The UK has the highest rate of teenage pregnancies in western Europe, something that the government seems determined to change. But has it struck the right balance between providing for teenage mothers and taking action that might lead to a fall in the number of teenagers becoming parents? Ruth Winchester reports.

Last month, the Department of Health published research showing that babies born to teenage mothers are 60 per cent more likely to die in their first year than those born to older parents.¹ The research concludes that halving the number of teenage pregnancies could prevent the deaths of 100 babies each year.

These shocking figures may help refocus ministerial attention on the ongoing teenage pregnancy strategy, put in place by the government in response to a report by the government's social exclusion unit (SEU) in 1999.² The report laid out for the first time the causes of teenage pregnancy, and the long-term social exclusion, ill-health and poor prospects that teenage pregnancy fosters.

The latest figures show that in England in 1999 there were just over 39,000 conceptions to young women under 18. A fifth of those - 7,400 - were to girls under the age of 16. The UK has the highest rate of teenage conceptions among western European countries - three times the rate in France and six times that of the Netherlands.³

Those most at risk of teenage pregnancy are children and young adults who are already disadvantaged by poverty, problems with education and low self-esteem. The risk of becoming a teenage mother is almost 10 times higher for a girl from the lowest social class, compared with a girl from a professional background.

Predictably, children in the care system and those who have been excluded from school are among the worst affected. One in four looked-after children becomes a parent before the age of 16, and nearly half of looked-after young women are mothers by the time they become fully independent. Society's attitudes are undoubtedly playing a part in this polarisation. As one youth worker said: "If you're pregnant and from a middle class area, they offer you a termination. If you come from a poor area they call the midwife."

Of the 39,000 conceptions in 1999, a little over 22,000 resulted in births - and the consequences of teenage parenthood can be incapacitating. Without education or training and with little access to child care, these young families are trapped in desolate, impoverished conditions with little hope of escape. Up to 90 per cent of teenage mothers are reliant on benefits, and while some have access to affordable social housing, most end up extremely isolated, often in unsuitable accommodation, and usually without appropriate services or support.

The consequences can be dire, as the DoH mortality statistics mentioned above reveal. But more often lives are ruined rather than lost. Teenage mothers are more likely to suffer postnatal and other forms of depression than older parents. They are more likely to smoke during and after the pregnancy, seek medical advice later than older women, and many have little idea about healthy eating and the needs of growing children. As well as long-term health problems, these children often become victims of the same cycle of poverty, low aspirations, low achievement and unemployment that their parents succumbed to. And so the cycle continues: children born to teenage mothers are significantly more likely to become teenage parents in their turn.

Given the misery that teenage pregnancies can generate, the government has taken a pragmatic approach to the problem. Rather than insisting that teenage pregnancy is a social evil that must be stamped out, it has opted to improve the availability of contraception, educate young people better about sex and relationships, and ensure that those who do become parents have the support they need to ensure that they and their children flourish.

The teenage pregnancy unit⁴ (TPU)was set up to implement the 30-point action plan outlined in the SEU's 1999 report. The unit's brief is, more specifically, to halve the rate of conceptions among under-18s in England by 2010, and to reduce the risk of long-term social exclusion for teenage parents and their children by getting more of them into education, training and employment. The unit is funded by a wide range of government departments and its work is woven into a range of other government initiatives including Sure Start, Connexions and Supporting People.

The work is centred around two core strands - preventing teenagers getting pregnant in the first place, and supporting those who do become parents. Prevention work is perhaps the most controversial area, and the unit is likely to face some tough challenges in the next few years. Most recently, the multi-disciplinary advisory group overseeing and guiding the work of the TPU have made it clear they believe targeted and proactive sex education is essential for children and teenagers before they reach 16 - an ideal that some parents and pressure groups are vocally opposed to. Even more controversially, there has been a public statement to the effect that children need approachable and confidential contraceptive services before the age of 16.

The advisory group, chaired by Lady Winifred Tumim, has laid its cards on the table by stating that barriers to contraceptive services and advice should be removed for the under-16s. In a recent article, Tumim argued: "All young people should have better access to confidential health services, including full contraception, on secondary school premises where appropriate."

Gill Frances is deputy chairperson of the advisory group, and head of the children's development unit at the National Children's Bureau. She says: "I'm very excited about it [the teenage pregnancy strategy] which isn't something I say often about government initiatives. It puts teenage pregnancy in the context of sexual health for the first time and says we have to sort our services out. If you look at other European countries, some of them have very pragmatic approaches to sexual health and sex education. In Holland, who do you think teenagers ask about sex? Their parents. In the UK? It's their peers or a help line. That tells us something."

Frances believes that young people should have straightforward, uncomplicated access to sexual health services, which means putting services into schools, youth clubs and drop-in centres - anywhere they congregate. She acknowledges that there may be trouble ahead, but insists: "All the research tells us that the vast majority of parents don't want their children to get pregnant, they don't want them to catch sexually transmitted diseases, and they don't want them to have their hearts broken. There will always be a small percentage of parents who make a fuss about it, but we should be making policy that addresses the needs of the majority rather than panders to the sentiments of a very small minority."

She also argues that sex education and contraceptive services should be deliberately targeted at those young men and women who are most likely to become parents. "I'm not saying that those who are not at high risk shouldn't get it - they're entitled to it and they need it. I'm saying that the high risk groups, like children in care, need more of it and they need it earlier."

On the support side, 20 Sure Start Plus pilots are being run in the 20 districts in England with the worst teenage pregnancy rates.⁵ The scheme is an extension of the national under-fours Sure Start scheme, but aimed specifically at teenage parents. It has four key targets - improving teenage parents' health, increasing the number who breastfeed, getting more teenage parents to stop smoking, and improving learning.

Janet Kent is scheme co-ordinator for the Wakefield Young Families Project, run by Barnardo's, one of the Sure Start Plus pilots. It works with 80 young families, and runs schemes such as antenatal classes, social groups, education and training for teenage parents. A new scheme called Food Direct delivers locally grown produce, together with recipes and suggestions, to parents' homes.

According to Kent, the teenagers she works with have a lot of potential, but many have had difficult experiences at school and have become isolated as a result of their pregnancy. She says: "What we've found is that they aren't accessing services at all, either because they don't know about them or feel too intimidated to try them. A lot of them feel that they can't use mainstream services like antenatal classes, they tell us that the midwives are hostile to them and that the other people at classes look down on them. So we have a midwife who works specifically with young women, who is encouraging. If they want us to, we go and visit the delivery suite so that they feel more comfortable about the whole thing."

The Wakefield project is offering taster sessions and short courses to help young parents back into education, and offering longer courses. Kent says that the young women have "grabbed the opportunity with both hands. They want education, training and work".

Unfortunately there are still stumbling blocks for teenage parents who are keen to get back into education and training. According to Kent: "Child care is a very difficult area - there is no provision for child care unless you can afford a private nursery. There are some local authority places but they tend to be for children over two who are already potty trained. All the young women we see have young babies, which is a real barrier." The Wakefield project came up with the idea of a mobile creche, staffed by qualified carers, which operates from a room alongside the training room so that mothers can check on their babies when they want to.

Another problem is accommodation. The teenage pregnancy strategy makes provision for all lone parents under 18 to have access to semi-independent accommodation with support by 2003. There is some evidence that local authorities may be struggling to meet that target in the spirit in which it was intended, but a number of pilot schemes under the strategy have proved very successful.

In terms of progress to date, the unit has appointed a network of teenage pregnancy coordinators who are responsible for co-ordinating and implementing the teenage pregnancy strategy through local multi-agency groups. Each area has agreed a reduction target for teenage pregnancies, with more challenging targets for those with the biggest problem. A national media campaign has been run with advertisements on local radio and in young people's magazines, encouraging young people to take control and make informed choices about their sex lives. A similar campaign is about to be launched targeting parents who may feel reluctant about talking to their children about sex. And teachers and schools have received guidance on the importance of rigorous sex and relationship education for both young men and women.

It is too early to tell whether all this concerted effort may be starting to pay off, but the numbers of teenage pregnancies were already beginning to fall. Between 1998 and 1999 the under-18 conception rate fell by 4 per cent, and the under-16 rate fell by 7 per cent.⁶

But, significantly, the under-18 rate for the first three quarters of 2000 is lower than for 1999, and shows a clear downward trend over the past eight quarters. More importantly, the proportion of teenage mothers in education or work has increased from 16 per cent in 1997 to 29 per cent in 2001. Perhaps the biggest hurdle in tackling teenage pregnancy will be pulling off society's blindfold in relation to sex education and contraceptive services for under-16s, and giving the most disadvantaged young people something better to hope for.  

- Contact the teenage pregnancy unit on 020 7972 5073.

¹ Speech by public health minister Yvette Cooper to the Institute for Public Policy Research, 21 January, 2002.

² Social Exclusion Unit, Report on Teenage Pregnancy, The Stationery Office, 1999

³ Independent Advisory Group on Teenage Pregnancy, First Annual report, IAGTP November 2001

⁴ Teenage Pregnancy Unit, www.teenagepregnancyunit.gov.uk  

⁵ Sure Start Plus, http://www.surestart.gov.uk/home.cfm  

⁶ National Strategy for Neighbourhood Renewal, Action Update on Teenage Pregnancy Work, Stationery Office, December 2001