Jennifer Veitch examines Scotland’s poor record on teenage pregnancy
As with so many indicators of our national public health, teenage
pregnancy places Scotland around the top of the international league
table for all the wrong reasons. The rates are among the highest in
Europe, with almost 5,000 young women aged between 16 to 19 having
babies every year.
Another 300 girls aged between 13 to 15 will also become mothers before the age of consent, while another 4,000 scottish teenagers will have an abortion or a miscarriage.
When this all adds up to almost 10,000 teenage pregnancies – many of which will be unplanned, if not unwanted – it is little wonder that teenage sexual health has become a top public health priority in Scotland over the past decade.
Efforts to introduce a more pragmatic, targeted approach to the problem have not been without controversy, however. Former health minister Susan Deacon sparked controversy with her call to acknowledge the reality that as many teenagers were having sex before the age of 16, they needed to be able to access contraceptives such as condoms.
In January 2005, the Executive launched the sexual health strategy, Respect and Responsibility, backed up by £15 million of additional funding for its implementation. Based on principles of respect for self, respect for others and strong relationships”, the strategy called on NHS boards to appoint lead clinicians and executive directors for sexual health.
All local authorities have also designated a sexual health lead, and a number of initiatives are now under way across the country to improve sexual health and ensure the sharing of best practice.
The single most high-profile initiative remains the demonstration project, Healthy Respect, launched during Deacon’s time as health minister. Based in NHs Lothian, it supports education about sexual health and relationships and delivers services such as drop-in clinics aimed specifically at young people. The project also aims to provide the evidence base for future policy, and to “mainstream” any initiatives that are proven to work.
Now in its final year, an external evaluation of Healthy Respect’s second phase is being commissioned by Health scotland. While an interim report will be available in early 2008, the final conclusion as to whether the project has reduced teen pregnancies will not be available until the following year.
Its success is by no means certain. A report on its first phase found that there was no evidence that teenage pregnancy rates had been reduced as a result of the work done by Healthy Respect.
Project manager Dona Milne says it was too early for its work to have taken effect at that point. But she insists it did have an impact in changing the way health services approached the issue of young people’s sexual health.
“What the first phase [report] found was that Healthy Respect had managed to create a new way of working, in terms of bringing all the key partners together and delivering a different type of service so we were able to reach the young people who are not normally accessing services.”
She adds that Healthy Respect has encouraged the NHS and other partner organisations to tackle what was a notoriously difficult and often controversial topic.
“Sexual health was quite a sensitive area, and a lot of people had been apprehensive about tackling it in the past,” she says. “The evaluation found we were able to get the key partners involved and we built on that.”
During the early days of the project, she adds that negative media coverage failed to recognise the emphasis on respect that underpinned any advice or access to contraceptives given to young people.
“We spent a lot of time meeting with different agencies who could have an impact,” adds Milne. “People need to see things in action, and once the project got under way people could see that we were being responsible.”
Whatever the NHS or education partners do, Milne adds that the role of parents in shaping young people’s attitudes towards sex cannot be underestimated.
“A lot of our work focuses on relationships – not just young people’s relationships with boyfriends or girlfriends but also family relationships and what support young people have. Parents are one of the biggest influences on whether young people will have sex at an early age.”
Some recent initiatives have included a campaign called Quality Family Time, which encouraged parents and children to spend more time together to improve communication.
The project has also begun piloting Home Activity Resource packs, including homework for children to do with their parents to encourage families to talk about sex and relationships. Drop-in clinics set up in Lothian have found that young people do want to talk to someone, often when they are still thinking about having a sexual relationship and haven’t yet taken that first step. But Milne says young people also want advice about wider issues that might be worrying them, such as exam stress, eating disorders or skin problems, suggesting that a more holistic approach to teenagers’ health might be needed.
As might be expected, poverty and education are key factors in rates of teenage pregnancy, but so is risk-taking behaviour which Milne says cuts across social divides.
“In some cases, it is young people who have low self-esteem and chaotic family lives, but in terms of risk-taking behaviour, that doesn’t always apply [to] social disadvantage
it is young people who have low self-esteem and chaotic family lives, but in terms of risk-taking behaviour, that doesn’t always apply [to] social disadvantage 
,” she says. “Young people of all classes engage in risk-taking behaviour.”
However, because of its clear link to poverty, Milne acknowledges that those in the most deprived groups must be the top priority. “Those young people who live in the most disadvantaged areas are more vulnerable and they are the ones that we would like to target with additional support.”
In some communities, teenage pregnancy may not be seen as the wrong choice, and some young women will choose to have their children young. Milne acknowledges that some teenagers may well be in stable relationships and will have decided to get pregnant and keep their baby. But she adds: “The key thing is, is it an informed choice?
“We know that young women who get pregnant at an early age often end up on their own looking after a child with less family support and on a low income. Often that is because they have left education early and don’t have the qualifications.
“That often leads to a cycle where that child becomes a teenage mother or father. We want to try and avoid that cycle of deprivation.”
In tackling teenage pregnancy, there are, of course, limits to what an initiative like Healthy Respect or indeed the wider NHs can achieve. “We know that as a health service we can provide a number of things, but we can’t tackle everything,” says Milne.
“We need the support of local authorities because educational attainment will have a bigger impact on teenage pregnancy than contraceptive services alone.”
Milne does not attempt to predict what the final evaluation of Healthy Respect will conclude. But in the wider context of the national strategy on sexual health, she is confident that scotland will see an improving picture.
“I think we have the best chance of reducing teenage pregnancy. When we first began, there wasn’t much evidence about what was effective.
“Now we have the evidence from the Teenage Pregnancy Unit [in England], phase 1 of Healthy Respect and the sexual Health strategy. We now know who is most at risk and what are the most effective interventions.
“We have got young people’s sexual health on the agenda now and we need to keep working on it.”
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