Some information on teenage pregnancy
England's teenage pregnancy strategy to become global blueprint
World Health Organisation invites leader of programme that resulted in 51% drop in conceptions to share lessons
A teenage pregnancy prevention strategy that is credited for halving the rate of conceptions among teenagers in England is to be used as a blueprint in countries that want to emulate its success. Alison Hadley, who led the 10-year programme resulting in record lows in teenage pregnancies, has been asked by the World Health Organisation (WHO) to share the lessons of the project so they can be applied globally.
The teenage pregnancy strategy was set up by the Labour government to address soaring rates of pregnancy in England among teenagers from deprived backgrounds. It resulted in a 51% drop in conceptions over a 16-year period. According to the WHO, very few other programmes worldwide have had such success.
New teenage pregnancy figures are due to be published by the Office for National Statistics (ONS) on Tuesday, but figures released in March showed conception rates among under-18s at their lowest level. According to the ONS, in 2014 23 women under the age of 18 out of every 1,000 became pregnant in England and Wales, compared with 47 out of 1,000 in 1998. One of the reasons for the success of the programme was the length of time devoted to it. Ten years is unusually generous, with projects often limited to three or five at most. Also credited is the comprehensive, multi-agency approach, with work carried out in schools and colleges, among youth workers and social workers.
“It was a joined-up government strategy,” said Hadley. “No one department said they could solve it on their own, and it went on for a full 10 years which was pretty unprecendented. I don’t think I’ve ever seen such a big movement to address such a complex issue.
“That’s what the WHO are trying to extract. You need lots of time. You need the structures to deliver it properly. You will not do it overnight - you need it across government and multi-agency.”
The strategy came to an end when the coalition government came into power, but Hadley went on to set up the Teenage Pregnancy Knowledge Exchange at the University of Bedfordshire to ensure that lessons were not lost. Following an approach by the WHO, she has also co-authored a paper in which she identifies lessons from the strategy that may apply to other countries. The paper is published in the Journal of Adolescent Health on Tuesday. She has also travelled to Mexico to share her expertise, and hosted a visit from the Thai government, which has seen an increase in teenage pregnancy and is hoping to learn from the UK.
Dr Venkatraman Chandra-Mouli, who works in adolescent sexual and reproductive health for the WHO and co-authored the paper, first heard Hadley talk about the strategy in 2014. “This is a huge achievement. This is one of the great achievements of this generation.
“We really have to celebrate it. But we can’t photocopy a programme and put it in place in other countries. What we absolutely need to do is to take many of the principles of the UK strategy and apply them elsewhere.”
Hadley, who remains the government’s teenage pregnancy adviser, said: “The WHO made it clear that the UK strategy is unique in both its extraordinary success and its impact on families from deprived backgrounds and has many features that are transferable to low- and middle-income countries.
“It’s very exciting to think that the plans we rolled out, and that made such a positive impact across England, could be used around the world. Because teenage pregnancy affects the health and life chances of young parents and their children, high levels are a concern to an increasing number of countries.
“Our strategy demonstrated that effective education programmes and easier access to contraception equips young people to make choices and brings down rates even in deprived areas. Key to success was government commitment, strong coordination between agencies and sufficient time to effect change.”
There is still much work to be done in the UK, Hadley warned. “As we share the lessons internationally, we need to continue the reductions at home. Key to further progress will be to make comprehensive sex and relationships education statutory in all schools.
“We still lag behind our western European neighbours and there is considerable variation in rates across England. If we do not continue our work on prevention, the figures will rise again.”
(SOURCE 1.)
---------------------------
OP: According to the World Health Organization (WHO), “Ninety-five per cent of [births to teenaged mothers] (…) occur in low- and middle-income countries. The average adolescent birth rate in middle income countries is more than twice as high as that in high-income countries, with the rate in low-income countries being five times as high.”
The second article shows the human impact of teen pregnancy in poorer countries. (SOURCE 3.)
--------------------------
Each year about two million girls around the world give birth before they turn 15. Apart from the health risk this can also lead to them dropping out of school and affects future employment opportunities.
Photographer and filmmaker Pieter ten Hoopen met some teenage mothers ahead of the Women Deliver conference in Copenhagen on the health, rights and well-being of girls and women.
Keya, 14, Bangladesh
Keya, 14, lives with her husband Jahangir, 21, son Rahim, two months, and in-laws in an urban slum area in Bangladesh. Keya and her husband fell in love and wanted to get married against their parents' wishes when she was 13 years old. Due to excessive blood loss, Keya almost lost her life during the delivery.
"When I got married at 13 I was happy," says Keya.
"I only went to school for one year because my family was so poor. I had spent many years at home helping my mother with the household chores. I got to know my husband from our neighbourhood and knew I wanted to marry him.
"I became pregnant two months later. I wanted to have a child. When I first felt the labour pains, I didn't tell anyone.
"My mother-in-law asked me if I was feeling sick and I said I was. She tried her best to deliver my baby for me but she couldn't do it by herself. Then my mother came and took me to the local clinic."
---------------------
Ana, 15, Colombia
Ana, 15, lives with her daughter Karen, four months, parents and two sisters in a violent neighbourhood of a large city in Colombia. She was in eighth grade when she became pregnant by her boyfriend, who left her soon after. Ana got pre-eclampsia in her last trimester and needed urgent medical care.
"When I was eight months pregnant, I got very high blood pressure. I went to the clinic and they sent me to the maternity ward immediately. I didn't want to be a mother, but when Karen smiles at me, it's something beautiful."
---------------------
Aissa, 15, Burkina Faso
Aissa, 15, lives with her daughter Fati, 13 months, mother and two sisters in a rural area in Burkina Faso. She was sexually abused by her teacher and became pregnant as a result. The teacher was later suspended for one year.
"I was 14 when I got pregnant. It was after my primary school exam. I called my teacher to find out about my results. Ever since he got my number, he kept calling and asked me to come and see him. "I said I wouldn't go. Then one day, he threatened me and said that if I didn't come, I would have a problem. So I got frightened and went there to get the results of my exam. Then he raped me."
------------------
Elianne, Haiti
For the past five years Elianne has lived with her father and two siblings in a camp for internally displaced people following the earthquake in Haiti in 2010. Elianne became pregnant with her boyfriend and had to leave school. When she was seven months pregnant, she gave birth to a son who died shortly afterwards.
"I was seven months pregnant when I felt a pain in my lower belly. After a week, I decided to go to hospital to see what was wrong. Each hospital I went to refused me because they said my condition was very serious and that the baby or I could die during delivery."
-------------------------
Amira, 15, Jordan
Amira,15, lives with her two children Samer, one, and Amal, 12 days, and husband in a refugee camp in Jordan. She had to stop attending school because of the war in her home country, Syria. Amira got married at 13 and has two children who were born at the maternity clinic in the camp.
"It's so hard to take care of a child when you're a child yourself. For example, I'm not sure if I should be carrying my children all the time.
"Plus, I have to take care of my husband too. I don't have any free time for myself. My children take up much more time than all the housekeeping. My newborn baby cries a lot. Sometimes, I don't know why he's crying. He just does."
--------------------------
Mulenga, 14, Zambia
Mulenga, 14, lives with her daughter, parents, her father's second wife and 10 siblings in a remote village in Zambia. She used to go to school and wanted to become a doctor until her mother discovered she was pregnant.
"It's difficult being a mother. I don't have time to play any more. I have to stay at home to take care of my daughter and wash nappies. Before I had a baby, I used to play and go wherever I wanted. I liked to play football."
-----------------------
Poko, 15, Burkina Faso
Poko, 15, lives with her son Tiga, three, parents, grandmother and aunt in an urban area in Burkina Faso. She almost died during childbirth. Her family is very poor and cannot pay the school fees for Poko to continue her education.
"I was 12 when I got pregnant. At the time, I didn't know anything about these things. One day, a guy I used to meet wanted me to come to his place. I did not know why, but he said that when the night came, we could sleep together. I went there and he had sex with me. It was my first time."
-------------------------
Thandiwe, 15, Zambia
Thandiwe, 15, lives with her daughter, Anna, nine months, husband and in-laws in a remote village in Zambia. When Thandiwe was pregnant, she had to leave school and marry the father of her child.
"I still don't feel ready to be a mother because I didn't expect to have a child now.
"Before I was pregnant, I was in the sixth grade. I wanted to become a chef and work in town. Then I met a boy who was in the ninth grade.
"We didn't have a relationship, we only met about five times - that's all. I was scared when I found out I was pregnant. When my parents knew about it, they brought me to my husband's house and just left me. I didn't want to go there but they forced me to marry him."
(NB: Names have been changed to protect identities.)
SOURCE 2.
------------------------------
OP: Some important facts about teen pregnancy.
(1)“About 16 million women 15-19 years old give birth each year, about 11% of all births worldwide.
Ninety-five per cent of these births occur in low- and middle-income countries. The average adolescent birth rate in middle income countries is more than twice as high as that in high-income countries, with the rate in low-income countries being five times as high.
The proportion of births that take place during adolescence is about 2% in China, 18% in Latin America and the Caribbean and more than 50% in sub-Saharan Africa.
Half of all adolescent births occur in just seven countries: Bangladesh, Brazil, the Democratic Republic of the Congo, Ethiopia, India, Nigeria and the United States.” (SOURCE 3.)
(2) “Adolescent pregnancy (i.e., in females 13 to 19 years of age) is associated with an increased risk of maternal complications during pregnancy and delivery, as well as increased risk to the fetus and neonate. Complications associated with adolescent pregnancy include preterm delivery, low birth weight, and infant mortality. However, age-related biologic factors alone are not associated with an increased risk of fetal death. In infants of teenage mothers, much of the risk of low birth weight is related to behavioral and psychosocial factors. Thus, psychosocial risk factors should be a major focus of care.” (SOURCE 4 is the following journal editorial: American Family Physician 2007; 75(9):1310-1311.)
In other words, and simplifying what is said a bit, a huge ‘ingredient’ in the adverse outcomes associated with teenaged pregnancy is poverty.
(3) There can be issues with ‘global’ public health initiatives (i.e. those targeted at the entire population): one frequent issue being that they tend to fail to reach the most vulnerable in the population.
One example relates to the first article above: in England, despite the reduction in teen pregnancy rates, “Girls in state care and care leavers still at high risk of teenage pregnancy”. (SOURCE 5.)
(4) Some interesting additional information:
-‘New Global Focus Placed on Reducing Anemia in Adolescent Girls’ (i.e. “Young maternal age increases the risk for anemia during pregnancy”.)
-‘The Thin Red Line: Family Planning In Fragile Places’.
-The CDC reports that teen pregnancy in the U.S. has decreased, but notes that, “the U.S. teen pregnancy rate is substantially higher than in other western industrialized nations, and racial/ethnic and geographic disparities in teen birth rates persist.”
-Some medical information on teen pregnancy.
(5) OP: PLEASE NOTE that OP has no time for those who want to stigmatize or blame young mothers, or to say that they are bad parents. The point here is to point out the difficulties which can occur when children become parents and that this is a group which needs more help, as well as to point out the effect of the world's inequalities on this issue.
World Health Organisation invites leader of programme that resulted in 51% drop in conceptions to share lessons
A teenage pregnancy prevention strategy that is credited for halving the rate of conceptions among teenagers in England is to be used as a blueprint in countries that want to emulate its success. Alison Hadley, who led the 10-year programme resulting in record lows in teenage pregnancies, has been asked by the World Health Organisation (WHO) to share the lessons of the project so they can be applied globally.
The teenage pregnancy strategy was set up by the Labour government to address soaring rates of pregnancy in England among teenagers from deprived backgrounds. It resulted in a 51% drop in conceptions over a 16-year period. According to the WHO, very few other programmes worldwide have had such success.
New teenage pregnancy figures are due to be published by the Office for National Statistics (ONS) on Tuesday, but figures released in March showed conception rates among under-18s at their lowest level. According to the ONS, in 2014 23 women under the age of 18 out of every 1,000 became pregnant in England and Wales, compared with 47 out of 1,000 in 1998. One of the reasons for the success of the programme was the length of time devoted to it. Ten years is unusually generous, with projects often limited to three or five at most. Also credited is the comprehensive, multi-agency approach, with work carried out in schools and colleges, among youth workers and social workers.
“It was a joined-up government strategy,” said Hadley. “No one department said they could solve it on their own, and it went on for a full 10 years which was pretty unprecendented. I don’t think I’ve ever seen such a big movement to address such a complex issue.
“That’s what the WHO are trying to extract. You need lots of time. You need the structures to deliver it properly. You will not do it overnight - you need it across government and multi-agency.”
The strategy came to an end when the coalition government came into power, but Hadley went on to set up the Teenage Pregnancy Knowledge Exchange at the University of Bedfordshire to ensure that lessons were not lost. Following an approach by the WHO, she has also co-authored a paper in which she identifies lessons from the strategy that may apply to other countries. The paper is published in the Journal of Adolescent Health on Tuesday. She has also travelled to Mexico to share her expertise, and hosted a visit from the Thai government, which has seen an increase in teenage pregnancy and is hoping to learn from the UK.
Dr Venkatraman Chandra-Mouli, who works in adolescent sexual and reproductive health for the WHO and co-authored the paper, first heard Hadley talk about the strategy in 2014. “This is a huge achievement. This is one of the great achievements of this generation.
“We really have to celebrate it. But we can’t photocopy a programme and put it in place in other countries. What we absolutely need to do is to take many of the principles of the UK strategy and apply them elsewhere.”
Hadley, who remains the government’s teenage pregnancy adviser, said: “The WHO made it clear that the UK strategy is unique in both its extraordinary success and its impact on families from deprived backgrounds and has many features that are transferable to low- and middle-income countries.
“It’s very exciting to think that the plans we rolled out, and that made such a positive impact across England, could be used around the world. Because teenage pregnancy affects the health and life chances of young parents and their children, high levels are a concern to an increasing number of countries.
“Our strategy demonstrated that effective education programmes and easier access to contraception equips young people to make choices and brings down rates even in deprived areas. Key to success was government commitment, strong coordination between agencies and sufficient time to effect change.”
There is still much work to be done in the UK, Hadley warned. “As we share the lessons internationally, we need to continue the reductions at home. Key to further progress will be to make comprehensive sex and relationships education statutory in all schools.
“We still lag behind our western European neighbours and there is considerable variation in rates across England. If we do not continue our work on prevention, the figures will rise again.”
(SOURCE 1.)
---------------------------
OP: According to the World Health Organization (WHO), “Ninety-five per cent of [births to teenaged mothers] (…) occur in low- and middle-income countries. The average adolescent birth rate in middle income countries is more than twice as high as that in high-income countries, with the rate in low-income countries being five times as high.”
The second article shows the human impact of teen pregnancy in poorer countries. (SOURCE 3.)
--------------------------
Each year about two million girls around the world give birth before they turn 15. Apart from the health risk this can also lead to them dropping out of school and affects future employment opportunities.
Photographer and filmmaker Pieter ten Hoopen met some teenage mothers ahead of the Women Deliver conference in Copenhagen on the health, rights and well-being of girls and women.
Keya, 14, Bangladesh
Keya, 14, lives with her husband Jahangir, 21, son Rahim, two months, and in-laws in an urban slum area in Bangladesh. Keya and her husband fell in love and wanted to get married against their parents' wishes when she was 13 years old. Due to excessive blood loss, Keya almost lost her life during the delivery.
"When I got married at 13 I was happy," says Keya.
"I only went to school for one year because my family was so poor. I had spent many years at home helping my mother with the household chores. I got to know my husband from our neighbourhood and knew I wanted to marry him.
"I became pregnant two months later. I wanted to have a child. When I first felt the labour pains, I didn't tell anyone.
"My mother-in-law asked me if I was feeling sick and I said I was. She tried her best to deliver my baby for me but she couldn't do it by herself. Then my mother came and took me to the local clinic."
---------------------
Ana, 15, Colombia
Ana, 15, lives with her daughter Karen, four months, parents and two sisters in a violent neighbourhood of a large city in Colombia. She was in eighth grade when she became pregnant by her boyfriend, who left her soon after. Ana got pre-eclampsia in her last trimester and needed urgent medical care.
"When I was eight months pregnant, I got very high blood pressure. I went to the clinic and they sent me to the maternity ward immediately. I didn't want to be a mother, but when Karen smiles at me, it's something beautiful."
---------------------
Aissa, 15, Burkina Faso
Aissa, 15, lives with her daughter Fati, 13 months, mother and two sisters in a rural area in Burkina Faso. She was sexually abused by her teacher and became pregnant as a result. The teacher was later suspended for one year.
"I was 14 when I got pregnant. It was after my primary school exam. I called my teacher to find out about my results. Ever since he got my number, he kept calling and asked me to come and see him. "I said I wouldn't go. Then one day, he threatened me and said that if I didn't come, I would have a problem. So I got frightened and went there to get the results of my exam. Then he raped me."
------------------
Elianne, Haiti
For the past five years Elianne has lived with her father and two siblings in a camp for internally displaced people following the earthquake in Haiti in 2010. Elianne became pregnant with her boyfriend and had to leave school. When she was seven months pregnant, she gave birth to a son who died shortly afterwards.
"I was seven months pregnant when I felt a pain in my lower belly. After a week, I decided to go to hospital to see what was wrong. Each hospital I went to refused me because they said my condition was very serious and that the baby or I could die during delivery."
-------------------------
Amira, 15, Jordan
Amira,15, lives with her two children Samer, one, and Amal, 12 days, and husband in a refugee camp in Jordan. She had to stop attending school because of the war in her home country, Syria. Amira got married at 13 and has two children who were born at the maternity clinic in the camp.
"It's so hard to take care of a child when you're a child yourself. For example, I'm not sure if I should be carrying my children all the time.
"Plus, I have to take care of my husband too. I don't have any free time for myself. My children take up much more time than all the housekeeping. My newborn baby cries a lot. Sometimes, I don't know why he's crying. He just does."
--------------------------
Mulenga, 14, Zambia
Mulenga, 14, lives with her daughter, parents, her father's second wife and 10 siblings in a remote village in Zambia. She used to go to school and wanted to become a doctor until her mother discovered she was pregnant.
"It's difficult being a mother. I don't have time to play any more. I have to stay at home to take care of my daughter and wash nappies. Before I had a baby, I used to play and go wherever I wanted. I liked to play football."
-----------------------
Poko, 15, Burkina Faso
Poko, 15, lives with her son Tiga, three, parents, grandmother and aunt in an urban area in Burkina Faso. She almost died during childbirth. Her family is very poor and cannot pay the school fees for Poko to continue her education.
"I was 12 when I got pregnant. At the time, I didn't know anything about these things. One day, a guy I used to meet wanted me to come to his place. I did not know why, but he said that when the night came, we could sleep together. I went there and he had sex with me. It was my first time."
-------------------------
Thandiwe, 15, Zambia
Thandiwe, 15, lives with her daughter, Anna, nine months, husband and in-laws in a remote village in Zambia. When Thandiwe was pregnant, she had to leave school and marry the father of her child.
"I still don't feel ready to be a mother because I didn't expect to have a child now.
"Before I was pregnant, I was in the sixth grade. I wanted to become a chef and work in town. Then I met a boy who was in the ninth grade.
"We didn't have a relationship, we only met about five times - that's all. I was scared when I found out I was pregnant. When my parents knew about it, they brought me to my husband's house and just left me. I didn't want to go there but they forced me to marry him."
(NB: Names have been changed to protect identities.)
SOURCE 2.
------------------------------
OP: Some important facts about teen pregnancy.
(1)“About 16 million women 15-19 years old give birth each year, about 11% of all births worldwide.
Ninety-five per cent of these births occur in low- and middle-income countries. The average adolescent birth rate in middle income countries is more than twice as high as that in high-income countries, with the rate in low-income countries being five times as high.
The proportion of births that take place during adolescence is about 2% in China, 18% in Latin America and the Caribbean and more than 50% in sub-Saharan Africa.
Half of all adolescent births occur in just seven countries: Bangladesh, Brazil, the Democratic Republic of the Congo, Ethiopia, India, Nigeria and the United States.” (SOURCE 3.)
(2) “Adolescent pregnancy (i.e., in females 13 to 19 years of age) is associated with an increased risk of maternal complications during pregnancy and delivery, as well as increased risk to the fetus and neonate. Complications associated with adolescent pregnancy include preterm delivery, low birth weight, and infant mortality. However, age-related biologic factors alone are not associated with an increased risk of fetal death. In infants of teenage mothers, much of the risk of low birth weight is related to behavioral and psychosocial factors. Thus, psychosocial risk factors should be a major focus of care.” (SOURCE 4 is the following journal editorial: American Family Physician 2007; 75(9):1310-1311.)
In other words, and simplifying what is said a bit, a huge ‘ingredient’ in the adverse outcomes associated with teenaged pregnancy is poverty.
(3) There can be issues with ‘global’ public health initiatives (i.e. those targeted at the entire population): one frequent issue being that they tend to fail to reach the most vulnerable in the population.
One example relates to the first article above: in England, despite the reduction in teen pregnancy rates, “Girls in state care and care leavers still at high risk of teenage pregnancy”. (SOURCE 5.)
(4) Some interesting additional information:
-‘New Global Focus Placed on Reducing Anemia in Adolescent Girls’ (i.e. “Young maternal age increases the risk for anemia during pregnancy”.)
-‘The Thin Red Line: Family Planning In Fragile Places’.
-The CDC reports that teen pregnancy in the U.S. has decreased, but notes that, “the U.S. teen pregnancy rate is substantially higher than in other western industrialized nations, and racial/ethnic and geographic disparities in teen birth rates persist.”
-Some medical information on teen pregnancy.
(5) OP: PLEASE NOTE that OP has no time for those who want to stigmatize or blame young mothers, or to say that they are bad parents. The point here is to point out the difficulties which can occur when children become parents and that this is a group which needs more help, as well as to point out the effect of the world's inequalities on this issue.