Teenage Pregnancy Briefing Document

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					Teenage Pregnancy
Briefing Document

Towards 2010 and beyond

For more information on Teenage Pregnancy
Please contact:

Gail Teasdale
Teenage Pregnancy Co-ordinator for Hull

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                             Page 1 of 18
Why reducing teenage pregnancy matters
Evidence clearly shows that having children at a young age can damage young women‟s
health and well-being and severely limit their education and career prospects.
Longitudinal studies show that children born to teenagers are more likely to experience a
range of negative outcomes in later life, and are up to three times more likely to become a
teenage parent themselves. The facts are stark:

      At age 30, teenage mothers are 22% more likely to be living in poverty than
       mothers giving birth aged 24 or over, and are much less likely to be employed or
       living with a partner.
      Teenage mothers are 20% more likely to have no qualifications at age 30 than
       mothers giving birth aged 24 or over.
      Teenage mothers have three times the rate of post-natal depression of older
       mothers and a higher risk of poor mental health for three years after the birth.
      The infant mortality rate for babies born to teenage mothers is 60% higher than for
       babies born to older mothers.
      obstetric risks being greater for young people e.g. anaemia, eclampsia;
      mothers missing out on pre-conception health measures e.g. folic acid (usually due
       to unplanned pregnancy);
      more likely to move house and live in poor housing;
      more likely to have low incomes and have to rely on benefits alone;
      the children of teenage parents are 25% more likely to have a lower birth weight
      Teenage mothers are three times more likely to smoke throughout their pregnancy,
       and 50% less likely to breastfeed, than older mothers - both of which have negative
       health consequences for the child.
      Children of teenage mothers have a 63% increased risk of being born into poverty
       compared to babies born to mothers in their twenties and are more likely to have
       accidents and behavioural problems.
      Among the most vulnerable girls, the risk of becoming a teenage mother before the
       age of 20 is nearly one in three.

Rates of teenage pregnancy are far higher among deprived communities. The Index of
multiple deprivation (2004) demonstrates that the city of Hull has significant areas of
deprivation. It is ranked 9 th overall from the 354 local authority districts in England and is
the most deprived in the region. Of the 163 super output areas in Hull 76 fall within 10% of
the most deprived areas and a further 19 are in the top 20% of the most deprived in
England and Wales. The most deprived wards and super output areas are also those with
the highest rates of teenage conception. The poorer outcomes associated with teenage
motherhood also mean the effects of deprivation and social exclusion is passed from one
generation to the next.

There is also a strong economic argument for investing in measures to reduce teenage
pregnancy as it places significant burdens on the NHS and wider public services. The cost
of teenage pregnancy to the NHS alone is estimated to be £63m a year. Teenage
mothers will also be more likely than older mothers to require expensive support from a
range of local authority services, for example to help them access supported housing
and/or re-engage in education, employment and training.

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The challenge for local areas, therefore, is to provide young people with the means to
avoid early pregnancy, but also to tackle the underlying circumstances that motivate young
people to want to, or lead them passively to become pregnant or young parents at a young
age. It is also to ensure that those young people who become teenage parents are
supported to ensure they are able to re-engage in education, employment and appropriate
health services to ensure they can move out of poverty and support themselves and make
informed choices about future contraception (20% of all under 18 conceptions are repeat
conceptions). Therefore the teenage pregnancy strategy is not just about those who
conceive each year but all of the children and young people under 20 in the city which
constitutes 25% of the city‟s population (64,260)

Policy and performance drivers
There are many Government policies that have prioritised teenage pregnancy and
contribute to driving progress towards the target. In line with Government policy, a number
of regulators have included teenage pregnancy within their assessments.

        Local area agreements
        Change for children programme (Children‟s Act/Every Child Matters/Children and
         Young Peoples plan/ Joint Area review)
        Joint (DfES/DoH) PSA target (PCT)
        BVPI 197 (local authority)
        National service framework (NSF) Children, young people and maternity services
        Public Health white paper - Choosing Health
        White Paper – Your Health, Your care, Your say
        Local Public Service Agreements
        National Healthy Schools Programme
        Extended Schools
        Children‟s Centres
        Children‟s Trusts
        Sexual Health Strategy
        Key Strategies to reduce Health Inequalities e.g. infant mortality
        Supporting people strategy
        Transforming youth work/youth matters
        Healthy Care
        Care matters
        Hull and East Riding Alcohol strategy
        Community Strategy

Regulation and inspection

A number of performance management mechanisms are in place, which include an
assessment of progress towards the teenage conception target. National bodies with
responsibility for regulation that has an impact on teenage pregnancy include the following:

          Ofsted / Commission for Social Care Inspection: Annual performance
           assessment (APA).
          Ofsted: Joint area review (JAR)..
          Healthcare Commission: Annual health check:
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  At a regional level, Government Offices and Strategic Health Authorities contribute to
  performance management in relation to the teenage conception target, as part of the
  improvement cycle. Both the PCT and the local authority are assessed by regulators on
  performance in relation to achieving the teenage conception target.

Key risk factors for teenage pregnancy
The risk factors identified below are not exhaustive but reflect factors that local areas may
be able to identify among its population of young people. Further details on risk factors for
teenage pregnancy can be found in Teenage Pregnancy: Next Steps.

Where young people experience multiple risk factors their likelihood of teenage
parenthood increases significantly. Young women experiencing five risk factors (daughter
of a teenage mother; father‟s social class IV & V; conduct disorder; social housing at 10
and poor reading ability at 10) have a 31% probability of becoming a mother under 20,
compared with a 1% probability for someone experiencing none of these risk factors i.
Similarly, young men experiencing the same five risk factors had a 23% probability of
becoming a young father (under age 23), compared to 2% for those not experiencing any
of these risk factors.

Table 1: Factors associated with high teenage pregnancy rates
Risk factor Evidence
Risky Behaviours
Early onset  Girls having sex under-16 are three times more likely to become
of sexual       pregnant than those who first have sex over 16. ii
activity       Around 60% of boys and 47% of girls leaving school at 16 with no
                qualifications had sex before 16, compared with around 20% for both
                males and leaving school at 17 or over with qualifications.
               Early onset of sexual activity is also associated with some ethnic
                groups (see below)
Poor           Around a quarter of boys and a third of girls who left school at 16 with
contracepti     no qualifications did not use contraception at first sex, compared to only
ve use          6% of boys and 8% girls who left school at 17 or over, with
Mental         A number of studies have suggested a link between mental health
health     /    problems and teenage pregnancy. A study of young women with
conduct         conduct disorders showed that a third became pregnant before the age
disorder/       of 17iii.
involvemen  Teenage boys and girls who had been in trouble with the police were
t in crime      twice as likely to become a teenage parent, compared to those who
                had no contact with the police. iv
Alcohol        Research among south London teenagers found regular smoking,
and             drinking and experimenting with drugs increased the risk of starting sex
substance       under-16 for both young men and women. A study in Rochdale
misuse          showed that 20% of white young women report going further sexually
                than intended because they were drunk v. Other studies have found
                teenagers who report having sex under the influence of alcohol are less
                likely to use contraception and more likely to regret the experience. vi
Teenage        A significant proportion of teenage mothers have more than one child
motherhoo       when still a teenager. Around 20% of births conceived under-18 are
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d               second or subsequent births
Repeat         Around 7.5% of abortions under-18 follow either a previous abortion or
abortions       pregnancy.
Education-related factors
Low            The likelihood of teenage pregnancy is far higher among those with
educationa      poor educational attainment, even after adjusting for the effects of
l               deprivation.        On average, deprived wards with poor levels of
attainment      educational attainment had an under-18 conception rate double that
                found in similarly deprived wards with better levels of educational
                attainment. (80 per 1000 girls aged 15-17 compared with 40 per 1000)
Dis-           A survey of teenage mothers showed that disengagement from
engageme        education often occurred prior to pregnancy, with less than half
nt      from    attending school regularly at the point of conception. Dislike of school
school          was also shown to have a strong independent effect on the risk of
                teenage pregnancy. vii
               Poor attendance at school is also associated with higher teenage
                pregnancy rates. Among the most deprived 20% of local authorities,
                areas with more than 8% of half days missed had, on average, an
                under-18 conception rate 30% higher than areas where less than 8% of
                half days were missed.
Leaving        Overall, nearly 40% of teenage mothers leave school with no
school at       qualifications. viii
16 with no  Among girls leaving school at 16 with no qualifications, 29% will have a
qualificatio    birth under 18, and 12% an abortion under 18, compared with 1% and
ns              4% respectively for girls leaving at 17 or over.
               Leaving school at 16 is also associated with having sex under 16 and
                with poor contraceptive use at first sex (see below).
Family / Background factors
Living     in  Research has shown that by the age of 20 a quarter of children who
Care            had been in care were young parents, and 40% were mothers ix.
               The prevalence of teenage motherhood among looked after girls under-
                18 is around three times higher than the prevalence among all girls
                under-18 in England.
Daughter       Research findings from the 1970 British Birth Cohort dataset showed
of          a   being the daughter of a teenage mother was the strongest predictor of
teenage         teenage motherhood.
Ethnicity      Data on mothers giving birth under age 19, identified from the 2001
                Census, show rates of teenage motherhood are significantly higher
                among mothers of „Mixed White and Black Caribbean‟, „Other Black‟
                and „Black Caribbean‟ ethnicity. „White British‟ mothers are also over-
                represented among teenage mothers, while all Asian ethnic groups are
               A survey of adolescents in East London x showed the proportion having
                first sex under-16 was far higher among Black Caribbean men (56%),
                compared with 30% for Black African, 28% for White and 11% for
                Indian and Pakistani men. For women, 30% of both White and Black
                Caribbean groups had sex under-16, compared with 12% for Black
                African, and less than 3% for Indian and Pakistani women
               Poor contraceptive use has also been reported for some ethnic groups
Parental       Research shows that a mother with low educational aspirations for her
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aspirations        daughter at age 10 is an important predictor of teenage motherhood

Recent work by the Schoolgirl Mum‟s unit in Hull has found that young mothers had
increasingly complex needs (compared to 5 years ago) prior to pregnancy with almost all
of the young women experiencing issues such as being in care, mental health problems,
abuse, domestic violence, truancy or being excluded from school with the majority
experiencing several of these issues. It is therefore important that all staff working with
vulnerable young people are given the skills to support these vulnerable young people in
prevention of unplanned pregnancy.

Although the majority of teenage conceptions are not planned (according to feedback from
young parents), two thirds continue in the pregnancy and often young people have a
second child before they are 18. Repeat conceptions are approximately 20% of all under
18 conceptions. Work has been developed (began in May 05) to target teenage parents
within four weeks of giving birth with a one to one visit from a health educator to ensure
their future contraception needs are addressed which should prevent unplanned second

Rates of infant mortality in children to teenage parents are substantially higher than the
national average and contribute to the lower than average life expectancy for residents of
the city.

Teenage Pregnancy Targets

Hull has the following targets:
 Reduce the under-18 conception rate from the 1998 baseline by 55% by

 By 2010, to reduce under 18 conception rates in worst 5th of wards by
  60% (NRU)

 60% of teenage parents back into education and employment by 2010

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   Under 18 conception rate per 1000

                                                                                                                                                                                                                                                                            Kingston upon
                                                                                                                                                                                                                                                                            Hull UA rolling
                                       60                                                                                                                                                                                                                                   average
                                                                                                                                                                                                                                                                            Yorks & Humber
































                                                     1998                        1999                        2000                        2001                       2002                        2003                         2004                        2005

                                                                                                                                               Quarter & Year

Above is a graph showing the most up to date figures for under 18 conceptions in Hull provided by the National Teenage Pregnancy Unit
and collated by the Office of National Statistics. It shows that the increase in 2004 is not sustained and that the rates hav e now returned
to a downward trend. It is therefore vital that current interventions (some of which were implemented in the second half of 2004 in
response to national best practice and local research and consultation) are mainstream and sustained to maintain this decreas e towards
the 2010 target

Of the 23 wards in the city 13 are hotspot wards with rates in the top 20% nationally; ten of these are significantly higher than the h otspot
cut off rate (54.5 per 1000). Only Holderness and Beverley wards have a rate that is significantly lower than the England av erage.
Although current data is aggregated over a three year period, the figures can give us a static representation at a ward level . Latest data

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(2001-2003) shows that the wards with the highest numbers of under-18 conceptions over the 3 year period relate closely with those
areas that experience high levels of deprivation.
There is no trend data available for wards at present as it is currently provided by the office of National Statistics and ag gregated to
protect confidentiality in areas with small numbers. Local collection is being established to track progress at locality level.




 Rate per 1,000






                        Holderness 18.6








                                                                                                                                                                                                        Bransholme E
                                                            Kings Park

                                                                                                                                                                                                                       Bransholme W

                                                                                                                              Southcoates W

                                                                                                                                                                                                                                                   St Andrew's

                                                                                                                                                                                                                                                                                    Southcoates E
                                                                                                                                                                                                                                                                                                    Orch'd Pk & Greenwood
Figure 2: Ward rates with 95% confidence interval 2001-03
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1   Avenue            7    Derringham                  13   Marfleet                   19   St Andrew's
2   Beverley          8    Drypool                     14   Myton                      20   Southcoates East
3   Boothferry        9    Holderness                  15   Newington                  21   Southcoates West
4   Bransholme East   10   Ings                        16   Newland                    22   Sutton
5   Bransholme West   11   Kings Park                  17   Orchard Park & Greenwood   23   University
6   Bricknell         12   Longhill                    18   Pickering                            Of the four districts with the most
                                                                                                 similar socio-demographic
characteristics, Hull‟s 2001-03 rates was significantly higher than Middlesbrough and Plymouth. Hull‟s 1997-99 rates were significantly
higher than both Plymouth and Lincoln. Some projects implemented using NRF funding have been based on good practice implemented
in these areas e.g. Apause sex education program.

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Figure 3: Statistical neighbour comparisons
  Rate per 1,000
























                                                  1997-99                   2001-03

Although the increase in 2004 was concerning after initial good progress the use of this
data as an indicator is difficult as the under 18 statistics are 2 years out of date and so
does not include investment and work which has taken place since e.g. boys and young
men‟s work, prevention of second conceptions project, apause. There is a need to put in
place appropriate performance monitoring on a local level so we can see more recent data
which can accurately inform action e.g. number of conceptions in the looked after system,
no of repeat conceptions, postcode conception data to target provision. Hull TPU is
working in partnership with the local authority and the PCT‟s to establish this monitoring on
a quarterly basis to monitor progress against targets. This data will be shared with the
children and young people‟s partnership outcome groups to illustrate progress to targets
and areas of work needing to be addressed. There needs to be an average decline of 6.8
conceptions per 1000 per year to achieve final 2010 target. Departments and
organizations who have responsibility for these area of work will be responsible for
collecting this data as agreed and submitting it quarterly to the Teenage Pregnancy Unit.

Ethos of strategy

The strategy aims to work towards achievement of the World Health Organization‟s
definition of sexual health:

“Sexual Health is a state of physical, emotional, mental and social well-being, related to
sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health
requires a positive and respectful approach to sexuality and sexual relationships, as well
as the possibility of having pleasurable and safe sexual experiences, free of coercion,
discrimination and violence. For sexual health to be attained and maintained, the sexual
rights of all persons must be respected, protected and fulfilled.”

The ethos of the Hull Teenage Pregnancy strategy is to empower young people to make
positive healthy choices, raise aspirations, access appropriate services and to resist peer
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pressure. It is also to ensure that current and developing services respond to identified
need and provide accessible, understandable and factually correct information, advice and
guidance to all young people on key issues relating to Teenage Pregnancy.
The ethos is also to work to empower staff working with young people (both in public and
voluntary and community sector) to ensure they have the skills and knowledge to address
this issue and contribute to the delivery of the strategy and target.

The strategy does support a model of delay of early sex but this should not be confused
with abstinence. Delay supports young people to make informed choices about their life
and health and gives them the skills to do so. Abstinence is not a model which is effective.
Recent research in the USA has shown that the declining teenage pregnancy rates in the
US are due to better use of contraception, not abstinence, according to a new study from
Columbia University and sex education research centre the Guttmacher Institute.
Researchers found that just 14% of the drop in conception among 15 to 19-year-old girls
had been because they had avoided sex. Some 86% of the decrease was because of
improved use of contraception such as birth control pills and condoms.

Meeting young peoples needs
 Over the last few years the local strategy has widened its focus based on local
consultation and research from being predominantly health based, female focus and
primarily about increasing compliance of young women with contraception. While this is
still a key factor it has developed as part of a holistic strategy which also focuses on young
men as well as young women and on healthy relationships not just sex.

The local TPU has commissioned several successful consultation and research projects to
ensure services are informed by local needs including:

       Mystery Shopper (2002),
       The Truth is Out There (2003),
       Rooted (housing) (2004)
       Mind the Gap (2005) (one of the largest research projects in the country),
       Men Masculinity and Mayhem (2006).

    This research and consultation has helped ensure the local strategy has remained
    rooted in the core principle of being young people centered and has developed
    projects to respond to the identified need e.g. specific work with young men on sexual
    health and relationships, training for teachers to improve sex education delivery.
    Young people have also been involved in various aspects of project development,
    publicity design, recruitment of staff, delivery and evaluation. This had initially
    occurred mainly in projects funded by Hull TPU but is now happening in mainstream
To address teenage pregnancy there needs to be three tiers of services.

Tier One: Universal services – All services working with young people should be able to
provide basic accurate, understandable information and signposting to relevant services

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on issues such as sexual health and teenage pregnancy e.g. Connexions, Community

Tier Two: Enhanced services – Non Clinical services who not only provide basic
information and signposting but also condoms and pregnancy testing and support on
relationship issues e.g. Cornerhouse, Warren

Tier Three: Specialist Services – Clinical services which provided a comprehensive sexual
health service including a range of contraception e.g. Family Planning, GP‟s

This should ensure that whoever a young person confides in they will be able to access
basic information and signposting to enhanced or specialist services.

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Key characteristics of successful programmes
Local and national research and best practice guidance have identified the following key
areas of work which are essential to a successful strategy. These are:

      o Quality Sex Education in all schools
      o A well resourced Youth Service, with a clear remit to tackle big issues, such as
        teenage pregnancy and young people‟s sexual health (by both youth service and
        the voluntary sector)
      o Dedicated services and outreach
      o Key partners and local champion
      o Workforce training on sex and relationship issues within mainstream partner
      o Mainstreamed and sustained:
      o Provision of young people focused contraception/sexual health services, trusted
        by teenagers and well known by professionals working with them
      o Targeted work with at risk groups of young people, in particular Looked After
        Children and Care Leavers
      o Work on raising aspirations
      o Work with parents

.These are the areas of work on which the forward strategy focuses.

All work will be assesses against targets through the Teenage Pregnancy Partnership and
the new children and young peoples structures. It is essential that key projects are
mainstream and sustained as they are the hub of the strategy and without then it will be
impossible to deliver the above areas of work and redesign services to meet identified
need. However, more work also needs to be done by existing services and this work
needs to increase in pace. Each organisation needs to consider the targets, how it relates
to their client group and what they need for their organisation to tackle the issue effectively
e.g. training for staff, changes to how/where service are delivered. Other services also
have to be willing to support each other and work in partnership e.g. family planning are
currently doing so by putting a clinic in a youth centre to meet young peoples needs and
improve access. Over the next year all agencies working with young people need to
establish identified leads at operational and strategic levels in organisations such as area
teams for children‟s services, connexions, schools, area co-ordination teams. The new
children and young people‟s structures will assist in focusing agencies and departments on
targets to be achieved.

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Teenage Pregnancy is a complex issue and its success is integrated into the delivery of
other target and strategies as well as delivery of the teenage pregnancy strategy itself by
key partner organisations. Progress has been made but it needs to be consistent. It is
important that Teenage Pregnancy remains high on the agenda for all agencies and that
all agencies contribute to funding service development and provision and those efforts are
increased in order to achieve this stretched target.

      The forward strategy (which has been agreed by the strategic multi-agency teenage
       pregnancy partnership) be signed off by local authority and PCT
      The self assessment tool kit (which links to the strategy) be used by relevant
       departments to assess what and how much work is needed to deliver their area of
       the strategy.
      The local authority invests (as the PCT has) in the strategy in recognition that pump
       prime monies cannot be used to sustain the strategy long term. This would include
       policy changes and service redesign as well as teenage pregnancy being
       integrated into the work plans of all departments working with children, young
       people and families not just funding.

Teenage Pregnancy: Accelerating the Strategy to 2010 – DfES, 2006

Teenage Pregnancy: Next Steps. Guidance for Local Authorities and PCT‟s on effective
delivery of local strategies – DfES, 2006

Men, Masculinity and Mayhem – Hull TPU and Cornerhouse - 2006

Teenage Pregnancy Strategy Evaluation – School of Tropical Medicine and Hygiene, UCL
and BMRB, 2005

Sure Start Plus National Evaluation – Meg Wiggens et al – University of London, 2005

Mind the Gap – Hull TPU and Cornerhouse - 2005

Teenage Pregnancy: An Overview of Research Evidence – C Dennison HDA, 2004

Rooted – Hull TPU et al, 2004

Teenage Pregnancy and Parenthood: Review of Reviews Evidence Briefing – C Swann et
al HAD, 2003

The Truth is Out There – Hull TPU, 2003

Mystery Shopper – Hull TPU, 2002
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Hull Teenage Pregnancy Strategy – 2001

National Teenage Pregnancy Strategy - 1998

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Appendix A

Appendix A
TEENAGE PREGNANCY CONTRIBUTION TO 5 OUTCOMES FOR CHILDREN (taken from teenage pregnancy local planning guidance
for 2005/06)

Being Healthy      The Being Healthy outcome is about children and young people enjoying good physical, mental and sexual
                   health and living a healthy lifestyle. The joint DH/DfES PSA target to reduce under 18 conceptions by 50% by
                   2010 as part of a broader strategy to improve sexual health is listed as a target under the „sexually healthy‟
                   aim. The diagnostic rate of new episodes of STIs among under 16s and 16-19 year olds is a further indicator
                   under this aim. In relation to the Teenage Pregnancy Strategy the Being Healthy outcome includes the

                        All young people receive quality Sex and Relationships Education within Personal Social and Health Education in
                            schools and out of school settings including those in post 16 education
                        Parents feel confident and skilled in talking to their children about sex and relationships
                        All young people know about sexual health and contraceptive services in their areas
                        All young people have access to young people friendly contraceptive and sexual health services appropriate to their
                            needs in statutory and non- statutory settings
                        All young people have access to free pregnancy testing and counselling and speedy referral to NHS funded abortion
                            or maternity services
                        Teenage parents have access to antenatal and postnatal services tailored to their needs to improve the physical and
                            mental health outcomes for them and their children
Staying Safe       The Staying Safe outcome is about children and young people being protected from harm and neglect and
                   growing up being able to look after themselves. In relation to the Teenage Pregnancy Strategy it includes the

                       All services and practitioners working with young people around sexual health understand their duty of
                           confidentiality to young people but are able to identify abuse and exploitation of young people and refer
                           appropriately - linked to the Common Assessment Framework.
                       Support for young parents experiencing domestic violence.

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                        Support for young parents to help their children thrive and develop.
                        All under 18 lone parents are provided with accommodation with support in a safe environment.
Enjoying and         The Enjoying and Achieving outcome is about children and young people getting the most out of life and
Achieving            developing broad skills for adulthood. In relation to the Teenage Pregnancy Strategy it includes the following:

                     All young people have opportunities to build self-esteem and aspirations to fulfil their potential and minimise risk-taking
Making a Positive    The Making a Positive Contribution outcome is about children and young people making a positive
Contribution         contribution to the community and to society. In relation to the Teenage Pregnancy Strategy it includes the

                     Young people representative of the local community are involved in the needs assessment, planning, delivery and
                     monitoring of work to prevent teenage pregnancy, improve sexual health, and support teenage parents.
Achieving Economic   The Achieving Economic Well-being outcome is about supporting children and young people to achieve by
Well-being           offering education and training appropriate to their needs. The Teenage Pregnancy Strategy target to
                     increase the participation of young mothers in education, training and employment to 60% by 2010 contributes
                     to the DfES PSA target to reduce the proportion of young people not in education, employment or training by
                     2 percentage points by 2010, set out under the Achieving Economic Well-being outcome. In relation to the
                     Teenage Pregnancy Strategy it includes the following:

                         All teenage parents are provided with a co-ordinated package of support.
                         All young parents of school-age are supported to continue their education to meet their full potential.
                         All young parents 16 and over are supported to continue or re-engage with their education and training to meet their
                             full potential
                         All young parents under 19 in education or work based learning have appropriate childcare to meet their needs.
                         All lone parents under 18 who cannot live at home are provided with accommodation with support to make a
                             successful transition to independent tenancies.

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   Berrington A, Diamond I, Ingham R, Stevenson J et al (2005) Consequences of teenage parenthood: pathways which minimise the long term negative impacts of
teenage childbearing’ University of Southampton
    Wellings K, et al (2001) Sexual Health in Britain: early heterosexual experience. The Lancet vol.358: p1834-1850
    Maskey S, (1991) Teenage Pregnancy: doubts, uncertainties and psychiatric disorders Journal of Royal Society of Medicine
    Hobcraft J (1998) Intergenerational and life-course transmission of social exclusion: Influences of childhood poverty, family disruption and contact with the police.
CASE paper 15, LSE
    Redgrave K, Limmer M (2005) ‘It makes you more up for it’. School aged young people’s perspectives on alcohol and sexual health. Rochdale Teenage
Pregnancy Strategy: Rochdale
    Alcohol Concern (2002) Alcohol & Teenage Pregnancy. London: Alcohol Concern
     Hosie A, Dawson N (2005) The Education of Pregnant Young Women and Young Mothers in England. Bristol: University of Newcastle and University of Bristol
     National Statistics (2004) Census 2001 table: C0069 Mothers under 19 at birth (Commissioned by Teenage Pregnancy Unit, DfES)
    Barn R, Andrew L, Mantovani N (2005) Life after care: the experiences of young people from different ethnic groups Joseph Rowntree Foundation, London
 Viner R, Roberts H (2004) Starting sex in East London: protective and risk factors for early sexual activity and contraception use amongst Black and Minority
Ethnicity adolescents in East London University College London, City University and Queen Mary, University of London

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