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Teenage conceptions in Bradford

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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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