Pregnancy Advisor to Public Health England

2. Why teenage pregnancy still matters The importance of a whole systems approach to teenage pregnancy and young parents The contribution of improved support for young parents: making the case locally

3. Why teenage pregnancy still matters

4. England progress: 1998-2013  48% reduction in under 18 conception rate from 46.6/1000 15-17 year olds in 1998 to 24.3/1000 in 2013  Lowest rate since 1969 when data collection began  High rates are not inevitable, even in deprived areas, if young people are given choices  Evidence that concerted effort – and sufficient time - can make a difference

5. Under 18 conception rate | 1998-2013 5 Presentation title - edit in Header and Footer

6. Great progress, but more to do..  Rates remain higher than levels experienced by young people in similar Western European countries  Progress varies between and within local authorities - reductions range between 20% to 60%; - 29% of LAs have a conception rate significantly higher than the England average - Inequalities within LAs remain with high rate wards in all LAs  Outcomes remain disproportionately poor for young parents and their children

7. Poor child health outcomes 21% higher risk of preterm birth and 93% higher risk for second pregnancies 15% higher risk of low birth weight A third higher risk of stillbirth and 41% higher rates of infant mortality Affected by … Late booking for antenatal care (on average 16 weeks) Three times higher rate of smoking during pregnancy A third lower rate of breastfeeding Poor maternal nutrition

8. Poor emotional health and well being Three times the rate of post-natal depression of older mothers Higher rates of poor mental health for up to 3 years after the birth Higher risk of partnership breakdown and isolation More likely to live in poor quality housing Affecting the well being of their children and contributing to: Higher accident rates - such as from falls and swallowing substances More behavioural problems - conduct, emotional and hyperactivity problems

9. Poor economic well being 21% of all young people not in education, training or employment are teenage mothers or pregnant teenagers By age 30, 22% more likely to be living in poverty than mothers giving birth aged 24 or over Much less likely to be employed or living with a partner Young fathers twice as likely to be unemployed at age 30 – even after taking account of deprivation Which also affects the economic well being of their children who have: 63% higher risk of living in child poverty Lower academic attainment A higher risk of unemployment and low income in later life

10. Outcomes also affected by apprehensions of teenage mothers & young fathers  May have a number of vulnerabilities and have missed out on protective factors – SRE at school and home, positive role models, strong peer support, a trusted adult  May anticipate judgmental attitudes from staff – and other parents  May mistrust confidentiality and the overlap with social services  May worry about asking for advice in case practitioners think they can’t cope

11. Maintaining a whole systems approach to teenage pregnancy – including support for young parents

12. Strategic leadership & accountability SRE in schools and colleges Youth friendly contraceptive/SH services and condom schemes Targeted prevention for young people at risk Support for parents to discuss relationships and sexual health Training on relationships and sexual health for health and non- health professionals Advice and access to contraception in non-health youth settings Consistent messages to young people, parents and practitioners Strong use of data for commissioning and monitoring of progress Co-ordinated support for teenage mothers and young fathers Ten factors for an effective local strategy

13. Poor outcomes are not inevitable with effective partnership working  Solution to improved outcomes rests with a range of services working together – health, education, social care, youth support services, housing, the voluntary sector and Local Enterprise Boards  Key ingredients of effective support are: early identification and needs assessment in the antenatal period, dedicated support from a lead professional – coordinating and drawing in specialist services as necessary  Family Nurse Partnership: intensive support for young parents from family nurse, from no later than 28 weeks of pregnancy until child reaches two.

14. The importance of coordinated support lessons from serious case reviews* “In too many cases there had been insufficient support for young parents”  Young teenage parents need an environment in which they feel comfortable and supported. Adult centred services may not achieve this without additional teenage focus  There should be a joined up approach to teenage pregnancy and teenage parents with every agency understanding their role  Planned and coordinated transfer of care between midwifery services, health visitors and GPs is critical  Both parents need to be supported. The father is as important as the mother and they need support to help them become good parents * Ofsted: Ages of Concern: 2011

15. The importance of involving young fathers  75% of babies to teenage mothers are jointly registered with the father; only 20% are sole registrations  Young fathers have a strong influence over young mothers’ attitudes and decisions about smoking and breastfeeding  A good relationship with the baby’s father and supportive behaviour by him is a protective factor for postnatal depression Highly involved fathers (even if the couple don’t remain together) is associated with better outcomes for the child - emotional, behavioural and educational

16. Joining up the care pathway to support teenage mothers and young fathers?

17. Joining up the care pathway  Early pregnancy diagnosis and access to unbiased advice  Swift referral to antenatal booking + information to support healthy early pregnancy - folic acid & healthy start – and referral to Family Nurse Partnership  Careful pre-birth assessment in maternity services to identify and provide early help for any health, relationship, safeguarding or social problems  Antenatal care and preparation for parenthood for teenage mothers and young fathers, in a trusted and young people friendly setting – ideally meeting You’re Welcome criteria  Help with choosing postnatal contraception – with method provided before leaving maternity care

18. Joining up the care pathway  Clear referral pathway between maternity services and on- going support services, health visitors, teenage parent support service, children’s centres – so all young parents are known about  Dedicated adviser/HV/FNP, co-ordinating support on health – including emotional health, education, housing, benefits, parenting and attachment  More intensive help for the most vulnerable, and inclusive of young fathers

19. Joining up the care pathway  Personal development plans – for both parents building aspirations and skills, linked to RPA programme, local workforce development, employment and regeneration plans  Promotion of Care to Learn childcare funding and support with application form  On-going support on contraception and condoms with chlamydia screening annually or on change of partner  Information about all relevant support services to young parents and all practitioners working with them – and supported transfer from specialist support to mainstream services

20. The contribution of improved support for young parents: making the case locally

21. LA Child Health Profiles: Children in poverty (63% higher risk for children born to women under 20) Rates of adolescents not in education, employment or training (NEET) (21% of the estimated number of female NEETs 16-18 are teenage mothers) Infant mortality rate (41% higher risk for babies born to women under 20) Incidence of low birth weight of term babies (25% higher risk for babies born to women under 20) Maternal smoking prevalence (including during pregnancy) (Mothers under 20 are twice as likely to smoke before and during pregnancy and three times more likely to smoke throughout pregnancy) Breastfeeding initiation and prevalence at 6-8 weeks (Mothers under 20 are third less likely to initiate breastfeeding and half as likely to be breastfeeding at 6-8 weeks)

22. The contribution of improved support for teenage mothers and young fathers ▪ Giving every child the best start in life and reducing child poverty ▪ Reaching the most disadvantaged children and families: Core purpose of Children’s Centres, free education for disadvantaged 2 year olds, Health Visitor Implementation Plan and 0-5 Healthy Child Programme ▪ Narrowing educational inequalities and improving skills and employability: Raising the Participation Age, increasing young people in education, training and employment ▪ Address safeguarding issues by getting early help services right for teenage mothers and young fathers

23. In summary  Great progress but more to do to support young people to delay early pregnancy and improve outcomes for those who choose to become young parents  Teenage pregnancy needs to remain part of JSNAs and joint commissioning with all agencies understanding their part of the solution  Young parent support is key to long term prevention

24. For more information: Alison.hadley@beds.ac.uk Alison.hadley@phe.gov.uk Teenage Pregnancy Knowledge Exchange www.beds.ac.uk/knowledgeexchange/knowledgeexchange If you would like to be on the Teenage Pregnancy Knowledge Exchange contacts list, or have any follow up questions, please email me.