SCIE research briefing 9: Preventing teenage pregnancy in looked after children
Published August 2004 (updated August 2005)
The topic of this briefing is the prevention of pregnancy among a specific group: looked after children and young people, who usually live in foster homes, but may also be in residential placements or with family members.
Key messages
- Teenagers who become parents are known to experience greater educational, health, social and economic difficulties than young people who are not parents. Looked after children and young people are at greater risk of early pregnancy and social disadvantage than other groups. The prevention of teenage pregnancy among looked after children and young people therefore poses particular problems and may have significant beneficial outcomes
- The principal risk factors associated with teenage pregnancy, such as socio-economic deprivation; limited involvement in education; low educational attainment; limited access to consistent, positive adult support; being a child of a teenage mother; low self esteem; and experience of sexual abuse, are to be found more often in the looked after population than among children and young people who are not in care
- Strategy and policy documents regarding services and practices to reduce teenage pregnancy in general are available, but there is little on looked after children and young people specifically
- Access to good quality sex and relationship education has been demonstrated to reduce levels of teenage pregnancy and looked after children and young people are known to have less access to good quality, consistent sources of sex and relationship education and advice than many other children and young people
- Research and policy literature currently focuses on the provision of appropriate and adequate sex and relationship education in conjunction with accessible contraceptive services as the means of reducing teenage pregnancy. The limitations of school-based programmes for looked after children are widely recognised; additional sex and relationship education is therefore recommended
- Authorities that consult young people and develop specialist sexual health services for young people have greater success in reducing teenage pregnancy
What is the issue?
This section introduces and defines the scope of the briefing and the topic.
A SCIE Research briefing provides up-to-date information on a particular topic. It is a concise document summarising the knowledge base in a particular area and is intended to act as a 'launch pad’ or signpost to more in-depth material. The briefing is divided into the different types of knowledge relevant to health and social care research and practice, as defined by the Social Care Institute for Excellence (SCIE).
Levels of teenage pregnancy in the UK are high relative to other European countries (1). The Government is aiming to reduce by half the level of teenage pregnancy in under 18s, and to create a downward trend in under 16s, by 2010 (2). This briefing focuses on the prevention of pregnancy among a specific group: looked after children and young people. Looked after children (LAC) is a generic term introduced in the Children Act 1989 to describe children and young people "subject to care orders (placed into the care of local authorities by order of a court) and children accommodated by voluntary agreement of their parents". LAC usually live in foster homes, but may also be in residential placements or with family members (3).
Why is it important?
This section summarises research findings relating to the impact or consequences of pregnancy among looked after teenagers.
This issue is important because teenagers who become parents are known to experience greater educational, health, social and economic difficulties than young people who are not parents, and their children may be exposed to the consequences of greater social deprivation and disadvantage (1,4,5,6). These outcomes have been demonstrated to be more adverse still in the case of looked after children who become parents because this group are more likely than others to be unemployed, have more mental health problems, be expected to be independent, and to have little social or economic support (2,7). Until recently there had been no systematic monitoring of health progress and health outcomes in looked after children (8), but it is now recognised that the health and educational needs of LAC are different from and greater than many other groups of children and young people (8,9). LAC are exposed to greater risk factors for teenage pregnancy than many other groups. Young people in care are recognised as being one of the principal groups to experience social exclusion (2), and s ocial exclusion has been identified as a "key determinant of teenage pregnancy" (2,10).
Access to good quality sex and relationship education (SRE) has also been demonstrated to reduce levels of teenage pregnancy (11) and LAC are known to have less access to good quality, consistent sources of sex and relationship education and advice than many other children and young people (12,13,14). There is also a strong link between teenage pregnancy and age at first intercourse (15,16) and LAC are known to become sexually active earlier than other groups of children (12). As a result, looked after young people are two and a half times more likely to become pregnant as teenagers (2). It is estimated that one in four young women leaving care are either pregnant or already mothers, and almost half of female care leavers become mothers between the ages of 18 and 24 (17).
The prevention of teenage pregnancy among looked after children and young people therefore poses particular problems and may have particular, significant beneficial outcomes.
What does the research show?
Organisational Knowledge
This section lists and briefly summarises documents that describe the standards that govern the conduct of statutory services, organisations and individuals working in the field of preventing pregnancy among looked after children and young people.
Children Act 1989 (c.41)
This Act determines the responsibilities of social services in relation to looked after children. This includes the provision of sex and relationship education (SRE) in addition to that provided in schools.
Department of Health (2002). Promoting the Health of Looked After Children.
This document sets out a framework for the delivery of services from health agencies and Councils with Social Service Responsibilities (CSSR) to improve the health of looked after children and young people. The document describes the duties of social workers, services and foster carers to provide effective "personal, social and health education, complementing that which is provided by schools". This includes SRE. Chapters 7 and 11 offer information on teenage pregnancy.
Department for Education and Skills (DfES) (2000). Guidance on the Education of Children and Young People in Public Care.
The purpose of the guidance is to assist local authorities in their role as corporate parents to safeguard and promote the education of children and young people in public care. This document sets out the essential measures local authorities must take to ensure that young people in public care gain maximum life chances from the educational opportunities on offer.
Social Exclusion Unit (1999). Teenage Pregnancy. London, The Stationery Office.
This is the key document describing the current situation and outlining policy on teenage pregnancy in the UK. The combination of accessible sex and relationship education, and access to contraceptive services, is the principal recommendation of this report as an intervention to reduce the number of teenage pregnancies in the UK.
Acheson, D (2000). Independent Inquiry into Inequalities in Health Report. London, The Stationery Office. (Hardcopy only)
Fraser Guidelines
These guidelines state that contraception may be provided for a young person under 16, without parental consent, if the following criteria are fulfilled: the young person understands the advice and is competent to consent to treatment; the person is encouraged to inform her parents/guardians; it is believed that the young person is likely to commence or continue sexual activity with or without contraception; the physical or mental health of the young person will suffer if they do not receive contraceptive advice or supplies; contraceptive advice and treatment is in the best interests of the young person concerned.
Please note: research has consistently demonstrated that LACs are less available for school-based education programmes, including SRE and advice, than other children and young people (7).
Policy community knowledge
This section summarises documents describing proposed structural models for the delivery of policy and improved practice. These documents are published by public policy research bodies, lobby groups, think tanks and related organisations.
Welsh Assembly (2003). Looked-after children's entitlement to sex and relationship education. Children First. Sheet 3.
This proposed model for the delivery of SRE to children in care is based on legislation and national policy documents.
Welsh Assembly (2003). Referring looked-after young people to sexual health services. Children First. Sheet 4.
This proposed strategy for the delivery of confidential sexual health services and advice to young people in care is based on the Fraser Guidelines and other national guidance documents.
Meyrick J. (2002). An Evaluation Resource to Support the Teenage Pregnancy Strategy. Health Development Agency.
This document aims to identify the basic principles of project evaluation and apply them to the creation of local teenage pregnancy strategies for young people in general. It does not intend to be prescriptive or advocate any particular methods or approaches to evaluation.
Sex Education Forum; National Children’s Bureau (2001). Working with Young People in Sexual Health Settings: a providers guide.
This fact sheet gives guidance on developing appropriate, sensitive sexual health services which are young-people friendly. It is aimed at health visitors, primary care and clinical staff, school nurses and community workers.
Sex Education Forum; Council for Disabled Children (2001). Ensuring Entitlement: sex and relationships education for disabled children.
Disabled children and young people are less likely to receive SRE at home and in school than other children. This is a fact sheet which seeks to support the development of SRE policy and practice for disabled children generally.
A resource has also been produced offering recommendations specifically on the creation of policy and the provision of sexual health and education services for LAC, including the provision of training and advice for foster carers (7).
A project recently developed and tested a training programme for carers of children in public care (19). This was delivered through a local pilot scheme in London by a Children and Families team, as well as being part of the fpa’s open training programme. The training materials developed by the programme cover sexual health, relationships, pregnancy and parenthood for vulnerable children and young people in public care.
Finally, a recent UK study described a multi-agency consultation process to map services and resources, and identify gaps, to inform the development of a teenage pregnancy strategy based on the demands of the Social Exclusion Unit Report (2,20). The establishment of an inter-agency network to provide services to young people concerning sexual health has also been found to be effective (21).
Practitioner knowledge
This section describes studies carried out by health and social care practitioners, documents relating their experiences regarding the topic, and resources produced by local practitioner bodies to support their work.
Teenage Pregnancy Unit (2001). Guidance for Field Social Workers, Residential Social Workers, and Foster Carers on providing information and referring young people to Contraceptive and Sexual Health Services. Quality Protects.
This document describes how social workers and foster carers can provide access to confidential and unbiased advice on sexual health and contraception to young people, including looked after children.
Darlington Local Teenage Pregnancy Strategy (2001)
This document describes a local teenage pregnancy strategy for young people in general, based on the key Social Exclusion Unit report (2).
Teenage Pregnancy and Teenage Parenthood Strategy (2001)
This document describes the Lancashire local teenage pregnancy strategy for young people in general, based on the key Social Exclusion Unit report (2).
Time to decide: a guide to support young people in public care when making decisions about pregnancy. National Children’s Bureau (18)
This is a practical self-help guide developed for young women in care who find themselves unexpectedly pregnant, including the options available at different stages of pregnancy.
Research knowledge
This section summarises the best available research literature. The focus is on studies undertaken in the United Kingdom, so that their findings are as relevant as possible to the intended audience of the briefing.
Risk factors predicting teenage pregnancy have been consistently demonstrated by the research to include socio-economic deprivation; limited involvement in education; low educational attainment; limited access to consistent, positive adult support; being a child of a teenage mother; low self esteem; experience of sexual abuse; and living in care (1,2,10,13,14,15,22,23,24). Social exclusion, especially as a result of social and economic deprivation, has been identified as a "key determinant of teenage pregnancy" (2,10). Research has also demonstrated that LAC as a group are likely to satisfy many or all of these criteria (2).
Outside of the issues of social and economic disadvantage or deprivation, the research literature has identified the inadequacy of school and care-based sex and relationship education (SRE) and advice programmes as a major potential reason for levels of teenage pregnancy, especially among LAC (7,25,26). This is relevant because the principal source of information and advice on sexual health and contraception for children and young people has been demonstrated to be school-based programmes (22). LAC are known to have low levels of school attendance (9,27). School-based SRE alone has been demonstrated to be insufficient (28), but recent reviews have concluded that there is good evidence that school-based SRE, particularly when linked to contraceptive services, can have an impact on young people’s knowledge and attitudes, delay sexual activity and reduce pregnancy rates (1,25). These findings are the result of descriptive, non-randomised studies, however (29).
There is no evidence that sex and relationship education programmes lead to earlier sexual activity (1,11). There is also no strong evidence for the effectiveness of abstinence education programmes or programmes encouraging vocational development (1). Some studies have advocated peer-led SRE programmes (30), but there is no evidence that such programmes are effective in reducing levels of teenage pregnancy (11).
User and carer knowledge
This section summarises the issues raised by service users and carers in relation to this topic as described by the literature.
Research has found that young people, especially those in care, consider some current school and care-based sex and relationship education and advice programmes to be inadequate (7). Young people generally also report experiencing problems accessing confidential contraceptive services (16). A study to canvass the views of young people on more effective SRE to prevent teenage pregnancy found that they wanted good quality, consistent information from "youth-centred" services within youth settings or from media sources used by young people, such as magazines or the internet (30). These sources of information satisfied the need for easy and confidential access. It has also been found that authorities that consult young people and develop specialist sexual health services for young people have success in reducing teenage pregnancy (21). LAC are less likely than other groups to choose either abortion or adoption because of their own personal experience (13).
A consultation with seven young people who had been in care, undertaken for this briefing, echoed some of these findings, in particular the need for easy access to contraception, especially condoms, the importance of the accessibility and confidential nature of sex education and contraception services, and the provision of a separate, appropriate service for young people. This group of young people also thought that the attitude of the person who delivers sex and relationship education is very important; they should be friendly, relaxed, confident, non-judgmental and informed.
Those consulted thought that both residential and field social workers should also be a good source of information; they had been for many of these young people. They thought that social workers should have an information pack about sexual health services to share with young people, and actually taking them to see the services was also thought to be a good idea.
Useful links
This section lists sources of information relevant to services users and professionals who work within this field.
Children and Families. Department for Education and Skills
This document provides links to a range of government and non-government bodies and organisations. This was formerly Quality Protects.
The Teenage Pregnancy Unit is a cross-Government Unit located within the Department for Education and Skills which was set up to implement the Social Exclusion Unit's report on Teenage Pregnancy. This website contains information about the Government's Teenage Pregnancy Strategy, including guidance issued by the Teenage Pregnancy Unit as well as relevant publications from other Government Departments. There is also information about local implementation of the strategy and details about the Independent Advisory Group on Teenage Pregnancy.
The Social Exclusion Unit works mainly on specific projects, chosen following consultation with Ministers and interested groups. The Unit forms part of the Government's strategic multi-agency approach to tackling social exclusion.
The HDA works to improve people’s health and reduce health inequalities. The agency gathers evidence and produces advice for policy makers, professionals and practitioners, and works alongside them to get evidence into practice.
National Children’s Bureau (NCB)
The NCB promotes the interests and well-being of all children and young people across every aspect of their lives.
The Sex Education Forum is the national authority on SRE and aims to ensure that all children and young people receive their entitlement to good quality SRE in a variety of settings. Relevant fact sheets made available by the NCB include "Talking about sex and relationships with Children and Young People in Public Care" (1998), "Talking about sex and relationships: a fact sheet for foster carers" (2001), and "Working with Young People in Sexual Health Settings" (2001).
fpa (formerly The Family Planning Association) is a registered charity providing information and advice on sexual health. Relevant documents made available by the fpa include "Let’s make it happen", a training manual aimed at professionals working with looked after children and young people, published jointly by the fpa and the National Children's Bureau.
Barnardos run services across England, Northern Ireland, Scotland and Wales. The organisation aims to help disadvantaged children to overcome challenging experiences and tackle the effects of disadvantage and to help them develop into well-rounded adults. The organisation makes available a range of information and resources for teachers and professionals working with vulnerable children.
Brook Advisory Centres is a voluntary sector provider of free and confidential sexual health advice and services specifically for young people under 25. The centres provide contraception, advice, and counselling to young people about sexual health, as well as outreach, education, and satellite services in response to local need.
The Who Cares? Trust designs and manages a variety of development programmes, resulting in the production of practice materials for different audiences involved in or associated with the public care arena. The majority of development programmes, aimed at influencing practice in service delivery for looked after children in local authorities, are piloted in local authorities, prior to national dissemination of the findings and resulting materials. These programmes include education and health.
Mind, Body & Soul is a joint initiative between the Department of Health and the Department for Education and Employment. Mind, Body & Soul aims to provide young people between the ages of 14-16 with relevant and appropriate health information, as well as linking to a range of accurate, clear and credible websites on a variety of health issues.
LifeBytes is a joint initiative between the Department of Health and the Department for Education and Skills. LifeBytes aims to provide young people between the ages of 11-14 with relevant and appropriate health information, as well as linking to a range of accurate, clear and credible websites on a variety of health issues. The site is divided into topics and includes sex and relationships.
likeitis is developed by Marie Stopes International and offers information about all aspects of sex education and teenage life. Topics include teenage pregnancy, sex, peer pressure, sexuality, contraception, and emergency contraception.
Acknowledgements
Thank you to experts and service users for their contributions to this briefing.
