Review of Teenage Pregnancy in Buckinghamshire - Lynda Ayres December 2012

 
Review of Teenage Pregnancy
             in
     Buckinghamshire

         Lynda Ayres

        December 2012
CONTENTS

1. Introduction

2. Summary of Key Outcomes and Achievements of the Buckinghamshire Teenage
   Pregnancy Strategy

3. Recommendations

4. Background

5. Why Teenage Pregnancy Matters

6 .Teenage Conceptions in Buckinghamshire

7. The Buckinghamshire Teenage Pregnancy Strategy
   7.1 Prevention of teenage conceptions and sexually transmitted infections
   7.2 Support for teenage parents

Appendix
Conception Charts and Graphs

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Review of Teenage Pregnancy in Buckinghamshire

1. Introduction

   This review will provide an overview of the progress of the work of delivering the

   Teenage Pregnancy Strategy in Buckinghamshire from 2000 to 2010 and will

   consider the way forward. It is intended to inform colleagues and partners across all

   services working with children, young people and families in Buckinghamshire. It will

   be presented to partnership forums across the county including the Children and

   Young Peoples Trust Board, Local Children & Young People’s Trust Boards, Health

   and Well Being Board and the Buckinghamshire Sexual Health Network.

   The review has been prepared with information submitted by, and the support of, the

   members of the Buckinghamshire Teenage Pregnancy Reference Group who

   represent a range of services who work with children, young people and families

   including maternity, community and sexual health services, education, social care,

   youth service, Connexions, Children’s Centres and voluntary organisations

   This document demonstrates that effective partnership working has resulted in

   improved services which have contributed to enhancing the life chances and

   outcomes for children and young people in Buckinghamshire.

   The services which have collaborated to deliver the aims of the Buckinghamshire

   Teenage Pregnancy Strategy include: NHS Buckinghamshire and Buckinghamshire

   Healthcare NHS Trust (Public Health, Commissioners, Genitourinary Medicine

   (GUM), Contraceptive and Sexual Health Services (CaSH), Maternity Services,

   Children & Young People’s Community Services, Primary Care GP and Pharmacy

   Services), members of the Buckinghamshire Sexual Health Network, Education

   Services (Healthy Schools Team, Reintegration Service) Schools and Colleges, the

   Youth Service, the Voluntary Sector (Sexual Health, Youth Services and Substance

   Misuse Services), Connexions and Children’s Centres.

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2. Summary of Key Achievements of the Teenage Pregnancy Strategy

   There has been significant progress since the launch of the Teenage Pregnancy

   Strategy key achievements in Buckinghamshire include:

             Healthy Schools supported 87 practitioners from schools, health service and
              partner organisations to achieve the PSHE certificate.
             Sexual health awareness training (Sex Matters Tier 1) was delivered to over
              1,500 practitioners since 2003.
              ‘RU Ready’ principles around delaying first sex and consent are included in
              staff sexual health training and work with young people.
             The Buckinghamshire Sexual Health website provides a single portal for
              sexual health information and services; the site was visited by 6,906 people
              in 2011-2012.
             A ‘Personal Relationships and Sexual Health Policy for Children in Care’ was
              published in 2011.
             Approximately 50 practitioners across statutory and voluntary services are
              trained to distribute condoms and to perform pregnancy tests every year.
             The C Card condom distribution scheme registered 1445 new contacts in
              2011-2012.
             Health Zones, young people’s health drop-ins, have been launched in 6
              schools / academies and 6 community settings.
             The Youth Bus provides a ‘Health Zone on the Road’ to young people who
              have difficulties in accessing other services.
             Outreach Contraceptive and Sexual Health (CaSH) have developed and
              extended their reach as a result of commissioning Tier 2 services
             38 pharmacies participate in the Emergency Hormonal Contraceptive (EHC)
              scheme; over 500 young women are seen each year.
             18.8% of the eligible population of young people aged 15-24years old were
              screened for chlamydia; 7.2% tested positive.
             Termination services have been re-commissioned resulting in consultation
              and treatment services delivered in / adjacent to Buckinghamshire
             Collaborative working between Maternity services and Connexions in
              supporting young parents has resulted in Buckinghamshire identifying 79% of
              the DfE estimate of young mothers compared with the national average of
              64%.
             The ‘Guidance for education, support and reintegration for pregnant students
              and young parents’ was first published 2006 and updated in 2012.

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     Children’s Centres have worked in partnership with maternity, health visiting,
           youth services and Connexions to offer 8 Young Parents Groups across the
           county
          The Family Nurse Partnership (FNP) began recruiting pregnant teenagers for
           their intensive 2 year support programme from November 2012.

3. Recommendations

In order for progress to continue the following recommendations need to be taken

into consideration:

1. Sex and Relationships Education in schools /academies is at risk as PSHE/ SRE

     is not statutory as education institutions become more autonomous the

     opportunity co-ordinated approach to delivery of SRE is difficult to achieve (see

     5.1.1). All partners need to be aware and support school /academies to deliver

     evidence based, age appropriate sex and relationships education.

2. Public Health will be transferring to the Local Authority in April 2013 providing an

     opportunity to reflect upon progress with the Teenage Pregnancy agenda to date

     and to consider the way forward. This review has cited many areas in which

     Public Health are currently involved with commissioning of services around

     contraception and sexual health. It may be appropriate for some Local Authority

     responsibilities around prevention of teenage conceptions and STIs to be taken

     on by Public Health colleagues to avoid duplication of effort and aid

     communication for colleagues who will need to seek information from a single

     service within the Local Authority.

3. The Sexual Health website has been one of the most effective and efficient

     innovations related to teenage pregnancy and related issues over recent years as

     evidenced by the number of visits during 2011/2012 (see 7.1.2). It is user friendly

     holds an enormous amount of information and is simple to administer however it

     does require a dedicated individual to do this. The website needs to continue in

     its present easy to access format and not be hidden within a parent website when

     Public Health transfers to BCC.

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4. Health Zones in education and community settings have increased the availability

     of confidential services to young people and are an important preventative

     service. The post of Health Zone Co-ordinator has ceased. There needs to be

     careful consideration around continuing this role as without central co-ordination

     and support Health Zones may falter.

5. Support for young parents is part of the remit of Children’s Centres. There needs

     to be a co-ordinated approach across all providers so that young parents across

     the county receive an equitable service.

4. Background

In 1998 the Social Exclusion Unit (SEU) was asked by the Prime Minister, Tony Blair,

to study the causes of teenage pregnancy and to develop a strategy to reduce the

high rates of teenage pregnancy and parenthood in England.

The Social Exclusion Report on Teenage Pregnancy in England was published in

June 1999. The report stated that the UK had the highest rate of teenage

pregnancies in Western Europe.

The national Teenage Pregnancy Strategy was launched as a result of the Social

Exclusion Report’s findings. The strategy had four main components:

     1. National media awareness campaign

     2. Joined up action co-ordinated nationally and locally across all relevant

           statutory and voluntary agencies

     3. Better prevention through improving sex and relationships education (SRE)

           and sexual health services

     4. Support for teenage parents to reduce their long term risk of social exclusion

           by increasing the proportion returning to Education, Employment or Training

           (EET)

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All 148 top tier Local Authorities (LA) were required to develop Teenage Pregnancy

Strategies to reduce teenage conceptions and to support teenage parents. Local

strategies were led by a Teenage Pregnancy Co-ordinator. Local Teenage

Pregnancy Partnership Boards were set up. Teenage Pregnancy strategies were

performance managed by Regional Teenage Pregnancy Co-ordinators and

supported by the Government’s cross departmental Teenage Pregnancy Unit (TPU).

Funding was provided initially through a dedicated Teenage Pregnancy Grant to

every LA which has since been absorbed into general funding as part of the Early

Intervention Grant.

All local Teenage Pregnancy Strategies had two main aims:

           To reduce to under 18 conception rate by between 1 40-60% from the 1998

            baseline by 2010

           To reduce the risk of long term social exclusion for teenage parents and their

            children by increasing to 60% the participation of 16-19year old mothers in to

            education, employment and training (EET) by 2010.

The Teenage Pregnancy Independent Advisory Group (TPIAG), a non departmental

body, was set up in 2000 for a fixed term of 10 years to advise the Government on

the Teenage Pregnancy Strategy and to monitor its implementation. The Teenage

Pregnancy IAG final report was published in December 2010.

The current Coalition Government formed in 2010 discontinued Local Authority

teenage pregnancy targets. However, teenage pregnancy has remained an area of

policy interest. The under 18 teenage conception rate is one of the three sexual

health indicators in the Public Health Outcomes Framework (2013–2016) as one of

the national measures of progress on child poverty. Teenage Pregnancy is also

expected to be one of the three national indicators, along with late HIV diagnosis and

Chlamydia screening, in the new Department of Health Sexual Health Plan due to be

published in the autumn of 2012.

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Thus there is a continued focus on preventing teenage conceptions as well as the

 social impact of parenting upon teenage mothers and their children.

 After the release of the 2010 under 18 conception rates in February 2012 Sarah

 Teather, Minister of State for Children and Families and Paul Burstow, Minister of

 State for Care Services issued a joint statement. They said ‘This Government

 remains committed to reducing rates of teenage pregnancy still further and improving

 outcomes for young parents and their children. This is central to our aim to reduce

 inter-generational poverty and inequalities.’

5. Why Teenage Pregnancy Matters

 The rationale for tackling teenage pregnancy and supporting teenage parents are

 well documented and referred to in Teenage Pregnancy: Accelerating the Strategy to

 2010. The health and wider inequalities issues include:

            Babies born to teenage mothers have a 60% higher infant mortality rate than

             those born to older mothers

            Children of teenage mothers have a 63% increased risk of being born into

             poverty and are more likely to have accidents and behavioural problems

            Teenage mothers are 3 times more likely to smoke during their pregnancies

            Teenage mothers are 50% less likely to breast feed than older mothers

            Teenage mothers are 3 times more likely to have post natal depression and

             have a higher risk of poor mental health for 3 years after the birth than older

             mothers

            15% of all young people not in education, employment or training (NEET) are

             pregnant teenagers or teenage mothers

            Teenage mothers are more likely to have no qualifications at age 30

 1   45% in Buckinghamshire

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     Children born to teenage mothers do less well at school and disengage early

           from learning and sometimes well before they have finished compulsory

           education.

          Daughters of teenage mothers are twice as likely as daughters born to older

           mothers to become teenage mothers themselves. Similar disadvantages

           affect young fathers.

          Rates of chlamydia are highest in women aged 16-19yrs and men aged 20-

           24yrs

Efforts to improve outcomes for young parents will, in turn, reduce the chances that

their children will become teenage parents themselves and therefore less likely to

experience some of the factors associated with teenage pregnancy.

Supporting teenage mothers to access and use contraception effectively after the

birth of their first child will also help prevent subsequent unplanned pregnancies.

Programmes to prevent teenage pregnancy and support teenage mothers and young

fathers are part of a long-term effort to narrow social and health inequalities and

tackle child poverty. Tackling the risk factors for teenage pregnancy can have an

impact on a range of other local priorities included in:

1. The Buckinghamshire Children and Young People’s Plan 2011-2014 priorities:

          Closing the Gap
          Transitions
          Early Intervention and Secondary Prevention
          Family Focus
          Children and Young People’s involvement in decision making
2. Investing in our Children’s Future Prevention and Early Intervention Strategy 2012-
2015
3. Buckinghamshire Sexual Health and HIV Strategy 2009-2014
4. Buckinghamshire Child Poverty Strategy 2011-2014
5. Buckinghamshire Families First programme

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6. Teenage Conceptions in Buckinghamshire

Annual data for teenage pregnancy is published by the Office for National Statistics

(ONS) fourteen months in arrears; therefore the conception rates for 2010 (the

Teenage Pregnancy Strategy target year) were published in February 2012.

The England and Wales under 18 conception rate for 2010 was the lowest since 1969

at 35.5 conceptions per thousand young women aged 15–17.

Teenage pregnancy rates have been consistently lower in Buckinghamshire

compared with most other areas nationally. During 2010 there were 195 conceptions

(births and abortions) to women under the age of 18 years resident in the county,

compared with 234 conceptions in 2009.

The rate of conceptions was 20.2 per 1000 young women aged between 15-17yrs

(under 18s) becoming pregnant in 2010 compared with a rate of 24.2 per 1000 in

2009. (See Appendix 1)

This was the lowest rate in Buckinghamshire since the Teenage Pregnancy Strategy

baseline year of 1998. The Buckinghamshire 45% reduction of the under 18

conception rate target was not met. However it did reduce by 18.5% from 1998 to

2010 the lowest reduction achieved in the ten year teenage pregnancy strategy

period.

A research report published by BPAS in 2010 Young People in London Abortion and

Repeat Abortion stated that there is an acceptance of early motherhood associated

with social deprivation. Teenagers who have aspirations are more likely to terminate

than continue with their pregnancies. This seems to be the case locally as the

proportion of teenage conceptions leading to abortion has been consistently higher in

Buckinghamshire (59.5% in 2010) than for the South East (51.8%) and in England

(50.3%). The percentage of abortions to maternities in the more affluent southern

area of the county, are higher that other parts of Buckinghamshire and nationally

Chiltern District Council area 66% from 1998-2009 and South Bucks 71%.(See

Appendix 1). The majority of teenage pregnancies leading to delivery in

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Buckinghamshire occur in the urban areas of Aylesbury and High Wycombe where

there are also areas of higher deprivation.

This is of concern as there is evidence which shows that children born to teenage

mothers are more likely to experience a range of negative outcomes in later life (see

Section 5) and are more likely, in time, to become teenage parents themselves thus

perpetuating the disadvantage that young parenthood brings from one generation to

the next.

7. The Buckinghamshire Teenage Pregnancy Strategy

Teenage Pregnancy in Buckinghamshire was addressed through two strands.

           Prevention of conceptions and sexually transmitted infections (STIs) in

            young people

           Support for teenage parents – including prevention of subsequent

            pregnancies and supporting young mothers into Employment Education and

            Training (EET)

7.1 Prevention of teenage conceptions and sexually transmitted infections

The publication of Teenage Pregnancy: Accelerating the Strategy to 2010 in 2006

identified that comprehensive education about relationships and sex (SRE),

combined with easy access to effective contraception were key initiatives which had

an impact on reducing under 18 conceptions and sexually transmitted infections.

7.1.1 Sexual Health Education

Sex and relationships education (SRE), is the process of acquiring information and

forming attitudes and beliefs about sex, sexual identity, relationships and intimacy.

SRE enables young people to develop skills so that they make informed choices

about their behaviour, and feel confident and competent about acting on those

choices. It also helps to protect them against abuse and exploitation. SRE aims to

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reduce the risks of potentially negative outcomes from sexual behaviour, such as

unwanted or unintended pregnancies and sexually transmitted infections including

HIV. It also aims to contribute to young people’s positive experience of their sexuality

by enhancing the quality of their relationships and their ability to make informed

decisions over their lifetime.

All those who are involved with children and young people need to have the skills

and confidence to address sexual health issues when they arise.

In Buckinghamshire this has been addressed through staff training, information for

parents / carers and development of tools and support for those who deliver sexual

health education to children and young people.

Sexual Health Awareness Training for staff (Sex Matters Tier 1)

A one day Sexual Health Awareness course, ‘Sex Matters Tier One’, is

commissioned by BCC Children & Young People’s Services and delivered by Brook

to staff from Buckinghamshire statutory and voluntary services who work with

children and young people since 2003.

2012 Update:

       Over 1500 staff (140 per year) staff from statutory and voluntary children and

        young people’s services have been trained since 2003 with consistently positive

        course evaluations.

Sex Matters Tier 1 participants are asked about the impact of the training on their

practice 6-18 months after the course was delivered they said:

‘It has helped me deliver a more sensitive and knowledgeable service to vulnerable children.’

‘Has helped me a lot regarding young people as I have discussed and given appropriate
information. The young people that I work with are better able to make their choices.’

‘The course has given me confidence in engaging young people in the subject of sexual
health.’

‘The training has made me more confident when having discussions about sexual health. It
has also reminded me of the pressure's young people face growing up.’

‘Given me a fresh insight into how teens view their sexuality and the degrees of sexual activity in
this age range.’

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Sex and Relationships Education (SRE) in schools

A SRE Consultant was appointed in 2004 as a member of the Buckinghamshire

Healthy Schools Team. The role included supporting schools in delivering age

appropriate SRE from primary education through to Year 13 thus enabling children

and young people to make informed choices around personal relationships and

sexual health

The SRE Consultant was also responsible for training practitioners in the PSHE Certificate
which focussed upon knowledge and skills to deliver Substance Misuse and SRE in schools
and other settings.
Eighty seven staff, including teachers, community nurses and other professionals, involved
in PSHE education delivery, had formal training most leading to national accreditation from
2004 to 2011. Most staff were encouraged to undertake the sex & relationships (SRE)
module, as predominantly funded via The Teenage Pregnancy Strategy.

2012 Update:

       Central funding for the Healthy Schools programme ceased at the end of March

        2011. The coalition government’s policy is that Healthy Schools will continue

        but now ‘schools led’. As a result the Buckinghamshire Healthy Schools Team

        was disbanded in 2011 with loss of the role of the SRE specialist to support

        school / academies with SRE.

       Schools /academies have devolved budgets with little ‘free’ support from School

        Improvement Services. SRE support is delivered through traded services and

        has to compete with statutory curriculum subjects.

SRE and Parents /Carers

An information leaflet ‘Worth Talking About- Talking to children about relationships
and sex’ was developed and distributed in 2011.

The Speakeasy parenting course developed by the fpa is offered through
Buckinghamshire Parenting Support Team. It aims to:

       Increase parents' confidence and communication skills with their children

       Foster a positive and open approach to discussions of sex, sexuality and sexual
        health and

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     Increase factual knowledge around sex and sexual health.

RU Ready?

Buckinghamshire staff in CaSH, Youth Services and other agencies which are

involved with providing information and support to young people use the principles of

RU Ready? These are designed to support young people around delaying first sex

and ensuring that sexual activities are consensual.

Health Zones - Young People’s Health Drop-Ins

From 2004 Young People’s Health Drop-ins later known as Health Zones began to

deliver services in schools, and community settings. This service has been built upon

the ‘Check out’ service provided by voluntary youth services at the Youth Enquiry

Service (YES) in High Wycombe and Way-In at Chesham. The first school based

Health Drop-In was set up at Beaconsfield High School for Girls in January 2004.

A Health Zone Co-ordinator was appointed on a fixed term contract to 2012 to

provide support for setting up and delivery of Health Zones across the county.

Health Zones are delivered in a confidential environment, they provide general

information and support on health related issues which may range from eating

disorders, bereavement, chronic health conditions etc. and personal relationship

/sexual health issues.

Condoms are provided through the C Card scheme, pregnancy tests and chlamydia

screening is also offered at all Health Zones.

School / academy based Health Zones are delivered by practitioners who are not

members of school /academy staff thus ensuring that students receive an

independent and confidential service. The service is supported by the Health Zone

Co-ordinator and delivered by a multiagency team of 2 -3 practitioners who work in

partnership to staff the Health Zones. Community Public Health Nurses (SCPHN),

known as School Nurses, usually lead the school /academy multiagency Health Zone

teams which include youth workers, Connexions and substance misuse workers.

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Young people have been appointed as Health Zone Ambassadors and are involved

in setting up and promoting the service to their peers.

2012 Update

          There are 6 Health Zones in Buckinghamshire schools / academies at:
           Beaconsfield High School, Wye Valley School, Princes Risborough Upper
           School, John Colet School - Wendover, The Grange School - Aylesbury, and
           Aylesbury Vale Academy
          There are 6 Health Zones in community settings at: Buckingham Youth
           Centre, Youth Space Aylesbury, The Roundhouse – Wycombe, Youth
           Space- Wycombe, and The Crypt- Marlow,
          The Youth Bus Health Zone on the Road visits targeted locations offering the
           service in areas where young people have difficulties in accessing statutory
           services

7.1.2 Contraceptive and Sexual Health Services (CaSH)

Public Health, NHS Buckinghamshire and Oxfordshire Cluster have produced the

NHS Buckinghamshire Sexual Health and HIV Strategy 2009-2014 which was

developed with all local sexual health providers and commissioners the strategy

includes key priorities and an implementation plan. Public Health has worked in

partnership with the Local Authority and other stakeholders to commission and

develop a range of Contraceptive and Sexual Health (CaSH) services which

contribute to the reduction of teenage conceptions and sexually transmitted

infections.

The services commissioned by Public Health include:

a) Level Three Sexual Health and Contraceptive Services

     Public Health commissions three Level 3 Specialist Genitourinary Medicine

     (GUM), HIV and Contraceptive and Sexual Health (CaSH) services which are

     delivered by Buckinghamshire Healthcare NHS Trust through the Brookside

     Centre (CaSH) Services, Aylesbury and the SHAW (GUM) Clinic, High

     Wycombe. These services are well established and are available for all the

     population including young people.

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b) Long Acting Reversible Contraception (LARC)

     All methods of contraception are offered at Level 3 services including Long Acting

     Reversible Contraception (LARC). This method of contraception is reliable and

     often attractive to young people as once the device, an implant or intrauterine

     contraceptive devise (IUCD), is inserted and checked there is no need for repeat

     appointments.

     Public Health also secured funds to set up a programme of LARC training for GP

     practices and an enhanced scheme to increase the availability of the method

     across the county.

c) National Chlamydia Screening Programme

     The National Chlamydia Screening Programme (NCSP) was launched in 2003 as

     a result of evidence that young people aged 16-24 years were at high risk of

     contracting the bacterium. There has been close partnership working between the

     local CSP since the beginning of the screening programme in Buckinghamshire in

     2007. The scope of the programme has developed so that young people aged

     under 25 years are offered a chlamydia test, and treatment if the test is positive,

     through CaSH services, GP practices, and some pharmacies.

     2012 Update

               10,747 young people aged 15 to 25 years in Buckinghamshire were

                screened for chlamydia (this was 18.8% of the eligible population against

                a 35% target)

               7.25% of those tested were positive

d) Young People’s CaSH services

     Prior to 2000 weekly dedicated young people’s CASH services called ‘Check-out’

     had been established at Brookside Clinic in Aylesbury, the GUM service (now the

     SHAW clinic) in High Wycombe and by Brook in Buckingham. Condoms were

     also distributed through the two voluntary youth service ‘Check-out’ venues at

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YES in Wycombe and Way-In, Chesham. General Family Planning clinics were

     also held at Aylesbury Brookside, Wycombe Hospital and Chalfont Hospital.

     However young people in the rest of county were unable to access CaSH

     services local to where they lived or attended schools and colleges.

     2012 update

          A weekly Young People’s CaSH ‘Clinic in a Box’ hosted by YES, High

           Wycombe, and staffed by Brookside contraceptive nurses began in

           December 2008

           A new young people’s CASH service provided by Brook was set up in

           Burnham in 2010, this was in addition to the service already provided by

           Brook in Buckingham and will be taken forward by the THT (see below).

          A new contract for an integrated contraception and STI screening service

           provided by the Terrence Higgins Trust (THT) began in April 2012. One of the

           key target groups is young people. The service will provide outreach in a

           range of community settings building on services provided in Further and

           Higher Education venues and youth and community settings

          Sex and Relationship training for Further and Higher Education services staff

           will be offered so that they are better equipped to deal with their student’s

           relationships and sexual health issues.

     e) C Card Condom Distribution Scheme

     The Buckinghamshire C Card distribution scheme was launched in November

     2008 and is managed by the Brookside CaSH services.

     Sex Matters Tier 2 training has been developed for staff who offer condoms and

     pregnancy tests to clients. The scheme is delivered through statutory and

     voluntary service providers across the county these include Health Zones (see

     above) youth services, Connexions and substance misuse services.

     2012 Update:

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       60 staff were trained to deliver the C Card condom distribution scheme during

            2011/2012

           1445 young people were issued with C Cards during 2011/2012

           Approximately 20,292 condoms were distributed during 2011/2012

    f) Pharmacy Emergency Hormonal Contraception (EHC) scheme

    The Buckinghamshire scheme to train pharmacists to issue Levonelle EHC to

    young women aged 18 years and under who had unprotected intercourse within 72

    hrs began in 2005.

2012 Update:

       38 pharmacists currently participate in the scheme

       552 young women were seen in 2011/2012

       Participating pharmacists also offer chlamydia screening to young women who

        request EHC

g) Buckinghamshire’s Sexual Health website

            Buckinghamshire’s Sexual Health website www.sexualhealthbucks.nhs.uk

             went live in May 2009 and provides one portal for information on all

             contraception and sexual health services (CaSH) in Buckinghamshire with

             appropriate links to national websites.

2012 Update:

            The Buckinghamshire Sexual Health website received 9,571 visits from 6906

             people during 2011/2012

h) Termination (Abortion) Services

Public health is the lead commissioner for the termination service across Bucks,

Milton Keynes and Oxfordshire. This will be transferred over to Clinical

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Commissioning Groups for 2013/14. An important aspect to this service is the link

with local contraceptive services to avoid repeat terminations.

Prior to the current contract Buckinghamshire had to travel outside the county for

termination services, this was particularly difficult for teenagers.

2012 Update

          Abortion services are now more accessible for Buckinghamshire residents

           with clinics in Luton, Buckinghamshire, Milton Keynes and Oxford. Abortion

           Services in Buckinghamshire

i) Sexual Assault Service

The NHS has also commissioned the Sexual Assault Referral Centre (SARC) at

Upton Hospital and Bletchley Police Station. This will be transferred over to the NHS

Commissioning Board from 1 April 2013.

7.1.3 Vulnerable Young People - Young People in Care

Young people in care are considered to be particular risk of unprotected sex and

teenage pregnancy. A Personal Relationships and Sexual Health Policy for Children

in Care was written and published on the Buckinghamshire Local Safeguarding

Board website.

Sexual Exploitation

Some young people are vulnerable to being groomed for sexual exploitation.

Buckinghamshire Children & Young People’s Service has commissioned Barnardo’s

to deliver RU Safe? A Young People’s Sexual Exploitation and Missing Service which

supports those who have returned to home /care from going missing by providing

information on keeping safe and supporting those who have been sexually exploited.

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7.2         Support for Teenage Parents

7.2.1 Teenage Pregnancy Liaison Midwife

The Teenage Pregnancy Liaison Midwife was appointed in June 2005. This role was
created to provide additional support for teenage families to provide the best
outcomes for mothers during their pregnancy and for their babies.
The midwife built up close multi-agency working relationships, of note has been that
with the Connexions service. In April 2007 ‘Multi-Agency working to support pregnant
teenagers: a midwifery guide to partnership working with Connexions and other
agencies’ was published. This document included 2 anonymised case studies
supplied by the Teenage Pregnancy Liaison Midwife and the Connexions team which
demonstrated the clear pathway for teenage parents across Buckinghamshire that
had been set up and the benefits of this close working relationship on the teenage
mothers in Bucks. This formed the basis of the current multi-agency working.

7.2.2 Connexions Specialist Teen Parent Personal Advisers (TP PA)

Buckinghamshire Children & Young People’s Service commissions the Connexion

service.

A Connexions Teen Parent Personal Adviser was appointed in 2005 the role has

proved invaluable with excellent partnership working established between the

Connexions Teen Parent Personal Advisers and the Teenage Pregnancy Liaison

midwife who was also appointed in 2005 (see above). Connexions TP PAs also work

in partnership with Children’s Centres and Youth Services to deliver Young Parent’s

Support Group programmes.

The result off partnership working is that is that most young parents in

Buckinghamshire are known to the Connexions service and to BCC:

2012 Update

          DfE estimate of teenage mothers under 20 for 2011/2012 = 193
          No. of teenage mothers under 20 known to BCC was 153 = 79% known to
           BCC
           (The South East average of known teenage parents is 66% and the National
           average is 64%)

Review of Teenage Pregnancy in Buckinghamshire 2012   FINAL     Lynda Ayres          20
7.2.3 Guidance for Schools, Academies and Colleges to Support Pregnant

Students and Young Parents

The ‘Guidance for Schools, Academies and Colleges to Support Pregnant Students

and Young Parents’ was first published in 2006 and was updated in 2012. School

age young parents are monitored by the Exclusions and Reintegration Team. BCC

guidance is published to all schools, academies and pupil referral units on the

education, support and reintegration of pregnant pupils and school age parents.

7.2.4 Care to Learn

The Care to Learn Grant was launched in 2003/2004 which provides financial

support for teenage parents aged up to 20 years old who want to continue in, or

return to learning. It helps with the cost of their childcare and travel.

7.2.5 Young Parent’s Groups

The first Buckinghamshire Young Parent’s Group ‘Babysteps’ was hosted by the

Healthy Living Centre in Aylesbury in 2006. The young mothers who attended named

the group and requested further groups so ‘Step 2 It’ an accredited course was

developed and delivered at the Healthy Living Centre in November 2007. This was a

result of partnership working between The Healthy Living Centre, Connexions, Health

Visitors, Adult Learning, Youth Services and Sound Studio.

The model of young parents groups has been adopted by Children’s Centres across

the county with ‘Baby Steps’ and ‘Tiny Toes’ groups attracting young parents in

urban and rural areas.

2012 Update

          Children’s Centres in Buckinghamshire have developed the Young Parents

           Group model and continue to work with Connexions, the Youth Service and

           Health Visitors. Young Parents Groups were held at 8 Children’s Centres

           across the county during 2011/2012. Young Parents Groups

Review of Teenage Pregnancy in Buckinghamshire 2012   FINAL        Lynda Ayres       21
     The funding for education for Young Parents has been devolved to accredited

           learning providers. Aylesbury College took over this role during 2011/ 2012

           and delivered the programme to young parent learners

7.2.6. Family Nurse Partnership (FNP)

Buckinghamshire Family Nurse Partnership began recruiting clients in November

2012.

The evidence based FNP is an intensive home visiting preventative programme

offered to young women aged 19 years and under having their first baby. The FNP

programme begins in pregnancy and continues until the child is two years old. This

early intervention offers young parents and their children:

          Improved pregnancy outcomes

          Improved child health & development

          Reduced abuse & neglect

          Improved maternal life course development e.g. improved self sufficiency

          Investment in the programme and families will have individual, family,

           community and financial benefits

Conclusion

All the achievements of the Buckinghamshire Teenage Pregnancy Strategy have

been the result of committed and co-operative partnership working across a wide

range of statutory and voluntary services. This has provided a sound base on which

to build further developments to reduce the incidence of young people who contract

sexually transmitted infections, to reduce the number of teenage conceptions and to

provide co-ordinated support for teenage parents and their children.

Review of Teenage Pregnancy in Buckinghamshire 2012   FINAL       Lynda Ayres            22
Appendix 1
 Conception Rates by Area of Usual Residence
 Under 18 Conception Rates - Buckinghamshire
 Rates of conception are calculated from data of live birth, stillbirths and legal abortion. Rates are based on per 1000 females
 15 -17 yrs old
 Data is released from the Office of National Statistics (ONS) 14 months in arrears in February of each year
 Buckinghamshire's Teenage Conception target is 45% decrease from 1998 baseline by 2010

 Numbers              1998        1999       2000       2001     2002     2003     2004      2005     2006     2007     2008     2009     2010

 England              41,089      39,247     38,699     38,439   39,350   39,553   39,545    39,683   39,003   40,298   38,750   35,966   32,552
 South East           5,384       5,058      5,085      5,022    5,033    4,932    5,086     5,316    5,191    5,205    5,224    4726     4384
 Bucks                223         232        239        212      207      199      204       218      209      236      240      234      195

 Rates                1998        1999       2000       2001     2002     2003     2004      2005     2006     2007     2008     2009     2010

 England              47          45.3       43.9       42.3     42.6     42.1     41.5      41.1     40.4     41.7     40.4     38.2     35.4
 South East           37.7        36.2       36.1       34.8     34.4     33.1     33.5      34.2     32.9     32.8     32.9     30.1     28.3
 Bucks                24.8        26.3       27.1       23.4     22.6     21.5     21.9      22.7     21.3     23.9     24.4     24.2     20.2

 %leading
                      1998        1999       2000       2001     2002     2003     2004      2005     2006     2007     2008     2009     2010
 to abortion

 England              42.4        43.5       44.8       46.1     45.8     46.1     46        46.8     48.9     50.5     49.7     49.1     50.3
 South East           45          46         47.3       49.1     47.4     48.3     48.7      50.3     51.2     52.7     51       50       51.8
 Bucks                52          53         54.5       61       62.3     57.3     64.7      59.6     63.6     61.6     60.8     60.7     59.5

Review of Teenage Pregnancy in Buckinghamshire 2012   FINAL                        Lynda Ayres                                                     23
Teenage Conception Rates 1998 - 2010

     50

     45

     40

     35

     30

                                                                                                                                      England
     25                                                                                                                               South East
                                                                                                                                      Bucks

     20

     15

     10

       5

       0
               1998          1999           2000         2001   2002      2003       2004   2005   2006   2007   2008   2009   2010

Review of Teenage Pregnancy in Buckinghamshire 2012   FINAL                  Lynda Ayres                                                           24
% of Teenage Conceptions leading to abortion 1998 - 2010
                                                                 Rates are based on per 1000 females 15 -17 yrs old
    70

    60

    50

    40
                                                                                                                                          England
                                                                                                                                          South East
                                                                                                                                          Bucks
    30

    20

    10

     0
             1998           1999          2000          2001       2002    2003          2004   2005   2006   2007   2008   2009   2010

Review of Teenage Pregnancy in Buckinghamshire 2012   FINAL                       Lynda Ayres                                                          25
Under 18 conceptions data for LAD1 and LAD2 (all LAs including county districts) 1998-2010

 N.B. Rates are per 1000 female population aged 15-17.
 2010 data are provisional
 Sources: Office for National Statistics and DfE

                                    1998-                             2001-                         2004-                           2005-                       2006-                       2007-                        2008-
                                     00                                03                            06                              07                          08                          09                           10                 % change in rate
                                                    %                               %                                 %                           %                           %
                                               leading                         leading                           leading                     leading                     leading                    % leading                    % leading
                                                    to                              to                                to                          to                          to                           to                           to
 Area of usual residence   Number     Rate    abortion    Number       Rate   abortion   Number       Rate      abortion   Number    Rate   abortion   Number    Rate   abortion   Number    Rate    abortion   Number    Rate    abortion     98/00 - 08/10
 Buckinghamshire              694     26.1         53        619       22.5        60       631       21.9           63       664    22.7        62       686    23.3        62       711    24.3         61       669      23                        -11.9%
 Aylesbury Vale               245     27.1         53        227       22.9        56       236       24.1           61       233    23.6        61       237    23.9        59       250    25.4         56       231    23.4                        -13.7%
 Chiltern                      92     18.4         60            79      16        70        69       12.9           68        90    16.6        67       108    19.9        67       122    22.5         68       114    21.1                         14.7%
 South Bucks                   67     21.6         61         75       22.5        68        87        24            77        92     25         75        93    24.6        76        91    23.8         74        93    24.2                         12.0%
 Wycombe                      290     30.6         50        238       25.3        58       239       23.9           57       249    24.2        56       248     24         58       248    24.3         58       231    23.1                        -24.5%

Review of Teenage Pregnancy in Buckinghamshire 2012      FINAL                                    Lynda Ayres                                                                                                                                         26
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