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Teenage pregnancy and parenthood - Lecture Notes - English literature - Swann, C., Bowe,K., Study notes of English Literature

University of CambridgeEnglish Literature

It is widely understood that teenage pregnancy and early motherhood can be associated with poor educational achievement, poor physical and mental health, social isolation, poverty and related factors

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2010/2011

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Introduction
Evidence Briefing summary
Teenage pregnancy and parenthood:
This briefing presents the current evidence from
selected systematic and other reviews and meta-
analyses published since 1996. The full review –
Swann, C., Bowe,K., McCormick, G., Kosmin,
M. (2003) Teenage pregnancy and parenthood:
a review of reviews. London: HDA – will be
updated regularly as new evidence becomes
available. It can be accessed via:
www.hda-online.org.uk/evidence
It seeks to pull together learning from review-
level data about effective interventions to reduce
the rates of teenage pregnancy and improve the
outcomes for teenage parents.
It is widely understood that teenage
pregnancy and early motherhood can
be associated with poor educational
achievement, poor physical and mental
health, social isolation, poverty and
related factors. There is also a growing
recognition that socio-economic
disadvantage can be both a cause and
a consequence of teenage parenthood.
a review of reviews
Teenage pregnancy and parenthood in the UK
The UK has the highest rate of teenage
pregnancies in western Europe (UNICEF,
2001). Throughout most of the region,
birth rates to teenage mothers fell
during the 1970s, but UK rates have
been fairly consistent, staying relatively
stable since 1969 (Botting et al., 1998).
Between 1998 and 2000, the under 18
and under 16 conception rates have
fallen by over 6%, and:
• In 2000, 38,690 under 18 year olds
in England became pregnant
• 44.8% of these ended in legal
abortion
• 7,617 of these conceptions were to
under 16s
• 54.5% of conceptions to under 16s
ended in legal abortion. (Office for
National Statistics, 2000)
In 1998, the Social Exclusion Unit (SEU)
was asked by the Prime Minister 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 SEU published its report,
Teenage Pregnancy (SEU, 1999), and this
provides a comprehensive review of the
area and identifies the most effective
approaches to tackle teenage pregnancy.
The main aims of the national strategy
are to:
• Reduce the rate of teenage
conceptions, with the specific aim of
halving the rate of conceptions
among under 18 year olds by 2010.
The NHS Plan provides a target for
an interim reduction of 15% by
2004
• Set a firmly established downward
trend in the under 16 conception
rates by 2010
• Reduce inequality in rates between
the 20% of wards with the highest
rate of teenage conception and the
average wards by at least 25%
• Increase to 60% the participation of
teenage parents in education,
training and employment to reduce
their risk of long-term social
exclusion by 2010.
That report sets out a ten-year national
strategy for meeting these aims, and a
concerted programme of national and
regional work, coordinated by the
cross-government Teenage Pregnancy
Unit (TPU), is underway.
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Introduction

Evidence Briefing summary

Teenage pregnancy and parenthood:

This briefing presents the current evidence from selected systematic and other reviews and meta- analyses published since 1996. The full review – Swann, C., Bowe,K., McCormick, G., Kosmin, M. (2003) Teenage pregnancy and parenthood: a review of reviews. London: HDA – will be updated regularly as new evidence becomes available. It can be accessed via: w w w. h d a - o n l i n e. o r g. u k / e v i d e n c e It seeks to pull together learning from review- level data about effective interventions to reduce the rates of teenage pregnancy and improve the outcomes for teenage parents.

It is widely understood that teenage pregnancy and early motherhood can be associated with poor educational achievement, poor physical and mental health, social isolation, poverty and

related factors. There is also a growing recognition that socio-economic disadvantage can be both a cause and a consequence of teenage parenthood.

a review of reviews

Teenage pregnancy and parenthood in the UK

The UK has the highest rate of teenage pregnancies in western Europe (UNICEF, 2001). Throughout most of the region, birth rates to teenage mothers fell during the 1970s, but UK rates have been fairly consistent, staying relatively stable since 1969 (Botting et al., 1998). Between 1998 and 2000, the under 18 and under 16 conception rates have fallen by over 6%, and:

  • In 2000, 38,690 under 18 year olds in England became pregnant
  • 44.8% of these ended in legal abortion
  • 7,617 of these conceptions were to under 16s
  • 54.5% of conceptions to under 16s ended in legal abortion. (Office for National Statistics, 2000)

In 1998, the Social Exclusion Unit (SEU) was asked by the Prime Minister 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 SEU published its report, Teenage Pregnancy (SEU, 1999), and this provides a comprehensive review of the area and identifies the most effective approaches to tackle teenage pregnancy.

The main aims of the national strategy are to:

  • Reduce the rate of teenage conceptions, with the specific aim of halving the rate of conceptions among under 18 year olds by 2010. The NHS Plan provides a target for an interim reduction of 15% by 2004
  • Set a firmly established downward trend in the under 16 conception rates by 2010
  • Reduce inequality in rates between the 20% of wards with the highest rate of teenage conception and the average wards by at least 25%
  • Increase to 60% the participation of teenage parents in education, training and employment to reduce their risk of long-term social exclusion by 2010.

That report sets out a ten-year national strategy for meeting these aims, and a concerted programme of national and regional work, coordinated by the cross-government Teenage Pregnancy Unit (TPU), is underway.

Girls and young women from social class V are at approximately ten times the risk of becoming teenage mothers as girls and young women from social class I. Young people with below average achievement levels at ages 7 and 16 have also been found to be at significantly higher risk of becoming teenage parents (Kiernan, 1995).

We know less about who becomes a young father (but the above refers to young parents). Evidence suggests (Kiernan, 1995) that young fathers (defined as those who became fathers before the age of 22), like young mothers, are more likely to come from

lower socio-economic groups, from families that have experienced financial difficulties, and are more likely than average to have left school at the minimum age.

There is some evidence that certain groups of young people seem to be particularly vulnerable to becoming teenage parents. They include:

  • Young people in or leaving care (Biehal, 1995)
  • Homeless young people (JRF, 1995)
  • School excludees, truants and young people under-performing at school (Kiernan, 1995) - Children of teenage mothers (Botting et al., 1998) - Members of some ethnic minority groups (Botting et al., 1998; Berthoud, 2001) – for example, Caribbean, Pakistani and Bangladeshi women are more likely than white women to have been teenage mothers - Young people involved in crime (Botting et al., 1998) - Conception rates are slightly higher in the north of England than the south, although there is a lot of regional variation (Botting et al., 1998).

Who becomes a teenage parent?

Although parenthood can be a positive and life-enhancing experience for some young people, it may also bring a number of negative consequences for young parents and their children.

These factors include:

  • Negative short, medium and long- term health and mental health outcomes for young mothers (Botting et al., 1998)
  • Education and employment – as well as being more likely to have problems at school before they become pregnant, young mothers are less likely to complete their education, have no qualifications by age 33, be in receipt of benefits and if employed be on lower incomes than their peers (SEU, 1999)
  • Housing – 80% of under 18 mothers live in someone else’s household (eg parents) (Botting et al., 1998), and teenagers are more likely to have to move house during pregnancy
  • Family – teenage mothers are more likely to be lone parents (Kiernan, 1995), and more likely to find themselves in the middle of family conflict (SEU, 1999) - Young fathers – although there is little data on this group, health, economic and employment outcomes for young fathers post-parenthood seem to be similar to those of young mothers (Kiernan, 1995).

There may also be negative outcomes for the babies and children of teenage mothers:

  • Babies tend to have a lower than average birth weight (Botting et al.,
  • Infant mortality in this group is 60% higher than for babies of older women (Berthoud, 2001)
  • Some 44% of mothers under 20 breastfeed, compared to 64% of 20–24 year olds and up to 80% of older mothers (Botting et al., 1998)
  • Children of teenage mothers are more likely to have the experience of being a lone parent family, and are generally at increased risk of poverty, poor housing and having bad nutrition (Botting et al., 1998)
  • Daughters of teenage mothers may be more likely to become teenage parents themselves (Botting et al., 1998; Kiernan, 1995).

What happens to teenage parents and their children?

  • Checking that interventions and services are accessible to young people – in terms of location, opening hours and so on
  • Selecting and training staff who are committed to programme and service goals and to the needs of young people, who will respect the confidentiality of young people where possible
  • Making sure that information and education is in place before young people become sexually active
  • Working with teenage ‘opinion leaders’ and peer group influences
  • Making sure that interventions are age appropriate
  • Encouraging a local culture in which discussion of sex, sexuality and contraception is permitted
  • Joining up services and interventions aimed at preventing pregnancy with other services for young people, and working in partnership with local communities.

However, one recent systematic review of randomised controlled trials of interventions to reduce unintended teenage pregnancies (DiCenso et al.,

  1. found little, if any, evidence for the efficacy of interventions, with the exception of a multi-factor approach to life skills and pregnancy prevention. This review included only interventions which had been evaluated with randomised controlled trials, a very small and narrowly defined proportion of the available evidence, which may bias its overall results. Further research is needed to look in more detail at the types of studies reviewed by this paper, and a discussion of this review may be found in the full version of this briefing.

There was no strong (1 or 2 rated) evidence for the effectiveness of abstinence-based interventions (those that focus only on promoting sexual abstinence), and in fact DiCenso et al. (2002) found evidence that abstinence-only approaches had the opposite effect, actually increasing

pregnancy rates in the partners of male participants. On the whole, our findings indicate that abstinence approaches (despite heavy funding provision in the US) do not work, and programmes including abstinence messages only seem to be effective if messages about contraceptive services and other practical issues are included.

Cost effectiveness

Good evidence (category 1) was found to indicate that effective contraceptive services are highly cost effective in preventing teenage pregnancy. However, information on the cost effectiveness of other types of interventions was not identified.

Improving outcomes for teenage

parents

What we know Only three reviews dealt explicitly with improving outcomes for teenage parents

  • one category 1 review and two category 3 – so there is very little evidence to draw on here. From the three (NHS CRD, 1997; Nitz, 1999; Card et al., 1999) we found evidence to support the following:
  • Good antenatal care can improve health outcomes for mother and child, and are cost effective (category 1 evidence)
  • Home visiting, parental and psychological support can improve health and welfare outcomes for mother and child (category 1), and may prevent or delay repeat pregnancies (category 3 evidence). However, home visiting is not a single or uniform intervention, it is a mechanism for the delivery of a variety of interventions directed at different outcomes. Further work will need to be undertaken about what is meant by home visiting in a UK context
  • Improving housing for young parents and their children will increase health outcomes (category 3 evidence) - Support for young parents to continue education will improve educational and employment outcomes for parents, mother/child interaction, and social outcomes for children. Early educational interventions for disadvantaged children can improve long-term outcomes (category 3 evidence) - Clinic-based healthcare programmes for teenage mothers and their children can improve their health outcomes (category 3 evidence).

What we don’t know

Methodological issues There are a number of methodological problems with the review-level evidence base on preventing teenage pregnancy and improving outcomes for teenage parents that need to be kept in mind. These are:

  • Most of the reviews we considered commented on the poor methodological quality of the studies they reviewed
  • Many evaluation studies considered by reviews are actually measuring different things, making a synthesis of their findings very difficult to achieve
  • There is a notable difference in findings between reviews that looked at all kinds of evaluation studies, and those that looked only at randomised controlled trials
  • Reviews tend to rely on traditional evaluation studies, and often do not consider other types of study that might be relevant or useful, eg action research, qualitative research and expert opinion
  • It is difficult to determine ‘what works’ to prevent teenage pregnancy, when some teenage pregnancies may be wanted and planned, others may be unplanned but wanted, and yet others may be unwanted and unplanned – there are many different pathways to parenthood for young people, and more research is needed to understand them better.

Findings (continued)

This Evidence Briefing summary is part of a series of publications covering a wide range of public health topic areas to be published by the HDA over the next few years. Subjects will include:

  • Alcohol
  • Smoking
  • HIV
  • STIs
  • Drugs
  • Health impact assessment
  • Mental health
  • Accidental injury
  • Depression in later life
  • Low birth weight
  • Mobility in later life
  • Breastfeeding
  • Nutrition in pregnancy.

Evidence Briefings provide detailed expositions of the strengths and weaknesses of the evidence, identify gaps in the evidence, analyse future primary and secondary research needs, and discuss the implications of the

evidence for policy and practice. Each briefing is accompanied by a freestanding summary. The documents are also supported by the HDA website www.hda-online.org.uk/evidence

Electronic copies of the original systematic reviews upon which the Evidence Briefings draw as well as full bibliographical information about the relevant primary sources will also be found on the website.

Evidence Briefings provide a comprehensive, systematic and up to date map of the evidence base for public health and health improvement, with a particular focus on reducing inequalities in health. They are a resource that will be used by a variety of audiences as well as being source documents from which a range of other products may be developed.

Other evidence briefing summaries

Findings (continued)

Gaps in the evidence base We identified a number of areas in which little or no evidence was found, where research is needed:

  • Intervention and evaluation of interventions to prevent pregnancy aimed at specific vulnerable groups, eg young people in/leaving care, school excludees/persistent truants, children of teenage parents, young people from some black and minority ethnic groups (primarily Caribbean, Pakistani and Bangladeshi)
  • Intervention and evaluation of interventions aimed at improving outcomes for all teenage parents – we found very little review-level evidence on this
  • Interventions and evaluations of interventions that are based in the UK
    • the majority of studies considered

by the reviews we identified were US- based

  • Young men are often completely absent in the literature – there is an urgent need to find out more about the paths to early fatherhood, what works to prevent young fatherhood, and how best to support young fathers to improve their health, social, educational and employment outcomes
  • The nature of the relationship between poverty, deprivation and teenage parenthood – it is not clear to what extent the effects of teenage pregnancy are determined or mediated by poverty.

In addition to these gaps, there are a number of areas that would merit further development and research:

  • Youth development projects (Kirby,
    1. appear to have some promise for preventing pregnancy and improving contraceptive use; however, virtually all of the research considered by reviews here was based and carried out in the US
  • The effectiveness of Internet-based interventions, because this medium may be particularly suited to working with young people
  • Given the long-term costs that teenage parents incur in welfare and health, further work on the cost effectiveness of interventions might help to promote more government investment.