Funding cuts could reverse fall in teenage pregnancy rate, warn experts

BMJ 2011; 342 doi: (Published 17 March 2011) Cite this as: BMJ 2011;342:d1762
  1. Matthew Limb
  1. 1London

Gains from a decade of action to cut teenage pregnancy rates in England must not be allowed to be reversed, health experts have told a seminar in London. Sexual health services for young people need to be given a high priority under the government’s planned shake-up of public health, with proper funding and staffing, they said.

Around 90 experts from organisations including the NHS, local government, universities, and charities joined the Westminster Health Forum seminar “Tackling Teenage Pregnancy” on 15 March.

Alison Hadley, head of the Department for Education’s teenage pregnancy unit, told the seminar that the previous Labour government’s 10 year strategy to cut the teenage pregnancy rate had achieved “real progress.”

Though England continues to have the highest rate of teenage pregnancy in western Europe, the rate is at its lowest in 30 years, having fallen 18% in the past 10 years. There were 36 000 pregnancies in women under 18 years old in 2009, down from 44 000 in 1998. Most of the conceptions in 2009 were unplanned, and about half ended in abortion.

Ms Hadley said that although Labour’s strategy had not met its target to halve the teenage pregnancy rate by 2010, an estimated 50 000 more conceptions would have occurred over the period without it. She said that 89% of local authorities had reduced their teenage pregnancy rate, with some of the biggest falls in areas of high deprivation, such as Hackney and Tower Hamlets in London, Oldham, and Blackburn.

She said, “There is too much to lose; we can’t let this go backwards.”

Teenage pregnancy is linked to child poverty and worsens health inequalities, often leading to poor outcomes in the long term for young parents and their children, the seminar heard.

Ms Hadley said that there was good evidence to show what measures worked to reduce teenage pregnancy rates. These included high quality education on sex and relationships, easy access to “youth friendly” contraceptive services, and early intervention to target young women at the greatest risk of pregnancy.

Experts discussed how to communicate messages more effectively to young people and deliver effective sex and relationships education in schools, colleges, and youth services.

Jane Lees, chairwoman of the Sex Education Forum, said that “alarmist” media reports about the content of materials that might be used to support sex and relationships education in primary schools did not help. She said of such material that “it is not the Kama Sutra for 5 year olds.” Information had to be appropriate to children’s age to be effective, she added.

“Younger pupils will often ask profound questions about reproduction and relationships. It makes it quite clear that they are ready for sex and relationship education,” said Ms Lees.

Other experts spoke of the importance of consulting young people to reflect their concerns, training staff well to deliver services, and providing effective leadership and support to parents.

Kate Smith, head of the “healthy lives” initiative for the London Borough of Tower Hamlets, described how problems had been overcome there through consultation with communities that included religious groups with “negative” views on sex and relationships education. She said, “If we can do it in Tower Hamlets it is genuinely possible everywhere else.”

The seminar heard how forthcoming NHS reforms affecting commissioning and public health services might alter sexual health services for young people.

Kate Quail, the Department of Health’s head of national support teams for teenage pregnancy, said that people working in sexual health had been raising concerns about “huge disruptive change.” These included the possible effect of NHS reorganisation, greater competition for resources, and loss of posts and funding, she said.

Nursal Livatyali, a teenage pregnancy coordinator for the London Borough of Enfield, said she feared that posts such as hers would be lost in many local authorities that were short of cash. She said, “I don’t think the government is taking enough steps to ensure this wonderful downward trend [in teenage pregnancy rates] will continue.”

Simon Blake, chief executive of Brook Advisory Centres, said, “The big worry is the maths won’t add up. Will there be enough money and people?” He said that many voluntary bodies with a role to play in sexual health were “struggling to survive.”

The coalition government is about to draw up a new sexual health policy document. Judith Hind, contraception manager with the sexual health team in the Department of Health, said that the government wanted to join up services “in a way that matters for young people.”

She said, “We think this offers the best approach to make sure the gains we’ve made over the past few years will be taken forward.”


Cite this as: BMJ 2011;342:d1762

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