Teenage Pregnancy Strategy

ITEM 6

BOROUGH OF POOLE

COMMUNITY SUPPORT AND EDUCATION SCRUTINY COMMITTEE

TUESDAY 29TH JUNE 2004

TEENAGE PREGNANCY STRATEGY

1. Purpose To inform elected members about the Teenage Pregnancy Strategy.

2. Action Required That Members note the report.

3. Background Information 3.1 Context

 The UK has the highest teenage pregnancy rate in Western Europe.

 The Government 10 year Teenage Pregnancy Strategy was launched in June 1999

2 main goals:

- To reduce the rate of teenage conceptions with the specific aim of halving the rate of conceptions among under 18’s, and to set a firmly downward trend in the rate of conceptions among under 16’s by 2010

- To increase the participation of teenage parents in education, training and employment to 60% by 2010, to reduce their risk of long term social inclusion

These targets are also embedded in the NHS Plan.

3.2 Key Messages from Research

The following key messages informed the development of the strategy:-

 Sex education does not encourage early sexual experimentation but can increase the responsible use of contraception

 Young people are reluctant to use traditional primary care services to obtain sexual health advice and services

 Youth focused sexual health clinics in non-traditional venues have been shown to reduce the rate of increase of teenage conceptions

1  The risk factors for teenage pregnancy are similar to those for other risk taking behaviours, such as substance misuse and criminal behaviour. All these behaviours can result in social exclusion and can best be tackled by a range of interventions to increase the aspirations and life choices of young people

3.3 Local Strategy and Implementation

The Government Teenage Pregnancy Unit (TPU) has required Health and Local Authorities to form local multi-agency Teenage Pregnancy Reduction Partnerships and to produce a 3 year strategy in 2001 followed by annual plans which are received and commented on by the TPU.

For Members’ Reference Only, a copy of the local Strategy and Implementation Plan are attached.

The strategy and annual plan report under 6 main headings:-

1. Local Context 2. Local Co-ordination Arrangements 3. Media and Communications 4. Better Prevention: - Sex & Relationship Education (SRE) in school settings - SRE in non school settings 5. Better Prevention - Better Contraception Advice & Information Services 6. Better Support - Supported Housing, Education, Training and Employment for Teenage Parents Childcare - Support for Pregnant Teenagers and Teenage Parents

3.4 Poole Data (from Office of National Statistics)

Year Under 18 Conception Poole % England & South West conceptions rate/1000 Increase / Wales conception decrease since conception rate / 1000 1998 rate / 1000 1998 101 43.2 47.6 39.9 1999 94 38.9 -3.4% 45.8 37.9 2000 75 30.8 -9.0% 44.1 36.3 2001 77 29.8 -1.2% 42.5 36.8 2002 95 36.3 +6.5% 42.8 35.5

Decrease 1998 – 2002 is 16% Aggregate decrease since 1998 is 21%

2 Target set by Teenage Pregnancy Unit (TPU) for 2004 is 36.7 or 15% decrease. Although this means we continue to be within our target, we are concerned about the increase between 2001 – 2002. This was during a year when we had a much smaller grant (£23,000) and therefore less co-ordination time and fewer projects. Our current increased grant and action plan aims to address this and the Teenage Pregnancy Partnership will be monitoring the situation.

3.5 Funding

The Poole Teenage Pregnancy Reduction Partnership is funded through a Government grant (Local Implementation Fund). Finance in 2001-2 was £23,000, in 2002-3 was £25,000, in 2003-4 was £85,000 and for 2004-5 will be £98,000.

3.6 Sex and Relationship Education

 The TPU provide detailed guidance, which include relevant legislation on how the strategy should be delivered.

 The aim is to provide a good base of sex and relationship education in schools. This is co-ordinated through the Healthy Schools Scheme offering whole staff training (40% take up so far, working towards 100% by 2005) and governors and parents training sessions. The SRE scheme of work (6 lesson plans for each Year Group KS1 – 4 inclusive) was written by multi-agency team (2002) and is age and developmentally appropriate. It follows DfES guidance and builds in the use of school nurses and health promotion specialists. All Poole schools have this in place.

 The aim is not just to give information but to take a holistic approach on building good relationships, confidence to make appropriate decisions and not to be peer led, and to develop ambition and choices for the future.

 Focused work takes place on SRE for vulnerable young people out of school settings e.g.

. Specialist nurses work with LAC and Care Leavers and include sexual health advice in their assessments . There is an ongoing multi-agency project setting up creative ways of offering SRE through interactive methods using laptops, CD Roms, video’s etc. . Learning disability nurses offering sessions for social workers and carers and drop-in sessions . The male sexual health educator offers additional sessions for young men

3 3.7 School-based support, advice and guidance for young people:

 SRE in secondary schools should:

“enable and encourage young people to talk to a trusted adult if they are having sex or contemplating doing so. It is desirable, although not always possible, that that person should be their parent or carer”. (See DFES Sex and Relationship Education Guidance 2000)

 Teachers can never guarantee absolute confidentiality and must follow locally agreed Child Protection protocols, as outlined in “Working Together to Safeguard Children” (Dfee/DH)

 Every effort will be made to encourage young people to talk to their parents/carers about the issues raised.

 If a young person approaches a teacher for advice on e.g. contraception or pregnancy issues, the teacher’s role is to signpost him/her to the relevant health professional who may be situated in a variety of settings appropriate to young people e.g. Youth Advisory Centres, Family Planning Clinics, School Nurse Drop-Ins.

 The decision on the content and staffing of a school-based service is for the governing body of the individual school. Such a service may be at least partly delivered by health professionals.

 Health Professionals are governed by their professional codes of practice which state that confidentiality may only be broken in exceptional circumstances when the health, safety or welfare of the patient on others would otherwise be at grave risk.

3.8 Can health professionals give contraceptive advice and treatment (including abortion) to young people under 16 without parent consent?

Legally, yes, provided the health professional is satisfied that the young person is competent to understand fully the implications of any treatment and to make a choice of the treatment proposed. The health professional must establish that all of the following criteria are met.

 The young person understands the doctor’s advice;

 The doctor cannot persuade the young person to inform his or her parents or allow the doctor to inform the parents that he or she is seeking contraceptive advice;

 The young person is very likely to begin or continue having intercourse with or without contraceptive treatment;

 Unless he or she receives contraceptive advice or treatment, the young person’s physical or mental health or both are likely to suffer;

 The young person’s best interests require the doctor to give contraceptive advice, treatment or both without parental consent.

4 These criteria were outlined in Lords Fraser and Scarman in 1985, in the House of Lords’ ruling in the case of Victoria Gillick v West Norfolk and Wisbech Health Authority and Department of Health and Social Security. They are commonly known, and will be referred to in this guidance, as the Fraser Guidelines.

The Fraser Guidelines specifically refer to contraception but the principles also apply to other treatments, including abortion. They refer to doctors but also apply equally to other health professionals in England and Wales. (Teenage Pregnancy Unit Guidance 2001).

3.9 Can a young woman under 16 have an abortion without parental consent?

Yes. Legally, if a young woman is judged competent in accordance with the Fraser Guidelines she can consent to an abortion without parental involvement. However, in practice this is unusual and would only be done in exceptional circumstances when it is considered to be in the young person’s best interests. In such a situation, every effort would be made to help the young person involve another adult for support.

The Abortion Act states that a pregnancy may only be terminated if two independent doctors are of the opinion that this is justified under the Act. A trained counsellor is also seen before a termination takes place.

In Poole, Health Professionals follow this TPU and legislative guidance translated into local protocols. These ensure that the Fraser guidelines are adhered to, and every effort is made to encourage the young person to involve their parents/carers (unless it would clearly not be in the young person’s best interests to do so).

4. Conclusion

The Annual Plan reflects a pro-active multi-agency response to address this issue across the Borough and Members are asked to note the content of this report and the Annual Plan for 2004/05.

Jane Portman Neelam Bhardwaja Head of School Advice and Support Services Head of Children and Families Services

Contact Officers: Jan Lever RPSHCE Adviser, School Advice and Support Services Tel: 01202 633559

Jan Sayers Policy Officer for Policy and Performance Management, Children and Families Services Tel: 01202 264647