Introduction

Teenage pregnancy can be both a cause and a consequence of social exclusion and is more common in areas of deprivation. The poorer outcomes associated with teenage parenthood, including, increased risk of post-natal depression, and smoking in pregnancy, also means the effects of deprivation and social exclusion are passed from one generation to the next.

Evidence clearly shows that having children at a young age can damage young women’s health and emotional well-being. It can severely limit their education and career prospects, resulting in increased levels of poverty and social exclusion. Research shows that children born to teenagers are more likely to experience a range of negative outcomes in later life, including increased risk of obesity and lower educational attainment, and are up to three times more likely to become a teenage parent themselves. Most young parents do not regret having their children but wish they had waited until they were older.¹

The challenge for Nottinghamshire, is to provide young people with the means to avoid early pregnancy but also to tackle the underlying circumstances that motivate young people, either consciously or passively, to become pregnant or young parents at a young age.

Nottinghamshire’s teenage conception rates have been declining alongside national and regional progress; however there are a number of smaller areas within the county where teenage conception rates are persistently high. These areas are actively being targeted with programmes and interventions.

Unmet need and gaps

A comprehensive service has been commissioned across all districts of Nottinghamshire, (both coverage and type of service/intervention), including the provision of Contraception and Sexual Health Services, Emergency Hormonal Contraception (EHC) provision from Pharmacists and C-Card sites in accessible settings within hot spot wards across Nottinghamshire. There is however further work that could be done to continually review the targeted support for teenage parents the services provide along with collecting data to monitor access and use.

A service review carried out in 2013 on the National Healthy Schools Programme highlighted gaps and inconsistencies from schools in delivering sex and relationships education (SRE) programmes to pupils. It also stated that rather than existing school staff they would prefer an external provider to SRE. Currently the only provision to schools is given by C Card (young people’s contraception scheme) in supporting with SRE delivery as well as C Card sessions. Further work is required to understand what the challenges are for schools to deliver age appropriate SRE and whether an SRE package is commissioned for target schools or training is targeted to teaching staff to equip them with the skills and confidence to deliver programmes in a sustainable way. From March 2017 it has become mandatory for schools to deliver Personal Social Health Education (PSHE) or Sex and Relationships Education (SRE), this ensures pupils are taught the knowledge and life skills they will need to stay safe and develop healthy and supportive relationships, particularly dealing with the challenges of growing up in an online world. ²⁴ However, all schools are not fully equipped or have the tools to deliver SRE which is critical for the continued improvement of young people’s sexual health. In light of this there would need to be a planned approach across Nottinghamshire in supporting schools to deliver on this agenda at a consistent standard.

Proactively engage pregnant teenagers and young fathers to increase their access to children centres and participation in children centre activities.

Despite there being a specialist teenage pregnancy midwifery team in some districts of the County, there needs to be more work done to ensure services are meeting the needs of pregnant teenagers across the whole of the County in the way its delivered and reaching more young mothers.

Increased early identification, early access and effective care for all hard to reach groups who may not access ante-natal care before 12 weeks of pregnancy, for example teenagers, gypsy roma traveller (GRT), refugees and asylum seekers.

There is no dedicated careers advice service in Nottinghamshire so the need to support pregnant teenagers and teenage parents to access training or employment remains a challenge. This is apparent in the poor take up of the Care to Learn grant which is a key contributor to increasing engagement.  Uptake of the Care to Learn childcare grant for teenage parents is low and further work is required to promote the grant to young people and local practitioners in education and childcare settings.

Young fathers are often invisible to services with much of the support and focus given to young mothers. This is because often young fathers do not live with the mother, are disengaged as they feel ‘left out’ of parent services focused on mothers and also young fathers may present as single men. Further work needs to be done to engage young fathers in services as statistics show that:

• Children with highly involved fathers have better outcomes
• Young fathers influence the mothers smoking and breastfeeding choices
• Teenage mothers with a supportive partner are less likely to get post-natal depression
• Becoming a father can be a positive turning point in confidence and re-engagement with education and employment.¹⁵

Knowledge gaps

There are a number of gaps in knowledge and further work is required to identify data and knowledge in order to progress a successful strategy.

Health Provision

• Access to services for higher risk groups.
• Smoking prevalence and quitter rate data are not available by age or target group. Work needs to be done with Nottinghamshire’s smoking cessation service, SmokeFreeLife, to understand if and how pregnant teenagers and teenage parents access the service.
• Infant mortality data is limited because the numbers are relatively small. Further work is required to aggregate data to understand any local issues for teenagers and their children.
• Children Centre services have previously had a key role in engaging fathers, however in recent years, the needs of fathers have received a lower profile than the needs of mothers.  It is currently unclear what the current needs and views of fathers are in relation to outcomes for young children
• A more holistic approach considering both the health and social needs of teenage parents needs to take place. The learning from this needs to be shared to ensure universal and targeted services to proactively engage this group.

Education

• School readiness is a measure of how prepared a child is to succeed in statutory education.  The good level of development (GLD) is used to assess school readiness.  Currently children are defined as having reached a GLD at the end of the Early Years Foundation Stage if they have achieved at least the expected level in the early learning goals in the prime areas of learning (personal, social and emotional development, physical development and communication and language) and in the specific areas of mathematics and literacy. Currently there is no local data collected regarding GLD for children of teenage mothers.

Safeguarding

• There needs to be a better understanding on issues around sexual exploitation locally- a new Child Sexual Exploitation pathway is in place²⁰, but further work needs to done to grasp the complexities around this to best support young people.

Childcare

• Nottinghamshire requires an improved understanding of uptake of childcare opportunities for teenage mothers to access education or training. A greater understanding of local barriers would be required by engaging young people in local research.

Table 1: Recommendations for consideration by commissioners

Tina Bhundia

Public Health & Commissioning Manager,

Children’s Integrated Commissioning Hub, Public Health, Nottinghamshire County Council. tina.bhundia@nottscc.gov.uk, Tel: 0115 9772373

Kerrie Adams

Senior Public Health & Commissioning Manager

Children’s Integrated Commissioning Hub, Public Health, Nottinghamshire County Council. kerrie.adams@nottscc.gov.uk, Tel: 0115 9772198