Achieving success in reducing teenage pregnancy in Hull.

Abstract

Teenage pregnancy is a complex issue with a range of contributing risk factors including poverty, low educational attainment, truancy, not being in education, employment or training (NEET), low self-esteem, early sexual activity and poor contraception use. There are disproportionately poor outcomes for those who do become teenage parents. At age 30, teenage mothers are 22% more likely to be living in poverty, 20% more likely to have no qualifications than mothers giving birth aged 24 or over and are much less likely to be employed or living with a partner. Research and evidence-based practice has shown this issue cannot be addressed through a single intervention or service as the majority of teenage pregnancies are unplanned. Instead a consistent and co-ordinated partnership approach at a strategic and operational level across schools, health, youth services, social care and voluntary sector organisations is required to deliver improved outcomes. An early intervention and prevention approach which aims to reduce risks and build resilience, along with effective use of local data and performance management is vital to maximizse impact and ensure those areas/groups of young people most at risk are reached and supported.This paper aims to summarize the successful implementation of the National Teenage Pregnancy Strategy1 at a local level. It aims to inform future commissioning and policy and build on the evidence base to sustain the current downward trend, maximize impact and continue to deliver positive outcomes in a cost effective way for young people on this and other health issues.NATIONAL CONTEXTThe Labour Government's Teenage Pregnancy Strategy for England1 had a national target to reduce under-18 conceptions nationally by 50% by 2010. All local authority areas agreed on a local reduction target ranging between 40% and 60%. If all areas had met their targets then the national 50% target would have been achieved. However impact varied with some areas seeing significant reductions while others saw smaller reductions or even, in some cases, increases. Differing outcomes related to a range of local factors highlighted in this article including level of investment and prioritization of the issue at a senior and political level.The national strategy1 was informed by an international evidence review which identified thirty key action points categorized under four main themes:* joined up action, nationally, regionally and locally;* improved sex and relationship education;* access to youth friendly contraception and sexual health services; and* improved support for young parents to improve the disproportionately poor outcomes for them and their children.There was also a national campaign to reach young people and parents.Over the course of the strategy, further national guidance and updated strategies were published nationally and implemented locally. 2-7. These were informed by emerging evidence which underpinned the importance of key aspects of the strategy including high quality sex and relationships education (SRE)8 and the importance of improving access to and increasing the uptake of contraception.9 Furthermore the guidance was informed by deep dive reviews which compared similar areas (statistical neighbours) with contrasting progress which showed reductions associated with all elements of the strategy being in place.PROGRESS MADE IN HULLReducing under-18 conception rates was identified as a key issue for Hull following the launch of the National Teenage Pregnancy Strategy in 1998. As the strategy developed locally it was further informed by local consultation and research to address gaps in provision and enable service redesign to meet need, including understanding local barriers to accessing services,10 the sexual health needs of boys and young men,11 barriers to preventing unplanned conception,12 an evaluation of support for teenage parents13 and the local biannual Young People's Health and Lifestyle survey. …