Teenage Pregnancy is defined as conceptions which include those that lead onto a live birth and terminations in the under 18 age group. Teenage pregnancy generally creates inequalities in health, and usually leads to poor long term outcomes for both parents and their children according to the Department of Health (DH, 2013). Teenage Pregnancy falls into the category of a vulnerable group. A vulnerable group can be defined as those that experience a higher risk of poverty and social exclusion than the general population (European Commission, 2009). In 2001, the government as part of the Teenage Pregnancy Strategy launched the Surestart Plus pilot programme which would provide funding in 20 areas that had the highest rate of teenage pregnancy.
The aim of the pilot scheme was to work with this vulnerable group to tackle the reasons why they have poorer health and social outcomes, and to offer better antenatal and postnatal care to these mothers, and to offer opportunities in education and training so as to increase their chances of a better outcome in life. The aim of this piece of work is to focus on what makes teenage pregnancy fall into the category of a vulnerable group, how social and economic factors determine a vulnerable group, and examine the impact that Sure Start Plus has had on teenage pregnancy. As midwifes have been heavily involved with the scheme, it is important to delve into the role that the midwife has played in the project in order to assess whether or not the project was successful as a public health initiative which incorporates the principles of participation, collaboration and equity.
The United Kingdom has one of the highest number of births per 1,000 women aged 15-17 in the European Union, being five times that of the Netherlands, double those in France and more than twice those in Germany (family planning association 2010). The teenage pregnancy rate has dropped in recent years, with the estimated number of conceptions to women aged under 18 in England and Wales in 2011 at its lowest since records began in 1969. The number of conceptions to women aged under 18 in 2011 was 31,051 in comparison with 45,495 conceptions in 1969, a decrease of 32% (Office for National Statistics (2013). This may be due to increased awareness of contraception through education in schools and in the home. Nonetheless, there is still much work to be done to bring the rate further down in relation to the rest of Europe (DH 2013).
CMACE (2011) assert that the most vulnerable mothers in society are at higher risk of maternal death. Therefore, teenage pregnancy can affect a young woman’s health and wellbeing as well as limit her opportunities for continued education, therefore limiting career opportunities and socio-economic stability. Although some teenage mothers are very good parents, evidence does suggest that children born to teenage parents have more chance of poorer outcomes in life than those born to older mothers and that children of teenage mothers tend to continue the trend, and end up teenage mothers themselves (HM Government 2006). Berrington et al (2005) claims that a mother’s age, disadvantaged background and low attendance of available antenatal care all contribute to poorer outcomes.
The outcomes for both mother and child associated with teenage pregnancy include; late booking for maternity services, smoking in pregnancy, poor diet and maternal health, premature birth and low birth weight, infant mortality, hospitalisation of the infant, low breastfeeding rates, postnatal depression, broken relationships either with a partner or family leading to feelings of isolation and repeat unplanned pregnancies. These young women tend to leave school with no qualifications, and not return to education, therefore have no training and are less likely to have employment. These mothers tend to end up in poverty and poor housing even into the later years of their life. This is further backed up by Lewis & Drife (2004), who claim that mortality and morbidity of babies born to teenage mothers tend to have higher risks of complications. Therefore, reducing teenage pregnancy is of great significance in tackling the problem of health inequalities and child poverty within this vulnerable group in our society.
The government’s Social Exclusion Report (1999) on teenage pregnancy aimed to tackle the issue of teenage pregnancy. The Report highlighted two major areas that were to be targeted; firstly, through the National Teenage Pregnancy Strategy, which aimed to decrease the pregnancy rate amongst the under 18 age group by half by 2010, and secondly, with the aim to achieve that teenage parents and their children are better supported in health and education in order to avoid the risk of long term exclusion. One of the ways that this was to be achieved was through the Sure Start Plus pilot scheme. Prior to this, services for pregnant teenagers were not coordinated and there was no specific remit for agencies to engage with teenage parents, which led to disengagement from the services available.
The Introduction of the Children’s Act (2004) provided the legislative framework that was set out in Every Child Matters document (2003) which highlighted 5/ outcomes which every child and young person should have, being healthy, staying safe, enjoying and achieving, making a positive contribution to society and economic well being. This act meant that local authorities had a duty of care to put provisions in practice to help teenage mothers. The Department for Education and Skills (DFES 2000) issued a guidance document( Surestart Unit 2000) which defined the aims, objectives and related targets for the Sure Start Plus pilot programme.
The core aims set out at the beginning of the programme were to improve the social and emotional wellbeing of pregnant young women, young parents and their children, strengthen the families and communities of pregnant young women and young parents. Improve the learning of pregnant young women, young parents and their children, and improve the health of pregnant young women, young parents and their children. Funding was made available for the top 20 Local Authorities with the highest rate of teenage pregnancy.
The rates of late antenatal care and smoking in pregnancy and low birth weight babies was significantly high in the 20 areas that received funding prior to the Sure Start Plus pilot scheme. Mackeith and Phillipson writing in (1997) claimed that teenagers that were given the correct support could potentially become good parents and learn good life skills that could prevent them from entering a life of poverty and poor health. The Surestart pilot scheme’s aim was to engage with teenage parents and examine and fulfil the needs of this vulnerable group so that they would have a brighter future than what statistics of young women in their situation pointed to. One piloted area was Rochdale, where in 2001, one full time manager, 1 and a half full time midwives and one half time support worker was employed to work specifically with pregnant teenagers, through home working, meeting in community venues and schools.
Midwives were particularly important in this scheme as they should be seen as the lead professional in normal, uncomplicated pregnancies and should have a strong place in the community where women can easily access them as their first point of access into maternity services. Midwives are in a unique position to give health education to parents of any age, but in particular teenage mothers where they can be seen as someone they know and trust. Midwives should have a good knowledge and understanding of the health and social needs of the local community in which they work, and be able to identify vulnerable groups within society and give the appropriate support required. The RCM currently recommends that midwives understand their role as a public health practitioner and should aim to give good quality care to all. The Sure Start Plus midwives were specialist teenage pregnancy midwives who were trained to work outside the normal health remit of midwifery, and were able to provide information on housing, benefits, relationship problems, assist in helping with educational needs, introduce support networks that were available and assist in childcare needs.
They were to work specifically with teenage mothers and their partners if they had one in more accessible ways that would be more acceptable to teenage mothers in a place that the young mother would feel comfortable. This sometimes meant that midwives would have to meet young mothers in their homes, a friend’s home, a coffee shop or community venues and schools. Each teenage mother would receive an overall assessment of their individual needs, a holistic view of the teenage mother. This enabled the midwife to build up a rapport with the pregnant teenager, so that the teenager could confide and trust the midwife, which would lead to mutual respect. At times, it may be difficult for midwives to understand and deal with the issues involved with these vulnerable groups and to accept decisions and actions of the women involved. However, the midwife must remember that they are there in an advisory role to help and not there to make the decisions for these women.(Bowden 2006)
Mackeith and Phillipson (1997) in writing about young mothers claims that being judgemental against young mothers achieves only lowered self -esteem in the woman, resentment and breaks down the relationship between mother and midwife, this in turn leaves it more difficult for the midwife to encourage the young women as she is less inclined to take the information she has given her on board as there is no mutual respect. A review conducted in 2009, found that 10.5% of pregnant teenagers seen in 2007 quit smoking due to the support of specialist midwives and smoking cessation services. This has increased to 12.5% in 2008. Women breastfeeding on the labour ward increased from 32.6% in 2007 to 41.9% in 2008. Those receiving support from their families and the local community had risen from 77.7% in 2007 to 84.8% in 2008. The Connexions in Rochdale reports that a figure of 50% of young parents aged 16-19 in Rochdale in Education, Employment and Training (2011) compared with the national average of 32%.
These findings make it clear that the midwife has had a very positive and far reaching role in improving the services obtained and the overall wellbeing of this vulnerable group. The midwife also has an important role midwife in referring patients within a multidisciplinary team eg Social Services if needed, either for additional support or child protection. Pregnancy can be a golden opportunity for vulnerable young people to be in contact with services for the first time and get additional health and sex education. This may be an opportunity for them to turn their life around knowing that they have a baby to take care of. For some it may be their first opportunity to give and/or receive love and the support of trained professionals can drive this. It should be noted that not all teenage pregnancies are accidents and unwanted, and some may be accidents but still wanted. Those involved just require the necessary support available to them. Also, not all teenage mothers are lacking skills to become a parent and some are very good with the appropriate support.
A lot of this support coming from a midwife. A midwife is also trained in providing the vulnerable group with advice on healthy eating, breastfeeding support, parent craft, sexual health, and contraceptive advice with the intention of preventing any further unwanted pregnancies. The Sure Start Plus National Evaluation Report (2005), found that the contexts within which Sure Start Plus programmes worked differ in relation to population demographics, relationship with local authority boundaries; level of other specialist service provision, and programme funding. The Report also found that a lack of clear identity for the program has created confusion which may have lessened its influence on mainstream services. The name ‘Sure Start Plus’ was considered inappropriate because the similarity to Sure Start creates confusion and because it is not easily identified with teenage pregnancy or parenting. However, the Report found that the programmes worked successfully in partnership with NHS antenatal services; Connexions; the education service; Sure Start and the Teenage Pregnancy Co-ordinator.
Today the scheme is known as the Young Parents Support Service, and a specialist Teenager Parent Midwife work only with pregnant teenagers and trained with the complexities of young parents, as well as providing contraceptive advice and fitting contraceptive implants to reduce repeat teenage pregnancies. Advice and counselling on whether or not the young woman wants to keep her baby or have an abortion or put it up for adoption, the midwife plays the role of counsellor in this capacity for these women to talk through their options. Furthermore, the Midwifery 2020 initiative aims to strengthen the role of the midwife in public health. In conclusion, it is clear that teenage pregnancy is an issue in the UK today and the high rates need to be combated to reduce social exclusion and deprivation in these vulnerable young people and ultimately their children. One way that has been initiated to address this issue has been the Sure Start Plus scheme, which can be seen from the evidence above, has been successful in the areas that it has been piloted.
However, issues of finance remain an issue but it must remain that help remains for the most vulnerable of these young people. The role of the midwife in ensuring the success of the scheme has been vital, as they are the person that the pregnant teen deals with the most and is specially trained to address all of the teens social, personal and in some cases economic problems. The statistics clearly show that a midwives involvement has improved the health and social mobility of the pregnant teen. This should have far reaching implications for all midwives as they are trained to deal with women from all ages and walks of life, but highlights to all that special empathy and care should be given when dealing with this vulnerable group. The scheme has raised awareness for all midwives and not just those that are specially trained to deal with pregnant teens. However, maybe further training could be given to all new midwives, due to the high rate of pregnant teens in the UK.