How action plan cuts teenage pregnancy rate

Project
Teenage Pregnancy Action Plan

Purpose
To reduce the teenage pregnancy rate and improve sexual health services for young people

Funding
About £750,000 a year from Brighton & Hove Council, NHS Brighton and Hove and joint public health funding

Background
Managers and professionals in Brighton and Hove were striving to reduce the higher-than-average teen pregnancy rate. They built up a range of services, but the speed of progress was slow, explains Kerry Clarke, commissioner for teenage pregnancy.

"One issue that needed to be addressed was the idea that sexual health was everyone's responsibility, that it was possible to have an impact and that teenage pregnancy was not simply a part of young people's lives," she says. What was needed was a "fundamental shift" in attitude across all services working with children and young people, she says.

Action
The turning point came in 2008. Strategic leads, managers and frontline staff were consulted as part of a new strategy designed to develop a consistent approach to young people's sexual health. The process also included research with young people by the University of Brighton.

The strategy led to a screening tool to help identify young people at risk of unplanned pregnancy. Pregnancy prevention workers undertake intensive one-to-one work with more than 200 vulnerable teenagers each year covering issues such as the dangers of alcohol misuse, the role of contraception and using it effectively, and the consequences of relationship choices.

A key part of the strategy involved improving sex and relationships education and advice in schools and other settings such as youth clubs. Six out of nine secondary schools now have a health drop-in service.

The city also had a high multiple abortion rate. The local authority looked at different options with abortion provider BPAS and now has a specialist youth worker based at the service who sees all young women who come in. As a result, repeat term-inations dropped significantly ?in 2011.

Consultation with young people led to changes in the availability and accessibility of sexual health services.

The Morley Street Contraception and Sexual Health Service (CASH) run by South Downs NHS Trust is now open six days a week, with extended opening times and more drop-in appointments, for example. Data analysis has also helped focus on specific groups.

The authority discovered a high rate of teenage pregnancy among young women involved with local youth offending teams, so now ?a specialist nurse is attached to the youth offending service. Screening and access to contraception and sexual health advice for vulnerable groups such as looked-after children, young people in hostels and those who enter mental health and substance misuse services are also provided.

The council runs specialist accommodation for young single mums and couples with support from life coaches, health visitors and early years services.

Outcome
Teen pregnancy rates in Brighton and Hove have fallen by more than a quarter - 26.5 per cent - since the national baseline year of 1998, placing the city among the highest achieving authorities for teen pregnancy reduction.

The teen conception rate per 1,000 girls aged under 18 was 48.1 in 1998, but by 2010 it had dropped to 36.9. Figures from the Sussex Community NHS Trust show numbers of under-19s accessing CASH services are on the increase, from 3,097 in 2009/10 to 3,881 in 2010/11.

Meanwhile, the number of abortions among under-18s fell from 89 in 2009 to 75 in 2010 and 63 in 2011. The repeat termination rate has gone from seven per cent in 2009 to 12 per cent in 2010 and two per cent in 2011.

The under-16 conception rate in 2010 was 7.1 per 1,000, down on the previous year's 7.5 per 1,000 and nearly 20 per cent lower than the 1998 rate of 8.8.

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