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Teenage conceptions in Bradford The increase Provisional data for 2005 shows an increase in under 18 teenage conceptions in Bradford of 76 (from 452 to 528).This represents an increase in the rate from 44.1 per 1,000 to 51 per 1,000 (girls aged 15-17). Whilst this data is provisional it is likely that any finalised changes will be minimal so we should analyse their meaning, possible cause and possible solutions. The stats in context The national (England) under 18 conception rate of 41.1 per 1000 is at its lowest level for 20 years with an overall decline of 11.8% since 1998– the baseline year for the Teenage Pregnancy Strategy. Therefore, although the Bradford data for 2005 shows a marked increase on 2004, the overall reduction from 1998 of 10.8% is: Lower than (but similar to) the current national average (11.8%), Greater than (but similar to) the overall West Yorkshire average (9.2%) The same as Kirklees (10.9%), Greater than (but similar to) Wakefield (9.8%) greater than Leeds (2.9%) but Lower than Calderdale (20.4%) Bradford exceeded the interim Government target of a 2004 15% reduction with a total 22.9% reduction. Trajectories suggest that if current trends continue, the 2010 target will not be met either nationally or in Bradford. In order to meet the 2010 target, in Bradford there will need to be 286 fewer conceptions in 2010 than there were in 1998, and 242 fewer conceptions than the 2005 figure. The quarterly rolling average shows a current upward trend, which is of concern (APPENDIX 2) but which is not out of step with national and West Yorkshire trends and suggests a possible ‘levelling off. The Bradford YPSHPB has on previous occasions accepted that there was always likely to be a ‘levelling off’ at some point of the year on year reductions we had been achieving. This in no way affected our aim of achieving the 2010 target but acknowledged the probable impact of deprivation, social disadvantage, cultural and social norms in Bradford that the Teenage Pregnancy Partnership and LIG could not address without a much fuller political engagement and change in society and by national and local government. It would appear from the trajectories provided by the Yorkshire Public Health Observatory that they regard the levelling off to have happened Teenage conceptions data The national under 18 conception rate is at its lowest level for 20 years with a decline of 11.8% since 1998– the baseline year for the Teenage Pregnancy Strategy. The national under 16 conception rate for England in 2005 was 11.4% lower than the Teenage Pregnancy Strategy’s 1998 baseline rate of 8.8 conceptions per 1000 girls aged 13-15. Termination of Pregnancy Service Despite a well regarded TOPS pathway and improvements in service and access, terminations in Bradford are lower than national, West Yorkshire and any other local authority figures. Socio economic factors and aspirations have a large role to play in sexual health, particularly teenage conceptions and Bradford residents generally have lower levels of both. Bradford has a disproportionately low take up of termination (TOPS) services which might indicate a higher proportion of communities for whom early parenthood is normal. Hotspots There are clearly a number of hotspot areas where ward conception rates are notably higher than in other wards. These require targeting, not only to affect the overall figure but also to address health inequalities. We are at present awaiting 2005 ward data which is due out in early summer from DoH. This will identify key areas to focus and extend existing work. In the interim until the conception figures are available, the areas with higher teenage conceptions have been estimated by births to teenage mothers conceived under the age of 18 years during 2004-6. The diagram below suggests that the hotspots for Bradford were: Tong, Windhill & Wrose, Little Horton, Eccleshill and Wyke. Areas with low rates of teenage births (and therefore estimated conceptions) were: Wharfedale, Ilkley, Worth Valley, Craven and Bingley Rural. Births to Women Conceived under 18 years, 2004-6 Tong Wharfedale 70.0 Windhill and Wrose Ilkley Little Horton 60.0 Worth Valley Eccleshill 50.0 Craven Wyke 40.0 Bingley Rural Keighley West 30.0 Baildon Royds 20.0 10.0 Queensbury Keighley Central 0.0 Shipley Great Horton Manningham City Toller Bowling and Barkerend Bingley Keighley East Heaton Thornton and Allerton Idle and Thackley Bolton and Undercliffe Clayton and Fairweather Green Bradford Moor Wibsey Electoral Ward Births Bradford District Births England Conceptions (2005) Source: B&AtPCT Intelligence & Analysis Team Please note that this estimation may under represent areas that have a high teenage abortion to birth ratio. During the period 2004-6, around 1 in every 15 teenage girls in Tong had a baby that was conceived under the age of 18 years. This compares with: 1:19 in Windhill & Wrose, 1:21 in Little Horton, 1:21 in Eccleshill, 1:22 in Wyke, 1:206 in Wharfedale, 1:24 in England as at 2005. Strategic and Partnership Strengths The Young People’s Sexual Health Partnership Board (which includes teenage Pregnancy and teenage parents) and its reference group the TP Network Group have been instrumental in engaging partners and raising the issue of sexual health in a number of arenas. The chair of the Be Healthy ECM Task group and Associate Director of the tPCT has recently been appointed Teenage Pregnancy champion within CYPSE. The Partnership Board has made links with the Sexual Health Network to further develop young people’s sexual health service provision/Education. The YPSHPB acknowledges the impact of socio economic factors and aspirations of young people have a large role to play in sexual health and the choices Young People make, particularly on being a teenage parent. Working on these issues and those of deprivation and self esteem require long term investment and planning. They are key to both the ECM and NSF agendas which require multi agency engagement and long term planning and action. Early education around relationships is important in establishing self esteem and raising aspirations at an early age. This would then continue throughout school life developing positive wellbeing. It is part of the aim of the strategy over the next year to further engage with education providers in both formal and non-formal settings to ensure Sex and Relationship education issues are addressed. This work requires cross district and cross service engagement and is not solely the remit of the board or the strategy. Over the last year the board have worked at embedding the strategy in the children and young people’s planning cycle in the district to help address this broadening of the agenda. Although teenage pregnancy levels have risen there has been a positive increase in service provision tailored to young peoples needs. Training for professionals, teenagers and parents has been delivered through partnership working across agencies. Some examples of best practice and partnership working undertaken are attached (Appendix One). APPENDIX ONE Examples of Good Practice Below are just a few examples of good practice. There are many more. Moreover, the ones below only represent the area of sexual health service development or preventative work, not for e.g. support for teenage parents. If required further information on support for pregnant teenagers and teenage parents can be provided. Getting Better With Practice is a short 2 hr training programme aimed at whole practices to look at how each practice can make themselves more ‘young person’ friendly and improve uptake from young people of the sexual health services offered in Primary Care. It aims to help ensure that each practice can deliver a level 1 service as per the National Strategy and has been delivered to about 30 practices in Bradford and Airedale. One of the benefits of the Getting Better with Practice training has been the number of GP practices who have, as a consequence, established a Young People’s health drop in, including sexual health services and signposting as appropriate. Funding was found from YPSHPB and S & W PCT order to subsidise the provision of Emergency Hormonal Contraceptives (EHC) for young people (under 21), in order that they could access it free and confidentially from a range of pharmacies who have been trained specifically for the purpose throughout the district. Long Acting Reversible Contraceptives (LARCS) are currently being promoted, particularly the implant to ensure adherence and compliance and reduce the risk of unplanned pregnancies Free pregnancy testing kits were distributed to General Practices with funding from the YPSHPB to reduce the time taken between a positive test and possible referral to a TOPS service, helping to achieve the target that any woman should receive a termination of pregnancy within two weeks of first seeing the referring professional (e.g. GP) and enabling the possible utilisation of a medical rather than surgical termination. The Information Shop for Young People continues to provide a comprehensive sexual health service in a partnership approach between the Youth Service and both Primary and Secondary Care. Three CASH services and three YP GUM services are complemented by two sessions of the Lads’ Room, enabling young people to access a discreet and confidential service for all under 25s. The District Condom Distribution Scheme continues to provide free condoms and training to a large range of agencies (about 75 working with young and/or vulnerable people) in the voluntary and statutory sector (LA) which complements the provision now available at about 85% of General Practices, helping to reduce the incidence and prevalence of a range of STIs. Tic-Tac (Teenage Information Centres Teenage Advice Centres) have been established at Oakbank, Tong and Salt secondary schools. These provide a confidential teacher free zone where pupils can access health services to meet their needs which usually include a high proportion of sexual health issues, amongst others including such things as bullying, spots, periods, mental health issues, etc. Investigations are underway to see if further Tic-Tacs can be provided at Thornton or Emmanuel Schools, in two of the hotspot wards. Joint funding is being sought with DAAT and CAMHS involvement. APAUSE (Added Power and Understanding in Sex Education) has been piloted by the tPCT on behalf of the YPSHPB. The programme has evaluated well at both national and local level and mainstream funding has been secured from Choosing Health for its expansion and development across Bradford and Airedale. The tPCT will be working with the Council’s Education providers and commissioners to develop this programme which aims to help young people resist unwanted pressure, delay early sexual intercourse, use contraception and condoms and provide information about sexual health services across the district hereby contributing to a range of tPCT and LA targets. One of the successes of the project is the joint delivery by health professionals (i.e. school nurses), teachers and peer educators. Speakeasy is an FPA programme aimed at parents that is being piloted in Bradford and Airedale on behalf of the YPSHPB by the tPCT. It is an accredited programme aimed at equipping community based workers with the skills and confidence in order to train parents about sexual health issues, in part so that they can educate their children but in part for their own benefit. This is still in its pilot phase and depending on the evaluation will either be reviewed, amended or adopted and expanded. At this stage it seems likely that the latter will be recommended but with adjustments taking account of the needs of South Asian parents. Work has been carried out by Upfront specifically with South Asian communities. This has led to a very successful piece of sexual health work and relationship with Community Unity and also with the Council of Mosques who were amongst the first to accept the idea of community based Chlamydia screening. Working with vulnerable groups is an important part of the relevant strategies. Work carried out in previous years with Looked after Young People or those leaving care is to be picked up by an inter agency partnership to ensure that those Young people for whom sexual health often has poor outcomes are being addressed. All LAC receive a comprehensive HNA which includes sexual health, where needed LAC can access 1- 1 sessions, group work is offered to residential units who have identified a need and currently the LAC strategy is being refreshed with members of the YPSHPB having been asked to contribute. A training programme delivered to equip the Youth Offending Team with skills, confidence and the means to meet the needs of their client group proved sufficiently successful that this will be rolled out to other teams who have even more direct contact. Similar work with Pupil Referral Units is envisaged and will be encouraged. A first pilot is currently underway in one PRU. African communities from sub Saharan Africa have a high prevalence of HIV and work has taken place to establish credibility and acceptability with the various communities that comprise this larger group. Sexual Health conferences held with this group are to be built upon to encourage prevention work and testing. In addition Upfront have supported a number of pilots working with young people from sub Saharan Africa on a range of sexual health issues. .
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