According to a recent NHS report, teenage pregnancy is a common problem in the UK as about a third of under 16 female teenagers are reported to be sexually active and more than half 16-19 year olds do not use contraception the first time they engage in sexual practice (NHS report, 2005). The NHS reports that within Europe, teenage birth rates are highest in Britain and one in every ten birth given is by a teenage mother.
According to a Social Exclusion Unit report, teenage birth rates in England are twice as high as Germany, three times higher than France and six times higher than the Netherlands. National statistics report suggests that pregnancy rates are highest for 15-17 year olds and the recorded highest number of teenage conceptions were in 1995 through 1998 after which they have fallen slightly, probably due to health department and NHS awareness programs and strategies. According to Health department report, around 3, 514 abortions were carried out for girls of 16 and under. In the UK, approximately 25% of 15 year olds and 50% of 17 year olds have had sex with nearly 13% of 20 year old women having had a child in their teens. (UNICEF, 2001). Conception data used for statistical results usually include pregnancies that result in either one or more live or still births described as a maternity or a legal abortion under the Abortion Act of 1967 or both.
However according to the National Statistics Office, the following report has been provided:
In the year 2000,
38,690 under 18s in England became pregnant.
44.8% of these ended in legal abortion
7,617 of these conceptions are attributed to under 16s
54.5% of conceptions ended in legal abortion (Office of National Statistics, 2005)
However under 16 conceptions rate fell by 4% in 2001. The infant mortality rate is high for babies born of teenage mothers accounting for 12% of all infant deaths.
Considering the statistics given here, teenage pregnancy seems to be one of the major issues of concern for the Department of Health and the NHS and teenage a detailed pregnancy strategy at the national and local level is in place. The Social Exclusion Unit's report published a national strategy in 1999 to :
halve the rate of conceptions among under 18s and set a firmly established downward trend in the conception rates for under 16s by 2010;
and increase the participation of teenage parents in education and work. (SEU report, cited by NHS, 2005)
As part of the SEU's Action Plan, an Independent Advisory Group on Teenage Pregnancy was established as a non-statutory body in 2000 and its role was to monitor cases of teenage pregnancy and advise the government on the progress and overall success of the teenage pregnancy strategy. A reported £10 million Standard Fund Teenage Pregnancy grant has been marked since December 2000 in this regard with an aim to get teenage mothers back into mainstream life and education.
The targets of the Teenage Pregnancy Unit are given as follows:
Reduce by 50% the 1998 England under 18 conception rate by 2010, with an interim target of a 15% reduction by 2004.
• Achieve a well established downward trend in the under 16 conception rate by 2010.
• Reduce the inequality in rates between the fifth of wards with the highest under 18 conception rate and the average ward rate by at least 25% by 2010.
• Increase to 60% the participation of teenage parents in education, training or employment to reduce their risk of long-term social exclusion by 2010 (From the Teenage Pregnancy Unit report, 2005)
Achieving these targets seem to involve not just the health department administrators, but educators and teachers at school, parents at home and health workers, medical professionals and nurses in healthcare settings. An inter-professional working approach or IPW model is relevant for discussions on health care approaches to teenage pregnancy.
In healthcare settings approaches to tackle teenage pregnancy should be essentially collaborative and in this regard a study by Goudie and Redman (1996) point out that high rates of teenage pregnancy and demands of younger people for greater accessibility to health care services should prompt authorities to develop further appropriate services and one of the strategies suggested by the authors involved interagency working and young people’s ongoing involvement in health care projects for the community and hospital services.
One important aspect of collaborative nursing to prevent teenage pregnancy is imparting sex education in schools. In a report on teenage health system in the US, Polivka (1996) studied rural sex education offered in three different counties in the US and assessed the sex education programs offered as also the agencies involved and compared interagency collaborations across counties. The study took place in two phases and 85 participants were interviewed. Current programs were assessed in Phase 1 and interagency collaboration was assessed in Phase 2. Reports indicated that sex education programs were offered both inside and outside of school curriculum and settings and were done to enhance self esteem in teenagers, provide parenting education to teens and to advocate for the advantages of abstinence. Sex education is also imparted via newsletters, adolescent health conferences and in clinics and hospitals. After reported teenage pregnancies, sex education and advice were given in hospitals and clinical heath settings involving pregnant teenagers, adolescent mothers and parents of the affected teenagers. Collaborative sex education programs for youth, all over the world is thus an important aspect of spreading awareness on the perils of teenage pregnancy and aims to avoid it by involving parents, teachers, nurses, healthcare workers and professionals, different governmental and non-governmental agencies, health department and the teenagers themselves. However as Polivka has rightly pointed out, further research would be necessary to assess the impact of such collaborative program development efforts on interagency collaboration, teen sexual activity and pregnancy rates (Polivka, 1996).
Tabi (2002) gives a community perspective on a model to reduce teenage pregnancy and explains a study design that was used to validate elements of an educational career youth developmental model (ECYDM) that was aimed to reduce teenage pregnancy among African American teens in urban communities. The primary aim of the study was identifying factors responsible for teenage pregnancy among the chosen group of young people and planning and implementing a pregnancy prevention program relevant to the needs of the teenagers. Data was taken form both teen and adult participants and included pregnant and non-pregnant adolescents as well as teenage mothers and parents, school staff and community clergies. Data was collected by questionnaires, group interviews and individual interviews. The data supported the elements of the ECYDM model and the participants identified the need for an educational and career motivational program that would help to teach and counsel and provide information on health, education, career and social outcomes of uncontrolled sexual activity as part of pregnancy prevention program in urban communities. According to the author, teenage pregnancy must be addressed not in isolated basis but within the context of the individual, family, school and community. The authors emphasize 'Community partnership and collaboration of resources is necessary to reduce teenage pregnancy' (Tabi, 2002, p.275).
Furey (2003) takes a look at the teenage parent support programs to examine what works for teenage parent support programs and to determine the primary elements of successful teenage support and parental programs and to check flaws or gaps if any. According to this study method, databases were searched for systematic reviews and randomized controlled trials to ascertain whether parenting programs or social support or both are required in improving maternal and infant outcomes and perceptions in adolescent pregnancies. According to results and conclusion by Furey, social support and parenting programs designed for teenagers have been found to be effective in improving maternal child interactions and child cognitive development, but counseling during pregnancy have no effects on low birth weight, stillbirths or neonatal death instances. The author concludes that social support and parenting programs need to be combined with measures to increase minimum income, to reduce smoking during pregnancy and to increase breast feeding rates. The study emphasized on the need to introduce major packages and programs in the UK to keep people informed on national and local teenage pregnancy strategies.
Giving the other side of the story considering the teenagers’ perspective and perceptions of the acceptability of an educational intervention program, Symon and Wrieden (2003) attempted to assess the feasibility of nutritional education intervention sessions for pregnant teenagers in which the standard dietary assessment schedules were supplemented by a qualitative appraisal on the dietary practices and requirements. The teenagers who attended one or more of these dietary practices sessions were interviewed to get a view on their perceptions of these programs offered. A phenomenological approach was taken with qualitative study using semi-structured tape recorded group interviews of 10 pregnant teenagers aged 16-18 years in Scotland, UK. All these teenagers had attended one or more of a series of food preparation and dietary education sessions and were queried on their perceptions and feedback. All these teenagers found the sessions to be educational, social and quite practical. The teenagers appreciated being able to participate in a group exclusively for teenagers and felt a part of the groups which did not have older pregnant women. Following these dietary sessions, some of them reported to have changed their dietary habits and also sought maternity related information from the midwife who led the discussion. Seeing the advantages of such programs, the authors concluded that introduction of more such programs and carrying out extensive nutritional intervention programs in clinical settings are important and should aim to attract more concerned teenagers. The authors concluded that proper health initiatives and programs can actually emphasize the necessities for such interventions and aid in improving the general sexual health of teenagers and adults alike.
Bonsu (2005) discusses the rising instances of teenage pregnancy and sexually transmitted diseases in teenagers which has forced the government to take new initiatives in promoting better sexual health among teenagers. Government priority on teenage sexual health issues has been coupled with teenage pregnancy prevention strategies involving nursing and healthcare professionals to provide sex education and adequate health services among other things, to control adverse teenage sexual health effects. Bonsu highlights the role of contraceptive nurses who play a key role in advising young people on contraception and sexual health issues. The factors affecting teenage pregnancy, sexual activity and sexually transmitted diseases have been emphasized in highlighting the role of nurses and midwives who not only provide advice in health issues but encourage young people to take full responsibility for their sexuality.
Going beyond the role of nurses caring for pregnant teenagers, and addressing the need to involve nurses from all disciplines, Leishman (2004) suggests that childhood and teenage pregnancy poses a significant social and heath problem in the UK and has wide implications for nurses serving across a wide range of disciplines within the clinical setting. Leishman attempts to raise awareness on the extent of the sexual health problems and also attempts to involve nurses from other departments who accordingly also have significant responsibilities in controlling and preventing teenage pregnancy and are tools for identifying the risks of early pregnancy providing sexual health related advice in schools and community centers and hospitals. To this extent the focus was to spread awareness of nurse’s responsibilities in controlling pregnancy in teenagers by involving them in discussion groups even at nursing school sessions and during their training period as nurses.
However as we have already discussed extensively, focusing on the nurses’ role is not the only method of providing health services and Odembo (1992) discusses the issues in focus on adolescent health including fertility, sexuality and family planning methods. The problems in adolescents, formulating plans to tackle these problems, examining ways of linking research and services and creating a supportive network for groups and individuals working in the area of sexual health were the major aspects considered in the discussion. This last aspect of promoting sexual health is important as it tends to highlight on the collaborative role of community and social workers, the health department authorities, government agencies, educators, parents and nurses in not just spreading awareness but also in preventing further pregnancies in the same teenager and to bring down the rates and incidence of accidental teenage pregnancies. Odembo emphasizes that teenage pregnancies are not just common in developed worlds but is also becoming a growing problem for health authorities in the developing world and these unwanted births have enormous social consequences, particularly for young women who after getting pregnant lose the chances of continuing education, future employment and a normal social life. The consequences are detrimental to a country’s socioeconomic development and are a strain on the health system and finances of the government health department. In African countries for instance a Community Based Health Care program has been suggested and implemented to address adolescent reproductive heath as a national issue. This program focuses on education on family life, sex and AIDS, skills education, information education and communication, health and career related counseling, training by special education teachers, youth participation in programs, prenatal care and family planning, prevention and information on sexually transmitted diseases, research and dissemination of data, and primary schools and adult literacy programs and advice on sexual health and other adolescent issues. Similar programs and strategies are carried out jointly by the Teenage Pregnancy unit and NHS services to spread awareness on the consequences of adolescent pregnancies and to provide sex education and advice to facilitate a healthy and mature approach towards sex.
Initiative and progress to control and prevent teenage pregnancy has been focused on several areas including improvements of provisions of sex and relationship education in schools and the DfES (UK government's Department for Education and Skills) guidance for schools were also issued in this regard. Accreditation of teachers of SRE is underway according to the recent NHS report. The Teenage pregnancy Unit has funded and focused on education in schools in areas of religion, faith and sexual activity. Constant surveys are undertaken to give a good practice guide for implementation of these programs. A sex and relationships education module is also being planned to be started in schools as also in programs in health care settings. Guidance on services has also been focused to reach teenage boys to make them aware of their responsibilities in sexual health practices. Parallel guidance is also provided by the authorities to support workers and healthcare professional to meet the needs of teenagers and especially those of ethnic minority groups. A national media campaign helps to publicize the perils of early sex life and pregnancy concerns. At present every area in England has a local Teenage Pregnancy Coordinator and the primary responsibility of these local coordinators is to identify cases and provide emotional support to pregnant teenagers and mothers and to prevent further pregnancies in the area by providing educational services to the community. Help and advice lines have also been opened and phone numbers are available to teenagers across the UK for advice on issues of sexual health, diseases and pregnancy. Such services definitely involve an interagency, collaborative approach that highlights the necessity of the government departments of Health and Education, as well as nurses from all departments, parents and teachers to work towards a common aim of preventing teenage pregnancy.
In this context, Saunders and Brown (1997) highlight the collaborative aspect of nursing to prevent repeated adolescent pregnancies. In this report, nurse educators from a university setting and staff from county health department collaborated to establish an innovative program to prevent repeated pregnancy in adolescents. The program was operated jointly for 5 years and continues to operate under the health department. Success of the program depended on assessment, managing and evaluating all of which depended on a collaborative context. This program was modeled on an initiative to have weekly meetings with adolescent mothers and cash awards to avoid repeated pregnancy. The program was a collaborative effort of health department nurses and members of faculty of a nursing school. Loxley’s theory of collaboration in nursing practice has been highlighted in the study which illuminates relationships among structures, culture, power and hierarchy, values through systems theory, social exchange and cooperation theory with an emphasis on core skills in a collaborative approach that Loxley identified. Assessment, the first stage of the approach is an appraisal method that involves identifying resources, the needs of the patients and analyzing the strengths, weaknesses of the plan; building is creating structures and values as well as proper collaborative relationships for implementation of the initiative. Managing the process involved communication and exchange of information whereas the last stage of evaluation helped in measurement of the outcome of the initiative with constant feedback from participants and weekly goal settings and meetings with the mothers to get an understanding of the use and effectiveness of the program.
n this essay we emphasized the need for a collaborative working approach in preventing teenage pregnancy discussing the role of health workers and officials as well as nurses and educators to overcome this growing problem on teenage sexual health. Substantiating our claims with NHS reports we suggested the need for a ‘collaborative working together’ or inter-professional IPW approach that is also being increasingly recognized by the NHS and Department of Health in the UK.
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