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Alison Hadley OBE

As former Head of the Teenage Pregnancy Unit at the Department for Education, Alison Hadley played a key role in delivering the national Teenage Pregnancy Strategy. In this month’s eFeature she reflects on the progress made and identifies lessons that can be applied to further reducing teenage pregnancy and improving sexual health for the wider population. She also highlights how important it is to maintain priority in the new system and to combine the skills and commitment of those already in local government with those newly arriving into public health teams.

Next month ONS will publish the 2011 conception data. Judging from the quarterly trend, we should see a further decline in the annual under 18 conception rate, already down by 25% to the lowest level since 1969. Some local authorities, notably in London, may even reach their original 50% target!  As Duncan Selbie said in last month’s feature, as system leaders for teenage pregnancy, local government have been key to this success.

But there is no room for complacency! At a national level, we’re only half way to the original ambition of bringing rates down to those of comparable Western European countries; over two thirds of local areas have declines below the England average; and 7% have increasing rates. Building on local government’s commitment to the issue and retaining the lessons from the Strategy is critical for making further progress on teenage pregnancy but the lessons can also be applied to improving prevention and sexual health for the whole population.  So what did we learn?

Firstly, we know that concerted, coordinated and sustained effort makes a difference. High teenage pregnancy rates, or poor sexual health outcomes, are not inevitable even in the most deprived areas.  Secondly, we know what works. The international evidence is clear that high quality relationships and sex education (RSE) in and out of schools, linked to young people friendly services, helps young people make positive, informed choices and brings down rates. But we also learned that for effective local delivery the evidence needs translating into a ‘whole systems’ approach with practical actions for all relevant partner organisations.  Teenage pregnancy and sexual health are complex lifestyle issues with the solution not in the gift of any one agency.  The benefits of high quality sexual health services will only be seen if other partners contribute to prevention initiatives and provide swift and easy referral pathways. In the most successful areas on teenage pregnancy, local government has been at the heart of leading and monitoring this partnership approach.  They can play a similar role in building partnerships with relevant agencies reaching other age or high risk groups.

The third lesson from the Strategy was how to make the case for prioritising teenage pregnancy. Most areas understood the importance of the issue but struggled to justify additional funding over competing priorities. Once they understood the contribution reducing teenage pregnancy made to improving other poor outcomes for children and young people, the rationale for investment was much clearer.  In the new policy context, these interdependencies are clearly set out in the Public Health Outcomes Framework (PHOF).  At a conservative estimate, progress on teenage pregnancy will contribute to improving at least 25% of the PHOF indicators. Doing a similar exercise on broader sexual health outcomes would be helpful.  The other critical factor in discussing priorities is making the very best use of local data. In the early stages of the Strategy, some areas with increasing rates of teenage conception were convinced that it was due to historical, and intractable, norms of teenage parenthood. It was only when they were shown that their rising rates were entirely accounted for by abortions that they accepted they could make a difference. Other areas, notably large counties with rates at or below the national average, didn’t see the need to prioritise teenage pregnancy work. But when the top tier data were peeled back, they saw a stark picture of districts and wards with extremely high rates, affecting the health and wellbeing of young people, and driving inequalities for future generations.

Understanding the local data on teenage pregnancy and sexual health is clearly critical for getting the Joint Strategic Needs Assessment (JSNA) right. While the PHOF data tool offers a colour code assessment of whether a Local Authority is similar, better or worse than the England average, it is only an assessment of top tier data. District and ward data on teenage pregnancy and sexual health need to be included to identify the underlying inequalities – and most importantly, inform commissioning decisions. The other vital piece of the JSNA jigsaw is consulting with young people, or any other population group, on where they live their lives.  Mapping the services and contact points they use helps to integrate prevention and service publicity, highlight key areas for outreach and get referral pathways right, especially when they cross commissioning boundaries. It also identifies the agencies and practitioners who need to be partners in the whole systems approach, understand their contribution to the solution and make every contact count.

The fourth lesson of the Strategy was that by the end of the ten years we had broad consensus on the importance of relationships and sex education and access to confidential contraception and sexual health services.  Although the legislation for statutory PSHE fell at the last hurdle, parents, young people and faith groups backed the move; the Sex. Worth Talking About campaign showed conversations about contraception and Chlamydia on TV before the watershed - with no fuss; and many areas have used the consensus to develop LA wide RSE programmes, school and college based sexual health services and innovative social media campaigns.  As local government takes on the responsibility for sexual health, reassurance of the support of the silent majority is important, particularly for elected members who may face complaints from vocal individuals.

So although the health reforms and funding cuts do pose significant risks, there are real opportunities to build on the progress we’ve made and to combine the skills and commitment of those already in local government with those newly arriving into public health teams. The challenge for us all will be to retain the learning in the new system, make sure new decision makers are well informed and to keep sharing effective practice.

Alison is now based at the University of Bedfordshire, where she is in the process of setting up a  Teenage Pregnancy Knowledge ExchangeThe aim of the Knowledge Exchange is to build on the huge progress made over the course of the Teenage Pregnancy Strategy and ensure the lessons learned – on prevention and support - are transferred into new systems and to strategic leaders and frontline practitioners.  Alison’s contact details are below:

 Alison.Hadley@beds.ac.uk

Teenage Pregnancy Knowledge Exchange
Faculty of Health and Social Sciences
University of Bedfordshire

 

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