Teenage conceptions in Wales The challenge of intervention and evaluation

Background NHS Wales annual quality framework 2011/2012 teenage conceptions are a targeted area Funding from WAG to carryout and evaluate interventions (300K over three years)

Why teenage pregnancy matters Most are unplanned and about half end in an abortion Teenagers who become parents are known to experience greater educational, health, social and economic difficulties than young people who are not parents and there are frequently poorer outcomes for the child The principal risk factors associated with teenage conception are: socio-economic deprivation; limited involvement in education; low educational attainment; limited access to consistent, positive adult support, low self esteem; being a child of a teenage mother These risk factors are to be found in the looked after population more than among children and young people who are not in care

Preliminary data analysis What does the Welsh data tell us? Data source: Public Health Wales Observatory

When analysed at ward level it is evident that most wards with no or few conceptions and a few wards with very high numbers (ward size varies) Variation in numbers of teenage conceptions across wards

Vulnerable groups : there is tentative evidence of a relationship between teenage conception rates and the rate of looked after children within each UA. Although this does not demonstrate a causal link it highlights the potential importance of this group. Other UK data supports the vulnerability of LAC and teenage conceptions

Focusing on the LA with high Teenage Conception numbers : The rate varies from year to year (2005 to 2008) however these differences are not significant Yearly proportion of year old females who experience TC Count of TC by LA

Task and finish group set up: practitioners, researchers, commissioners to; 1.Look at evidence for what works (review led by Dr Mercer UWIC) 2.Look at data on teenage conceptions from across Wales (HPT and NWORTH) 3.Gather information from practitioners on current interventions in Wales 4.Identify target groups 5.Design intervention – support implementation 6.Evaluate 7.Inform policy

Progress to date First scoping meeting held Dec 2010 March 1 st meeting to look at evidence for effectiveness of interventions to consider implications of Welsh data to identify populations to be targeted to outline appropriate methodological approach Next stage will then be to engage with HBs, local teams to move forward with intervention

Guiding principles 1.To be led by the evidence base 2.To be led by Welsh data to identify groups and geographic areas of highest need 3.Where possible to build on existing services and skill 4.To be realistic in setting measurable and meaningful outcomes 5.To undertake robust evaluation

What works? Giving young people the knowledge and skills they need to experience positive relationships and good sexual health – not enough on its own Improving young people’s access to and use of effective contraception when they need it Intervening early with those most at risk

LARCs This is more reliable than other methods of contraception As an indication of the potential financial benefits of LARCs a 10% switch rate of female contraceptive users from the oral contraceptive pill to LARCs would save approximately £300,000 Public and clinical awareness of the advantages of LARCs is not as widespread as with other methods of contraception

Options available Using NICE guidance as a start Offering, in wide range of settings, one to one consultation: Advising on prevention Discussing and offering all methods of reversible contraception, including LARC Advising on use of emergency contraception other reproductive issues and concerns

Teenage conceptions amongst LAC / care leavers Difficult data to obtain however initial scoping work in North Wales suggest: In area of high TC, 36% of teenage conceptions were amongst LAC / Care leavers Amongst LAC / care leavers approx 9.4% of young women conceive - with poor outcomes in over half of the live births

Warnings from Scotland Evaluation of integrated ‘healthy respect’ program Lower benefit seen in organisations working with vulnerable young people ‘‘Difficult to determine what effect Healthy Respect has on teenage pregnancy’’

Conclusions Considerable variation exists across Wales at both ward and UA level in teenage conceptions Considerable variation over time in the counts and rates seen across wards The ward level data identifies those populations with the greatest number of teenage conceptions and thus where interventions could best be focused The increased vulnerability of LAC, and by inference care leavers merits attention Regional difference may exist across Wales; thus in some areas target vulnerable young people e.g. LAC / care leavers, in other target vulnerable communities This has significant implications for the design of studies to evaluate the effectiveness of intervention. Studies need to be of sufficient size and design to take into account this background variation