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Sexual Health is a fundamental constituent of health. Teenage pregnancy is an aspect of sexual health which has been of great public health and social importance due to the implications it poses. According to UNICEF (2001), UK has the highest teenage pregnancy rate in Western Europe. This essay will critically analyse the factors that contribute to teenage pregnancy in the UK, that is, socio-economic , education- related factors and as well as risky behaviours. To get a better understating of this topic, effects of teenage pregnancy as well as current strategies, interventions and recommendations for improved care in tackling teenage pregnancy will be discussed. The essay will be concluded with a summary of the literature.
Teenage pregnancy can be defined as a term employed to refer to giving birth of young women under 20 which result in live births or abortions ( Ewles 2005). The scale of problem is appalling. Approximately 91,200 conceptions in teenagers take place per year, 7700 among girls under 16 years of age and 2200 among 14 year olds or younger (Chambers et al 2001). Moreover, 46% constitutes to those who have legal abortion and 56% of those aged under 16 years who partake in an abortion. According to Ewles ( 2005), UK teenage pregnancy rates are much higher compared to other European countries, in that, they are five times as high as compared to those in Netherlands, three times as high as compared to France and two times higher in Germany.
Teenage pregnancy poses a great public health threat due to the causal link associated with health inequalities. The high rates of abortion and sexually transmitted disease elucidates that young people are not having protected sex and this is supported by the appalling STI rates which are highest in 16-19 year old women ( Baker et al 2007).
Furthermore, Elwes ( 2005) states that one in ten sexually active teenagers is infected with a sexually transmitted disease ,illustrating lack of public awareness about sex education, contraception and condom use.
In order to tackle teenage pregnancy, it is important to understand the factors that contribute to teenage pregnancy. Research evidence has identified the key risk factors which are acknowledged to be associated with teenage pregnancy. Ewles (2005) states that low expectations is a major factor, where we see there is a significant association between young people from lower-social economic classes and high rates of teenage pregnancy and birth.
Lack of employment and disengagement from education or training can potentially give rise to feelings of inadequacy and hoplessness thus goals and aspirations seem unattainable affecting the outlook of one’s future. Moreover, according to the survey conducted by the Department for education and skills (2006), low education attainment and leaving school at 16 with no qualifications are evidently independent risk factors of teenage pregnancy. Consequently, parenthood can be perceived as an appropriate approval to gain adulthood status with no employment or educational attainment to show for it. However, the SEU (1999) did not find evidence to support these findings.
Ignorance about sex and relationships has been identified as another risk factor. Notwithstanding being surrounded by sexual images and messages from an early age and despite being sexually active, research demonstrates that there is poor knowledge on consensual and safe sexual relationships, contraception and STI’s among young people (Ewles 2005). A study conducted by the Health Education Authority (1999) reported that 25% of teenagers aged 14-15 years perceived that the contraceptive pill protected them from acquiring a sexually transmitted diseases which can be exacerbated by myths, such as first sexual experience will not end up in pregnancy, that are apparent in the society. In a nutshell, young people have impractical perceptions on pregnancy and parenthood (SEU 1999).
Mixed messages have been associated with teenage pregnancy, given that, children and teenagers in the UK are bombarded by sexual images and messages which can potentially lead one to believing and accepting sex as the norm in the society even at a young age (Ewles 2005). It is argued that in the UK, sex appears to be the custom and relatively necessary, whereas contraception and sexual health awareness is inadequate thus elucidating young people cannot make informed decisions (NHS 2004). Simultaneously, there may be insufficient communication between parents or teachers and young people on sex and contraception thus leaving young people uninformed.
Poverty is another factor, where the risk of becoming a teenage mother is approximately 10 times more in girls and women from social class V( unskilled and manual) as compared to women in social class 1 (professional) ( DOH 1999) . Additionally, research evidence illustrates young women who have experienced care or foster and homelessness are at risk as well (Chambers et al 2001). A study reported women in this category are two times at risk of becoming teenage mothers compared to those raised by birth parents (Baker 2007). A complimentary study also found out that approximately 50% of girls leaving care become mothers within 18months to two years ( DOH 1999).
A British cohort study conducted in 1970 reported that one of the strongest predictors of teenage pregnancy is being a daughter of a teenage mother because they are 1.5 times at risk as compared to children born of older women (Baker 2007). According to DOH (1999), having a history sexual abuse is identified as a risk factor where we see young people may be reluctant to abstain from sexual pressure subsequent to abuse that ensued.
Numerous studies have elucidated the association between mental health disorders and teenage pregnancy, in addition, Maskey’s study conducted in 1991 illustrated that a third of young women with conduct disorders become pregnant before the age of 17 ( Baker 2007).
Crime is also a factor especially with teenagers who get involved in unlawful activities causing police intervention because they are twice likely to become teenage parents. (Chambers et al 2001). Tyrer et al conducted in a study in 2005 and reported that 39% of young female offenders are teenage mothers even as approximates propose that more than 25% of young male offenders are teenage fathers or fathers-to-be ( Zaplin 2006).
Risky behaviours for example early onset of sexual activity and poor contraceptive use are factors associated with teenage pregnancy. The average age of first sexual intercourse has fallen from to 16 ( House Of Commons 2002-3) and girls having sex under 16 are three times more likely to become pregnant that those who have sex over 16 years ( SEU 1999). Approximately 60% of boys and 47 % of girls dropping out of school at 16 with no qualifications engaged in sex compared to 20% for both males ( Baker 2007).
Ethnicity has a fundamental link with teenage pregnancy. Consistent with the 2001 census, data on mothers under 19years demonstrated that teenage pregnancy rates are considerably higher among mothers of ‘mixed and black Caribbean, ‘other black and ‘black Caribbean’ ethnicity (Baker 2007). Early onset of sexual activity is linked to ethnic groups where a survey conducted in East London (Viner and Roberts 2004, ) illustrated that first sexual encounter under 16 was higher among Caribbean men (56%) compared with 30% for black African and 27% for white men and 11% for Indian and Pakistani men. As for women, 30% for both white, black Caribbean, 12% for black African and 3% for Indian and Pakistani women. In addition, poor contraceptive use among specific ethnic groups has been associated with teenage pregnancy (Baker 2007).
Having acknowledged the factors and effects associated with high rates of teenage pregnancy, Tony Blair commissioned the Social Exclusion Unit (SEU 1999) to develop a teenage pregnancy strategy, known as the National Teenage Pregnancy Strategy in 1999 ( Ewles 2005). Its main aims were to halve the number of teenage conceptions by 2010 and establish a consistent decline in trend in the under -16 teenage pregnancy rate ( SEU 1999).
According to ( Chambers et al 2001 ) , a total of 150 teenage pregnancy co-ordinators were appointed in each local authority area in England, in 2000, who lead the force to execute the Social Exclusion Unit report. Each local area has employed a 10-year strategy, with local under -18 pregnancy rate reduction targets of between 40% and 60%, which strengthens the national reduction target of 50% ( Ewles 2005).
As recommended by the SEU(1999) , the main preventative interventions in tackling teenage pregnancy are effective school-based sex and relationships education ( SRE) that are established with the help of local authority, particularly when correlated with contraception use and services. HDA (2004) reported that SRE programmes was highly rated by young people who received it and were positively impacted by the knowledge and decreased the level of report over first sexual intercourse .However, from the UK- based systematic evaluation of SRE programme they found out that the multi-faceted approach had no effect on contraception use and sexual behaviours ( NICE 2004). (DFES) stated that effective education programmes should be focused on mitigating behaviours that cause teenage pregnancy and are based on theory and highlight background information on sexual matters Moreover clear information on use of contraception is necessary and young people should be informed about the risk factors, how they can avoid sex as well protection against pregnancy and STI’s.
Activities that help deal with peer and social pressure are fundamental and how to acquire communication, negotiation and refusal skills by employing participatory teaching methods ( HDA 2004). Ewles ( 2005) argues that abstinence education as recommended by the strategy has proved to be ineffective
The strategy stated the need to involve and provide information on prevention to teenager’s parents which is fundamental. SEU (1999) recommended that youth Services should involve programmes that integrate a long term, multi-dimensional approach that is a combination of self-esteem building, voluntary work, and educational support (Ewles 2005) and have a clear focus on addressing issues that affect young people for example, sexual health and substance abuse. HDA (2004) states that, the adoption of development programmes has proved to be successful in America and has been elucidated as a competent approach to teenage prevention.
Chambers et al (2003) argues that provision of effective sexual health services has been identified as a factor for reducing teenage pregnancy. The DFES (2006) recommended the availability and accessibility of well-publicised contraceptive and sexual health advice services targeted for young people, with a an established responsibility that commits to health promotion work and delivery of reactive service. In addition, engaged and coordinated action among all key mainstream delivery partners who are responsible for reducing teenage pregnancy – health , Education, Social services and youth support services as well as the voluntary sector is vital ( Ewles 2005). Moreover, HDA (2004) recommended that practicing confidentiality and having long term provision of services has proved effective in teenage prevention.
Another key recommendation is the need for a keen focus on tailored interventions that target young people who are susceptible to teenage pregnancy especially with Looked After Children, that is, those in care and foster ( Acheson 2001 ). The strategy advocated for professionals in partner organisations for example, Connexions, working with the most vulnerable young people need consistent Sexual and Relationship Education training that are readily available ( HDA 2004).
Moreover, the national teenage strategy introduced the national media campaign aimed at mitigating myths and provides young with clear and accurate information to make it possible for young people to make informed choices thus reducing teenage pregnancy rates ( Ewles 2005). It recommended that effective information should be clear and unambiguous ( HDA 2004) .
The current focus on awareness and education is supported by the two national media campaigns which are ;’ R U thinking’ is addressed to young teenagers encouraging them to delay onset of sexual activity and shun peer pressure; Want Respect? Use a condom is targeted at young people who are sexually active by promoting condom use by relating condom use with ones conduct and behaviour that will earn respect from their peer ( DFES 2006).
The Teenage Pregnancy Strategy’s main priority is to reduce under 18 pregnancies by providing young people with ways and incentives to defer parenthood until they able to cope with the challenges that come with it. Nevertheless, the strategy is dedicated to support and reducing the risk of poor outcomes for teenage parents and their children, with a target to increase the participation in education, training or employment of teenage mother’s aged 16-19 by 2010 ( DFES 2006).
According to the Acheson Report ( 2001) the inequalities faced by teenagers who go on to be mother as compared to older mothers are perturbing because there is an increased likelihood they have mental health problems, especially, post-natal depression; are 50% likely to breast feed as well as have a higher occurrence of smoking during pregnancy and experience relationship breakdown . In addition, when they become older, say in their thirties, it is evident that they are more likely experience poverty, be subjected to unemployment, lack qualifications and live on benefits which makes them susceptible to get trapped in the poverty cycle which can potentially lead to a poor adult life.( Ewles 2005).
Children born of teenage parents are 60% more at risk of infant mortality and can possibly die in their first year, 25 more at risk be conceived with a low birth weight, are particularly at much higher risk of growing up experiencing poverty, poor housing and nutrition for a long haul and are at a greater risk of becoming teenage parents themselves ( Ewles 2005).
To prevent poor out comes for teenage parents and their children, the strategy recommends and provides support and interventions that include antenatal and postnatal support where they are provided with impartial information on alternative of parenthood, abortion and adoption and pregnancy testing services as well ( Ewles 2005). They are advised and get help with psychosocial issues for example, anxiety that they may face during and after their pregnancy with the help of youth-friendly maternity services characterised by tailored models of care ( Chambers et al 2005).
Together with providing young parents with development skills in parenthood, the strategy recommends and is committed to provide services that will support them to stay or resume to education, training or employment ( Ewles 2005). This is includes finding preferred courses, getting help with childcare so that young parents can continue with education or work as well as providing them with necessary help for them to remain in school or get alternative methods to continue with education ( DFES 2006).
The strategy introduced the Sure Start Plus programme to provide every child with the best start in life by providing education, childcare, health and family support ( National Audit Office). It recommends and recognizes the crucial benefits of a committed personal advisor for teenage parents, who tailors ongoing support packages to meet various individual needs for example housing and financial needs (Ewles 2005).
In consistent with the priorities of the strategy in terms of better support, it acknowledges that high quality support to all teenage parents living without family or parents is needed ( DFES 2006). Furthermore, some young mother under 18 can be susceptible to social exclusion when they live without any support, leading to isolation especially when disintegrated from their social support networks, that is, family. The strategy aims to tackle this by providing supported housing to all under 18 lone parents who cannot live at home or with their partner and are provided with suitable needs ( Ewles 2005). This reduces the detrimental effects of poor housing on health.
In conclusion, this essay has discussed the factors that contribute to teenage pregnancy and its impact on public health. Moreover, the implications of teenage pregnancy have been highlighted. The government, through the Social Exclusion unit and the establishment of the National Teenage Pregnancy Strategy , has been involved in tackling teenage pregnancy through joined up action, national media campaign , better support for teenage parents and better prevention as discussed. According to Naidoo and Wills , education and persuasion through mass media campaign may be an effective strategy in tackling teenage pregnancy because these techniques are geared to change people’s behaviours and lifestyles willingly as a result of information, support and advice.. HDA (2004) states that young people should be provided with sufficient education and clear information about all facts of sex and relationships and its implications coupled with confidential and accessible sources of contraceptive services in tackling teenage pregnancy.
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