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Preventing unwanted teenage pregnancies

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VOL: 97, ISSUE: 19, PAGE NO: 38

Sarah Bekaert, RN (Child), is community nurse in schools, Lower Clapton Health Centre, Hackney, London

Government targets and recent policy have consistently emphasised a need to reduce the number of unwanted teenage pregnancies, but the east London borough of Hackney is reporting record levels of conception among young people. So there is now new impetus to improve projects that are concerned with the sexual health of young people.

Government targets and recent policy have consistently emphasised a need to reduce the number of unwanted teenage pregnancies, but the east London borough of Hackney is reporting record levels of conception among young people. So there is now new impetus to improve projects that are concerned with the sexual health of young people.

Teenage Pregnancy, a report by the Social Exclusion Unit (1999), outlined targets for a reduction in the number of unwanted teenage pregnancies. But after two years, what progress has been made? Britain has the highest rate of unwanted teenage pregnancies in western Europe and Hackney has the third highest rate of conception among girls aged under 16 in England. Between 1992 and 1997, conceptions in the 15-17 age group increased from 67 to 78 per 1,000 (East London and The City Health Authority, 2000). In 1995-1997, 52% of them were terminated.

Government proposals
The Department of Health described several strategies to tackle the problem of unwanted teenage pregnancies. First, it proposed a national publicity campaign to tell teenagers how difficult it is to be a good parent and how easy it is to get pregnant. It also aimed to make sure that young men, who are often ignored in such campaigns, would get the message.

According to the campaign, young men need to know how to resist peer pressure to have sex at too young an age. They also need to be made aware of the potential cost to their health of having unprotected sex and to be left in no doubt about their financial obligations to support their children.

Parents were also included and it was proposed that they be given more advice and support so that they would be able to talk to their children about sex and relationships. Effective and accessible NHS contraceptive services for young men and women and increased funding in areas with high teenage pregnancy rates were also recommended.

The campaign was supported by a range of organisations, including the British Medical Association, the fpa (formerly the Family Planning Association) and the anti-abortion group Life. But some members of the opposition parties were sceptical - notably Conservative health spokesperson Ann Widdecombe, who said: 'We have never had so much sex education, so much availability of free advice, so much ready availability of contraception, and yet we have got record levels of teenage pregnancies.'

In July 2000 the Hackney Gazette ran the headline: 'Gymslip abortions highest in London' and told its readers that the borough had one of the highest rates of unwanted teenage pregnancies in the country and the highest abortion rate in London.

A couple of months earlier Tackling Teenage Pregnancy in Hackney, a report by East London and The City Health Authority (2000), was published. After a survey of existing provision in the borough, it described a new series of projects that aimed to reduce teenage pregnancies and support young parents. As a 10-year plan, it should not be expected to produce instant results.

What Hackney has to offer
Hackney's population is ethnically diverse and generally young, impoverished and growing rapidly. The survey showed there were some good projects to support young parents, but there was also a lack of coordination and consistency.

Existing practice included lunch-time drop-in centres in three of the borough's secondary schools which were jointly organised by the school nursing service and City and Hackney Young People's Service (CHYPS). These two services have since collaborated further to set up similar drop-in centres at all secondary schools in the borough.

The community psychology department has also produced a teaching pack titled Respect, which promotes non-violent relationships. A series of anti-bullying workshops has also been organised in nine primary schools. Meanwhile, Hackney Community College has opened its doors to teenage parents and stepped up the provision of child-care facilities.

It has also been proposed that a specialist school nurse should support schools by providing particular input on education in the areas of sex and relationships, as well as support for teenage mothers and pregnant young women and specialist advice and support for school health teams. The role of this nurse would be to expand the lunch-time and after-school drop-in sessions in secondary schools and carry out follow-up work with young women who report missed periods or need emergency contraception.

Proposals for the CHYPS scheme also include the use of an outreach nurse to ensure that young people have access to a free and confidential contraception and advice service every day of the week. This nurse would oversee the provision of emergency contraception, free condoms, repeat prescriptions of the Pill, pregnancy testing, advice and referral to other services. The post has been advertised but has not yet been filled.

There are now more family planning clinics in the borough and more open-access contraception centres, which are based in GP clinics near several secondary schools. These centres are open at times that suit young people - in the early evenings and at weekends. Another proposal for future consideration is to open a clinic in the local hospital's department of sexual health. This would provide an integrated contraceptive and genitourinary medicine service specifically for young people.

A CHYPS worker has also been appointed to address the needs of young men. His role is to encourage young people not to enter into sexual relationships before they are ready and to foster a sense of responsibility among those who do. This role will also involve supporting young fathers, helping them to learn the skills they need to look after their children.

A series of workshops for children in years 10 and 11 (aged 14-16) is now being carried out in all secondary schools in the borough. These cover issues such as relationships, contraception, pregnancy and parenting. Facilitators at these workshops include members of the CHYPS team as well as school nurses, family planning nurses and others who work with young people.

Plans to distribute advice and support materials in the community are still in their infancy, but proposals for the future include a video about the reality of teenage parenthood that could be shown in schools and other youth settings as well as more widespread use of the Respect teaching pack on non-violent relationships. It is likely that the borough will also organise a series of card, leaflet and poster campaigns in the local community and distribute condoms at a range of local centres frequented by young people.

Conclusion
Since the Social Exclusion Unit's (1999) Teenage Pregnancy report, there has been an expansion of sexual health services and sex and relationship education for young people in Hackney as well as improvements in interagency collaboration.

School nurses have a fundamental role to play in the drive to reduce unwanted teenage pregnancies and the school nursing service is the foundation on which other services can be built. As public health practitioners, school nurses are ideally placed to help children, young people and their parents access the support and services they need.

Central to the government's campaign are measures to improve sex education in primary and secondary schools, and school nurses are vital to this strategy. School nurses have an expanded role in sex education. Without parental consent they can advise teenagers, including under-16s, on how to get contraception when necessary. They also have a responsibility to ensure good links between young people and local services.

School nurses can also provide support in areas such as personal relationships, stress management and risk-taking behaviour. Sex education often focuses on the negotiation skills that can help them to say no to sex as well as practical knowledge to help them avoid unwanted pregnancy and sexually transmitted infections. Low self-esteem is often an important factor when dealing with high teenage pregnancy rates and much work needs to be done to raise the self-worth of many of the young people concerned.

To gain the confidence of young people in schools, there must be a positive school culture that supports sex education. The school nurse must also have a good working relationship with teachers and be able to negotiate skilfully.

Overall, there have been many positive and innovative steps forward in school nursing services, both nationally and locally. But whether these recent improvements in practice will have the desired effect on teenage pregnancy in the coming years remains to be seen.

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