research - pregnancy - Abortion and teenage pregnancy
In 2000 there were 175,542 abortions performed
on women resident in England and Wales.
How the number and rate of abortions has changed?
From 1968 to 1973, the annual numbers
of legal abortions for women living in England and Wales increased
rapidly and then levelled off at about 100,000 a year. Abortion
numbers then rose each year until 1991, mainly because the
numbers of women in the population aged 15 to 44 (the fertile
ages) grew due to a large increase in the birth rate in Britain
between 1956 and 1963. There were more abortions between 1975
and 1990 because there were more women to become pregnant.
A further factor in the rise in the number of abortions was
the fall in the popularity of marriage among young women.
Unmarried women are more likely to have an abortion if they
have an unplanned pregnancy. The number of abortions has remained
stable between 1998 and 2000. Reasons for this new stability
could be due to abortion becoming a more acceptable solution
than ever before when contraception fails or women fail to
use it properly.
|Numbers and rates of
abortions carried out on residents of England and Wales
for the last 5 years per
1000 women aged 15-44
The number of abortions in England and Wales
declined between 1990 and 1995, and better use of contraception
is likely to have been an important factor in this. There
was a 7 per cent increase in the number of abortions in 1996,
largely due to the effects of a Pill scare in 1995 about the
safety of certain brands of oral contraceptives. This undermined
the confidence of many women in hormonal methods of contraception
and decreased their use. The abortion rate has continued to
rise, possibly because of continued concern about the safety
of contraceptive hormones, especially among young women, and
possibly because abortion is seen by more women as an acceptable
way to manage an unwanted pregnancy. The increased abortion
rate in 1996 was widely publicised and may have educated women
that abortion is a legal and safe choice.
Who pays for abortions?
Unlike maternity services when a woman wants
to continue a pregnancy, abortions are not automatically available
through the NHS. On average, throughout England and Wales
the NHS pays for approximately three-quarters (74.9 per cent)
of abortions. There are significant differences between regions.
In some areas the NHS pays for more than 90 per cent of abortions,
in other regions it pays for less than 50 per cent. Statistics
are published annually by the Office of National Statistics
showing the contribution of each health authority to the funding
of abortions in their area.
At what gestation do most abortions occur
Almost 90 per cent of abortions are in
the first 12 weeks of pregnancy. Just 1.5 per cent are after
|Abortions in England and Wales
2000 by gestation (total 175,542)
|Under 9 weeks:
|20 weeks and over:
Later abortions are often for the following
• The woman may not have been able
to get a hospital appointment earlier in the pregnancy;
• she may not have realised she was pregnant (this is
more common with young women and women approaching the menopause
both of whom may have infrequent periods);
• very young women may feel unable to cope and so hide
• sometimes the pregnancy was originally wanted but
the woman's circumstances change (perhaps because she is abandoned
by her partner or finds that her parents are not willing to
provide her with a home or any other support);
• fetal abnormality is an important reason for late
abortion, as many cannot be diagnosed early in pregnancy.
At what age do women have abortions?
|Abortions in England and Wales
2000 by age (total 175,542)
|45 and over:
The highest number of abortions is among
women aged 20-24. However, a great deal of attention has been
focused on teenagers because England and Wales has one of
the highest teenage pregnancy rates for 15-19 year olds in
One woman in five who has an abortion is married;
many others are in stable relationships. Abortion is not only
an issue for single women. 47 per cent of women who have abortions
have at least one child already.
Why do women from abroad travel to Britain
In 2000 almost 10,000 women who lived abroad
travelled to England to have an abortion.
Most of these women came from other parts of
the British Isles, mainly from Northern Ireland (1,528) and
the Irish Republic (6,391). Those from elsewhere in the world
came because abortion is available in their countries only
up to 12 weeks (France and Italy) or not available at all
(the Arab states), or to ensure complete confidentiality.
The numbers have fallen from their peak of 57,000
in 1973 because most other European countries now have abortion
laws that are less restrictive than those in Britain.
For more information contact:
BPAS Head Office
West Midlands B95 6BX
Tel: 01564 793225
Fax: 01564 794935
The Reality of Irish Abortion:
Facts and stats: the reality of Irish abortion
BPAS has provided the ifpa with access to data
detailing age, gestation and area of residence for the 8.214
Irish clients to whom it has provided abortion services since
BPAS statistics analysed by the ifpa reveal
the following key headline facts:
39.5% of all Irish clients, since January 1997,
have self-referred, indicating that they have not availed
of counselling in Ireland before travelling. While this figure
is still high it does show that 60% have accessed some form
79.5% of all Irish clients, since January 1997,
have had their abortion at 12 weeks gestation or less. UK
Office for National Statistics (ONS) figures for 1996 indicate
that this figure was 73% that year.
3.5% of all Irish clients, since January 1997,
have had their abortion at 20 weeks gestation or more.
Tables A and B contain age and gestation data
for 1997, 1998, 1999 and for January to June 2000. Table C
contains data for each of the Health Board areas. County data
will only be released for selected counties. In particular
we will not release data for any county in respect of which
there are less than 35 recorded abortions This is to safeguard
the interests of the clients involved.
There will undoubtedly be interest in the number
of abortions in Counties Wicklow , Kerry and Donegal given
the dependancy of the current government on Independent TDs
representing those counties.
Table D provides data for selected counties
and shows that the main urban areas and counties Wicklow,
Kerry and Donegal all have significant levels of abortion,
notwithstanding the current legal position. This means that
abortion is a daily reality in the constituencies of leading
members of the government and the independent TDs on which
|Age at time of Abortion,
BPAS Clients January 1997 to June 2000. Source:
ifpa/BPAS 8 July 2000
||Jan to June 2000
|16 - 19
|20 - 24
|25 - 34
|35 - 44
|Gestation at time of Abortion,
BPAS Clients January 1997 to June 2000. Source:
ifpa/BPAS 8 July 2000
|9 - 12
The following table has been prepared using
client address data to calculate the total number of BPAS
clients, in 1999 ONLY, drawn from each of the Health Board
areas. The percentage distribution of these figures has been
applied to the full ONS figure for 1999 to provide an estimate
of the full year total for each health Board.
|Clients treated by BPAS January
to December 1999 who supplied Irish addresses. Source:
ifpa/BPAS 8th July 2000
|Health Board Area Total
||Actual Number of BPAS Clients
||Percentage of BPAS
of ONS 1999 Total Statistic based on BPAS
Dublin, Kildare, Wicklow
Carlow, Kilkenny, Tipperary SR, Wexford, Waterford
Galway, Mayo, Roscommon
Donegal, Leitrim, Sligo
Cavan, Meath, Monaghan, Louth
Laois, Longford, Offaly Westmeath,
Total figure for Tipperary is divided evenly
between the two Health Board areas for North and South Riding.
The total BPAS figure used in all geographical
tables for 1999 is 2445. Of the 2,460 clients included in
age and gestation tables, we were unable to allocate 15 clients
to a county of residence.
Table D (Selected Counties)
In 1999 BPAS recorded 2445 Irish abortions where
the county of residence could be determined as compared with
total ONS figures of 6214. ONS figures provide no county data.
The BPAS figure of 2445 was equivalent
to 39.58% of the ONS total. The estimated figures in column
3 below have been arrived at by multiplying the BPAS figure
by 2.541 and rounding to the nearest whole number. This is
the only method for county by county estimation currently
||BPAS 1999 Total
||Estimated Overall Total
|Cork City and County
|Dublin City and County
|Source: ifpa/BPAS 18 July
For Further Information:
Tel: 086 811 5115 (Mobile) or 01 878 0366 (Office)
Abortion in England and Wales was first made
illegal in the 19th century. Before then English Common Law
had allowed abortion provided it was carried out before the
woman felt the fetus move ('quickening') when it was believed
the soul entered the body.
Abortions performed after quickening were an
offence under Common Law but there were no fixed penalties
and the woman having the abortion was not necessarily held
responsible. In 1803 the law changed and abortion became a
criminal offence from the time of conception with penalties
of up to life imprisonment for both the pregnant woman and
Section 58 of the Offences against the Person
Act 1861 made abortion a criminal offence punishable by imprisonment
from three years to life, even when performed for medical
reasons. No further legal changes occurred in England until
1929. The Offences Against the Person Act is still in place
and the current law simply provides exceptions to the 1861
law by clarifying when an abortion can be legal.
The Infant Life Preservation Act amended the
law so that abortion would no longer be regarded as a felony
if it was carried out in good faith for the sole purpose of
preserving the life of the mother.
The 1929 Act made it illegal to kill a child
'capable of being born live', and set 28 weeks as the age
at which a fetus was assumed to be able to survive.
The Infant Life Preservation Act has never applied
In 1938, Dr Alex Bourne performed an abortion
on a 14 year old girl after a gang of soldiers had raped her.
Dr Bourne informed the police and was prosecuted. In court,
the judge ruled that Dr Bourne had acted in the 'honest belief'
that the abortion would 'preserve the life of the mother'.
This opened the way for other doctors to interpret
the law more flexibly because it established that preserving
a woman's life could mean more than literally preventing her
The Abortion Act 1967 came into effect on 27
April 1968 and permits termination of pregnancy subject to
certain conditions. Regulations under the Act mean that abortions
must be performed by a registered practitioner in a National
Health Service hospital or in a location that has been specially
approved by the Department of Health - such as a BPAS clinic.
An abortion may be approved providing two doctors
agree in good faith that one or more of the following criteria
A. the continuance of the pregnancy would involve risk to
the life of the pregnant woman greater than if the pregnancy
B. the termination is necessary to prevent grave permanent
injury to the physical or mental health of the pregnant woman;
C. the continuance of the pregnancy would involve risk, greater
than if the pregnancy were terminated, of injury to the physical
or mental health of the pregnant woman;
D. the continuance of the pregnancy would involve risk, greater
than if the pregnancy were terminated, of injury to the physical
or mental health of any existing child(ren) of the family
of the pregnant woman;
E. there is a substantial risk that if the child were born
it would suffer from such physical or mental abnormalities
as to be seriously handicapped; or in an emergency, certified
by the operating practitioner, as immediately neccessary:
F. to save the life of the pregnant woman; or
G. to prevent grave permanent injury to the physical or mental
health of the pregnant woman.
In relation to grounds C and D the doctor may take account
of the pregnant woman's actual or reasonably foreseeable environment,
including her social and economic circumstances.
Most abortions of unwanted pregnancies are carried
out under grounds C or D because the doctor confirms that
it would be damaging to the woman's mental health to force
her to continue the pregnancy.
Doctors and other medical staff have the legal
right to 'conscientiously object' to taking part in abortions
unless this is necessary to save the life or prevent grave
permanent injury to the woman.
Section 37 of the Human Fertilisation and Embryology
Act made changes to the Abortion Act. It introduced a time
limit of 24 weeks for grounds C and D. Grounds A, B and E
are now without limit. Before this change a 28 week limit
had applied for all grounds.
The Human Fertilisation and Embryology Act also
confirmed that when a woman had a multiple pregnancy it was
legal for a doctor to terminate the life of one or more fetuses
leaving others alive.
The Abortion Act 1967 and Section 37 of
the Human Fertilisation and Embryology Act 1990 do not apply
to Northern Ireland.
The effective lack of relevant research into
Government social exclusion strategy
Action Point 27 of the Social Exclusion Unit
Report on Teenage Pregnancy requires that:
Ø The local co-ordinator make sure that in their area,
professionals and teenagers have a checklist setting out the
services available during pregnancy.
Ø This will list the sources of advice on options to
keep the baby, adoption or termination. It will also cover
counselling, education and training, financial issues, housing
and advice on future contraception needs.
1. The guidance includes advice to enable every
local area to develop:
By Spring 2001 a checklist referral system for professionals
working with pregnant young women
a summary service checklist for young people
By Spring 2002 a youth service directory for young people
2. The guidance has been produced following
a seminar held by the Teenage Pregnancy Unit, which involved
a number of local co-ordinators who have produced service
checklists, and a range of professionals in the voluntary
and statutory sector who work with pregnant young women.
3. The guidance also addresses general issues
involved in promoting services for young people to increase
their uptake of health and related services.
Section 1 Background
Section 2 Producing a referral checklist for professionals
working with pregnant young women
Section 3 Producing a checklist of services for young people
Section 4 Producing a directory of services for young people
Annex A Referral checklist
Annex B Different approaches to producing checklists
Annex C Different approaches to producing directories
Annex D Increasing the effectiveness of service information
Annex E Research findings
3. Increasing young people's uptake of advice,
support and information services is an important part of achieving
the Government's ten year strategy to halve the rate of conceptions
among under 18s and increase teenage parents' involvement
in education, training and employment.
4. By collating information about what services
are available to young people at the local level, local co-ordinators
will be able to identify any gaps and facilitate the planning
and promotion of services in a co-ordinated way, through the
5. It is especially important to ensure that
young women who are or who think they may be pregnant receive
information and support from professionals in a co-ordinated
and timely manner.
6. The Social Exclusion Unit's report does not
prescribe exactly how the checklist of services should be
produced and it is clear that local areas will need to respond
to local needs, in respect of ethnicity and cultural issues,
literacy rates etc. It is not anticipated that every area
will produce an identical checklist, though some areas may
choose to work in partnership with others.
7. We would encourage every area to move towards
the production of a comprehensive directory of services, which
would include services available during pregnancy and factual
information on key issues, such as the law, benefits, housing,
employment rights as well as sexual health and relationships.
This directory would be aimed at all young people and would
provide information for professionals working with young people
including young women who are pregnant or young mothers under
8. As a first step, we would expect every local
area, by Spring 2001 to produce, a credit-card sized list
of key local phone numbers for young people's sexual health
and contraceptive services (including emergency contraception,
and 'where to go if you think you may be pregnant') and a
referral checklist for professionals who provide information,
support and advice to young women who are pregnant.
9. The strategy guidance issued in September
refers to the need to advertise local services to young people
as part of local campaign work. We have asked you to provide
information on procedures for ensuring accurate and up to
date information on services is disseminated and how directories
of services are being produced and distributed.
• We would therefore expect local strategies and three
year action plans to include plans to address this action
point and for March 2001 reports to indicate likely progress
in achieving the specified timescales.
10. Best practice guidance on providing effective
contraception and advice services for young people has been
posted on the TPU website, and an audit framework is being
• The process for auditing services against this framework
needs to be developed in conjunction with the above action
and the timescales for progressing this should be included
as part of local strategies and three year action plans.
11. Early in 2001 TPU will be issuing a forward
timetable of key actions and dates to assist local co-ordinators
in planning action in the light of emerging guidance.
• Regional co-ordinators will be asked to review progress
in September 2001 and discuss priorities and time-scales with
the local co-ordinator.
12. Producing checklists and directories should
be done in consultation with young people. There are a variety
of ways to engage young people, and Annexes C and D identify
a number of approaches.
13. A young woman who finds or suspects she
may be pregnant may turn to one or more professionals (and
in a few cases, to none). It is important that professionals
have accurate and up to date information and are in a position
to refer the young women appropriately.
14. Professionals likely to come into contact
with pregnant young women or mothers need to be aware of sources
of advice on:
• Counselling on options to keep the baby, adoption,
abortion and future contraception needs
• Education, training and employment opportunities and
• Benefits, housing and financial issues
15. Young women may delay contacting services,
so when a pregnancy is confirmed it is essential that they
receive access to co-ordinated support and advice quickly.
Special attention needs to be given to ensuring that sexual
health services consider how they ensure access to counselling
and other relevant health professionals. Health professionals
need to consider how they provide referral on education, financial,
housing and benefits advice. Education and training providers
will need to consider links with health providers and advice
on childcare and financial issues.
16. Practitioners in health, education and social
services should be involved in agreeing a referral procedure
to ensure that a pregnant schoolgirl is offered help, advice
and support in a co-ordinated manner. Annex A provides a list
of relevant professionals and an example of a referral flow
17. Representatives from each service should
provide details of their role and key contact details by geographical
area, as appropriate. Where possible, named contacts should
be identified to lead on enquires from, or on behalf of, a
18. The local co-ordinator should consider bringing
together a working group to develop the referral checklist,
and a process for dissemination and updating.
19. An evaluation of the referral checklist
should also be developed with relevant professionals.
20. A young woman who continues with the pregnancy
will have many information needs and is likely to come in
contact with a range of professionals over a two to three
year period. Midwives in particular may be in a position to
advise on the development of a notebook for the young mother
in which she, and the professionals she is in contact with,
can record essential information, questions and contact details.
Alternatively, professionals might wish to consider developing
a young person's guide to becoming a parent, similar to the
one produced by Barnardo's Young Parents Network in Belfast
(see Annex A for details).
21. The first stage in the production of the
checklist is to decide what services you want to identify
as the 'gateway' for young people i.e. the place or places
you would direct them to for initial professional contact
on sexual health or pregnancy issues. Annex B highlights the
need for checklists to include information on emergency contraception
and where to go if you think you may be pregnant.
22. It may not be practicable to list every
available service, but you might want to either give a variety
of telephone numbers for young people's services, or perhaps
give just one number for a local help-line, who can then provide
further information on specific services. If you wish to include
a national contact, the ruthinking website details (www.ruthinking.co.uk)
can be used. In accordance with the guidance issued in the
media pack the Sexwise number should not be included in any
publication with an official or adult endorsement or branding.
If you are in any doubt about this please seek clearance as
detailed in the media pack.
23. Each of the services which you propose to
include will need to be contacted and their agreement secured.
It is possible that their uptake could be increased. They
may get young people seeking advice on issues in which they
do not specialise, and they need to know where to refer them.
24. Once you have identified the services to
be included on the checklist, you need to decide the format.
Some examples of checklists are discussed at Annex B, which
identifies some of the pros and cons for each approach.
25. Where general youth information directories
or guides exist, co-ordinators are advised to work in partnership
to ensure that information is included about emergency contraception,
confirming a pregnancy, options for termination or adoption,
as well as contraception. In the education, training, benefits
and housing section, it is important that the rights and entitlements
for young parents under 18 are included. This information
is subject to change, and up to date information is available
from local benefits offices.
26. Where general information directories do
not exist, co-ordinators will need to consider in partnership
with others (e.g. the youth service, careers service, benefits
office etc) options for producing a directory of services
for young people.
27. The first stage of producing a directory
is to decide upon the scope of the topics and issues to be
covered. It will not be possible to provide information on
all issues relevant to young people, but key topics need to
be identified. Annex D provides information on a number of
28. As with the checklist of services it is
important to consider the key services which provide a 'gateway',
and include details of services catering for marginalised
29. Unlike checklists, directories give an opportunity
to provide basic information on issues or situations as well
as service contact details. Some directories are designed
in the form of questions or include young peoples' own comments
about services (see Annexes C and D). Directories should provide
a clear statement about services' confidentiality policy and
a description of their ethos.
30. Involving professionals and young people
in writing and agreeing sections will help increase ownership
of the directory. Annex D explores the importance of co-ordination,
young people's involvement, specific situations and added
incentives as ways of increasing the effectiveness of service
Staffing needs will vary depending on the scale and focus
of the guide and the extent of involvement of young people.
A team and/ or the appointment of a project worker will need
to be considered. It is important that someone has an overview
of the project and a common framework for information collection
The extent of young people's involvement will need to be identified.
Some directories have been produced and designed by young
people as a project. This level of involvement requires funding
to be identified for meetings, residentials, visits and expenses,
including childcare and transport. Other directories have
involved or commissioned particular groups of young people
to undertake specific activities such as service visits and
reviews, designing the format or dissemination strategies.
The layout of the text and the overall look of the directory
is important and needs to have credibility with young people.
Young people should be involved to ensure that design and
format will attract interest but not be stigmatising. Non
standard page sizes, bindings, more than one colour print
and design features, such as tabs for different sections should
be considered but will have cost implications.
A clear dissemination strategy should be developed, which
will determine the necessary print run. Checklists are likely
to be produced in greater numbers and have a wider distribution
than directories. It is important that the dissemination strategy
considers targeted distribution to ensure that young people
in care, young men and black and minority ethnic young people
are involved and receive copies on a frequent basis.
A directory can become out of date in two ways. The factual
information may change i.e. agencies move, close or change
their opening times or phone numbers etc and new services
and agencies start up. Secondly staff and agencies' ways of
working and their approach to young people may change. It
is common for directories to be updated on an annual basis.
Checklists, on the other hand, have the potential to be updated
on a more frequent basis. It is recommended that the date
of publication is given and a phone number to ring if it is
more than six or 12 months out of date. Local websites are
increasingly being developed for and by young people, and
these provide an opportunity to provide up to date information.
A ring binder format enables inserts to be added. Providing
update information in electronic format for professional organisations
might be considered as an option.
The Local Implementation Fund and the Local Co-ordination
Fund are available to support the development and production
of checklists and directories. Where generic directories are
produced, it is anticipated that a partnership funding package
will be developed.
Referral checklist for professionals
Local areas will need first to consider how to establish a
referral procedure among professionals and between organisations.
Then a view needs to be taken about how best to ensure that
professionals are aware of who to contact in order to ensure
speedy referral. A sample list of professionals and a referral
checklist is provided for adaptation at local level.
The primary target audience for the checklist
is professionals. However, some of the information may also
be adapted for a pregnant young woman. Professionals involved
in supporting a pregnant young woman under 18 will require
information on the roles and responsibilities of other professionals,
referral procedures and contact details.
Some areas will, in addition, want to consider
adapting this information to produce a booklet or leaflet
for young women who are continuing with the pregnancy.
At Forest Health Care Trust, Redbridge & Waltham Forest
HA, an adolescent pregnancy and maternity working group was
set up and produced a booklet called 'Pregnant at School'
for professionals. This listed all key professionals with
a description about their roles and responsibilities and some
Barnardo's Young Parents Network in Belfast produced a referral
checklist as part of a booklet called 'A young person's guide
to becoming a parent'. This was written by young parents to
provide basic facts and information and useful contacts. It
contains sections on community midwives, antenatal classes,
health visitors, social workers, schools and welfare officers,
being in hospital, breast feeding, coming home, fears and
baby blues, money matters, help with health costs and a directory
Contact: Barnardo's Young Parents Network, 453 Ormeau Road,
Belfast, BT7 3GQ
Tel: 028 90492802
The content of a checklist
The range of professionals involved in supporting a pregnant
young woman should be included with a brief description of
their roles and responsibilities. The following provides an
indicative list which should be adapted to local circumstances.
Contact details for a named lead person should be included
School nurses have a role to promote and maintain the health
of the pupils to enable them to benefit from education. School
nurses can offer support, counselling and referral for a young
woman who thinks she might be pregnant.
The guidance on Sex and Relationship Education states that
schools should have a clear and explicit confidentiality policy.
Teachers should ensure that they act consistently with that
policy. In accordance with the SRE guidance and the DfEE guidance
'Teenage Pregnancy: Guidance to Schools, LEAs and Social Services
Departments on supporting parents and pregnant girls of compulsory
age in education', teachers cannot offer or guarantee pupils
unconditional confidentiality. They are not legally bound
to inform parents or the head teacher of any disclosure unless
the head teacher has specifically requested them to do so.
A member of staff who finds out that a pupil is pregnant should
ensure that the pupil receives full information about services
in her local area, how to access them and has the opportunity
to talk through the options.
In cases where a pupil has decided to continue
with her pregnancy, the head teacher will need to be informed
so that arrangements can be made for her continuing education.
The head teachers should tell relevant members of school staff
according to school policy and nominate a member of pastoral
staff to talk to the young woman and take responsibility for
her continuing education. The head teacher should make sure
that the pregnancy is dealt with sensitively by both teachers,
and pupils within the school. The nominated member of staff
is not obliged to tell the pregnant pupil's parents or carers,
but they should take steps to ensure that wherever possible
the young person is persuaded to talk to them. They should
make sure that the pregnant pupil has access to the appropriate
local Health and Social Services. In Sure Start Plus areas,
the young woman should be given contact details of the Sure
Start Plus Advisor. Where possible, the head teacher should
respect the young woman's wishes on confidentiality.
Within the guidelines for the Youth Service, youth workers
will help the young woman consider her choices and options.
They will help the young woman access confidential services,
and will offer liaison with parents and other professionals.
Free pregnancy tests are provided via GP surgeries. The result
of a pregnancy test should be no longer than two to three
days. If a young woman is given a longer time-scale she should
seek assistance from another GP or clinic service.
A midwife is an advocate, a friend and a professional advisor
from time of first contact until 28 days after the baby is
born. The initial referral is likely to come from social services,
school nurse, health visitor, GP or teacher. Antenatal care
can be provided in a variety of locations, as midwives recognise
that teenagers are often reluctant to attend antenatal classes.
Health visitors are nurses with special training. They provide
care and support for mother and child until the child reaches
five. The health visitor is likely to want to make contact
with a pregnant schoolgirl in the antenatal period in order
to establish a relationship. Initial contact can be made via
a home visit, health centre or clinic. The health visitor
has a key role in ensuring liaison with other professionals,
and planning immediate and long-term support for the mother
and child's health and well-being.
The fact that a schoolgirl is pregnant does not necessarily
mean she will require psychological intervention. Most girls
however will want support to help them think through options
for education. The educational psychologist has a role to
link with other agencies to ensure the young women has access
For young people in the care system social workers provide
a source of advice and information to help decide whether
to continue with the pregnancy. This is likely to include
a discussion about options on adoption and the future care
of the baby, and a assessment and support around family breakdown
and alternatives to living at home. When there is a perceived
risk that a young woman or unborn child is suffering, or is
likely to suffer, significant harm, social workers under Section
47 of the Children Act 1989 will make enquiries to enable
them to decide whether they should take any action to safeguard
or promote the child's welfare.
Lone parents may be referred to housing departments by social
services or approach them directly. Social Services and Housing
will undertake a joint assessment of the young woman's housing
and support needs. The Government's policy is that all lone
parents under the age of 18 who are unable to live with their
family or partner should be provided with housing with support,
not a independent tenancy. This policy is to be fully implemented
Appointed by the LEA to ensure that young people, including
teenage mothers attend school or other education facilities.
A school age mother should have an individual reintegration
plan and panel (see Circular 11/99 for details on reintegration).
Personal Advisors and Learning
In Connexions pilot areas, partnerships will need to consider
how to provide an integrated support package, for example
by designating certain personal advisors as specialists in
supporting teenage mothers and fathers.
Learning mentors in Excellence in Cities areas
and personal advisors in areas with Connexions will work with
pupils facing barriers to education. Compulsory school age
mothers or fathers will receive support from a learning mentor
or personal advisor to help them access learning effectively.
The level of involvement will depend on the needs of the individual.
In Sure Start Plus areas, the Sure Start Plus
advisor will offer personal support and advice and help with
accessing counselling and other services to enable pregnant
teenagers to make a well-informed decision about the future
of the pregnant. For those who continue with the pregnancy,
Sure Start Plus advisors will co-ordinate an individual support
package for the young parents, both mother and father. In
areas where there are Connexions and Sure Start Plus pilots,
the Sure Start Plus advisor will normally act as the young
mother's Connexions personal advisor.
The following flow chart
is an example of a flow chart written from a professional's
point of view. A flow chart from a young person's perspective
could also be developed. Local areas will need to design their
own versions, inserting named leads and contact details where
Robinson et al (1998) The Really Helpful Directory –
services for pregnant teenagers and young parents, second
edition The Maternity Alliance and the Trust for Study of
Adolescence 1998 ISBN 0 946741 45 X
A directory which provides details of different
types of projects in the UK. Residential accommodation, educational
facilities, antenatal and parent craft provision and support,
information and services. (Please note that the only service
advertised for Coventry and the West Midlands is LIFE.)
Youthaid have produced a useful booklet called
'Under 18 and Pregnant', revised in 1997. It contains information
on training, employment, education and benefits rights for
pregnant young women and young parents. It has not been updated
and some of the information is now out of date. ISBN 0 907658
30 X from Youthaid, St John Street, London EC1V 4NT .
Different approaches to producing service checklists for young
Characteristics of service
They vary in size and format. Some are produced as a poster,
A4 leaflet or leaflet folded to handy purse or wallet size.
Outline information is provided, the name of the service,
phone numbers, details of opening times and what is provided.
Some checklists are specific to sexual health services. Others
include sexual health services among other services such as
Citizens Advice Bureau, drug agencies, leisure and benefits
A Sexual Health Services leaflet which provides comprehensive
and clear information on all sexual health services in Nottingham,
and specific young people clinics are mentioned. The opening
times are provided and the fact that the services are free
and confidential is emphasised along the side of the leaflet.
It is an attractive bright green and yellow leaflet which
folds up to A5 size, including website and national phone
4 Young People, East Kent
A laminated card advertises free, confidential help and advice
on sex and relationship services for young people and provides
details on opening times and area. The two tone colour cover
was designed by young people.10,000 credit cards and 250 posters
cost approximately £588 paid by Schering Health Care.
The reprint of 40,000 credit cards cost £234.
People's health/advice, Brentwood
Laminated credit size card which provide a range of services
and phone numbers on one side and information shop details
on the other. Cartoon pictures were designed by young people.
Cost about £500 for 10,000.
Checklists need to ensure that they meet the needs of young
women who suspect that they may be pregnant. All cards should
identify sources of emergency contraception and specify that
it is effective if taken up to 72 hours after unprotected
sexual intercourse. The checklists also need to provide information
about where to go if you think you may be pregnant for pregnancy
testing and counselling.
Points to consider:
• Checklists are easy to produce and update.
• Low costs enable large numbers to be printed.
• The phone card style is small, discreet and easy to
• A checklist that provides sexual health services among
a range of services may be less stigmatising and be appropriate
for distribution through a wide variety of locations.
• If the checklist is clearly about sexual health i.e.
has 'sex' emblazoned on the front, it may deter some young
people from picking it up and others from keeping it.
• Young people need to have a motivation to keep the
card. If you only supply information about contraceptive services
the card is likely to have limited appeal to those who have
an immediate need for services. Including information on leisure
facilities e.g. cinema details, discounts, maps etc increases
the likelihood of retention.
Different approaches to producing a directory of services
for young people
Two types of directory have been considered: issue specific
directories and generic youth guides
Sexual health directory
These directories contain information about sexual health,
in addition to service information. For example, information
is included on different types of contraception, sexually
transmitted diseases, different sexualities and advice about
of safe sex .
Sexual Health Directory
It contains a wide range of information provided in a A4 glossy
magazine style format including information on safe sex, using
a condom, methods of contraception and STIs. Designed for
all who are sexually active. It includes photos, cartoons,
a quiz and tick box questions. Local and national services
and phone lines are listed at the back.
A magazine style can provide a wide range of information on
sexual health, although its size and boldness may deter its
use by young people. It is likely to be expensive to produce
and would need a targeted distribution. It would need to contain
information about emergency contraception and what to do if
you think you may be pregnant.
Young people's guides
These are characterised by covering a wide range of issues
relevant to young people, often divided into topic sections
such as 'you and your rights', 'travel and transport', 'money',
'home', 'family', 'leisure', 'health and relationships', 'housing
and homelessness', 'education, training and employment'.
Youth Fax 98 – a rough guide to living
A spiral bound booklet containing 14 sections including, 'you
and your rights', 'health and relationships', 'leisure and
community', 'housing and homelessness', 'money and benefits',
'education, training and employment'. Each section provides
an overview of the issues for a young person and contact details
of local and national services. The booklet is produced by
the West Yorkshire Fax consortium, including young people
from 'Young Batley' Youth Council
Rough Guide to Help, Advice and Information 1994 and 1998
This has a similar spiral bound format to the Kirkless Youth
Fax. The first version included young people's comments about
their feelings about contacting a service, what had happened,
what they would say to another young person about it and recommendations
for improvement. It includes the age, gender and ethnicity
of the young reviewer. It is divided into 11 sections.
The 1998 guide included information about the
issues, in addition to a feedback page with young people's
comments about visiting the services. It included the first
name of the young person and their age. Both editions were
produced and developed by young people as part of a youth
project. Some young people's involvement was recognised as
part of their GNVQ.
A filofax with a commercially produced diary followed by sections
on health, benefits, entertainment, local councillors and
the youth council. It includes a range of help line numbers
and local service details. The see through filofax cover is
hardwearing and designed for each year's diary to be inserted.
It was designed by a girls and young mothers group. It cost
about £2.50 each and was distributed to all year 11
pupils on their last day at school.
Millennium edition, Lancashire
A book format produced by young people linked to a website
and the 'What Now' young people information shops run by Lancashire
Youth and Community service. It contains sections on education,
work and training, money, benefits, relationships, sex and
sexuality, drugs, leisure, travel and transport, environment,
politics, religions and equal opportunities. Local and national
help lines and services are included.
Survival Guide 1997
A ring bound format, a bright yellow hard- wearing cover without
logos or organisational branding. Produced by the City Centre
Project with young people and a advisory group. It covers
housing, money and benefits, health, law, education and training,
lesbian and gay issues, 'Manchester on the cheap' and poems
and prose from young people. Details for local and national
services are provided, as well as a feedback sheet and a update
form for organisations.
The generic young people's guides provide a range of information
and service details in attractive and long lasting formats.
Sexual health is just one aspect of the information provided
and does not feature on the cover. This may encourage young
people to keep it without fear of embarrassment or stigma.
Where young people's feelings about making contact
are included, this may help others to recognise they are not
alone in feeling confused and vulnerable. Where young people's
views on the service are included, this is likely to help
other young people prepare for what will happen and provide
Services for a young woman who thinks she may
be pregnant, including emergency contraception and pregnancy
testing, are included in these directories to varying degrees.
Issues such as termination, and adoption when covered appear
in the section 'relationships and the family' or 'health and
relationships'. Employment, education and training issues
are usually included, but vary in the extent to which they
cover specific issues relevant to a teenage mother.
Selected directories available on loan from the National Youth
Agency, 17-23 Albion Street, Leicester LE16GD, Tel: 01162853700,
Increasing the effectiveness of service information
Whether you are producing a checklist of phone
numbers or a directory of services, it is important to consider:
• which services are promoted;
• what information is provided;
• how young people will be involved;
• how the services promoted are co-ordinated;
• opportunities for promoting services as part of specific
• added incentives that will increase the effectiveness
of the information produced.
Which services should be
In identifying the key local services that young people will
be directed to, it is vital that you consider the following:
Which services young people are most likely
to contact as a 'gateway'. You should involve young people
in considering which ones to include, especially for the checklist
– it is especially important to identify services required
The performance and reputation of those services
among young people. For example through:
• consultation with young people (you should ensure
that those underrepresented in using services such as young
men, black and minority ethnic groups and young people in
care are consulted);
• consultation with other professionals;
• mystery shopping (where young people visit a service
in order to feedback their views and impressions on the experience).
It is particularly important to select services
that have a good reputation among young people. The checklist
or directory will have little credibility if the services
are perceived to be unsympathetic to young people's needs.
Only if young people's first contact with professionals is
positive will they be likely to seek advice again in the future,
or keep referral appointments. A feedback process should be
considered, especially outlining who to contact if things
go wrong and they do not receive the service expected.
Information about the accessibility of the local services
e.g. opening times and days, transport links, and location
need to be considered. It is especially important to use young
people friendly directions ie use landmarks that will be familiar
where possible e.g. turn first right at McDonalds. In Coventry
photographs of the actual buildings are used on their leaflet
to help young people locate the service.
For example, do they:
• specify that young people / young men are welcome?
• advertise their confidentiality policy?
• state exactly what services are offered?
• give names for those professionals who are specifically
available for young people?
• offer discreet accessibility techniques? (e.g. young
people can ring and request a young person's appointment,
or use a code word )
• do they provide balanced and unbiased information
to young people ? If services or professionals provide a limited
service or have a particular perspective or ethos then this
should be clearly identified.
It is important that there is a co-ordinated approach among
professionals to respond to young people. In some areas they
have developed a system for youth issues/ enquiries in key
departments. For example, Plymouth have a named contact for
CSA enquiries, and this approach is due to be adopted by the
housing and benefits departments.
In some areas a young person's appointment system
is in place. Where this exists young people do not have to
specify or identify why they want to see the doctor or counsellor,
they just ask for a young person's appointment. Coventry has
adapted this in a GP Practice which is part of the condom
distribution scheme. A code word approach is used, young people
ringing up or presenting themselves 'ask for Jane', which
stands for I am a young person and need emergency contraception.
Services on the street using buzzer/intercom systems could
usefully considered the use of pass words.
Young people's involvement
There are a variety of ways to involve young people in service
checklist and directories. They should be consulted and involved
in advising on the services to be included, the imagery and
language used, ways of distributing and evaluating the use
and retention of the information and ensuring that service
providers receive feedback.
The project approach used by Birmingham involved
working with groups of young people from care, and black and
ethnic minority young people to undertake service reviews.
School and college groups were involved in researching and
visiting services as part of their GNVQ and citizenship curriculum.
As part of launching the guide young people in Birmingham
were involved in organising a conference to feedback their
finding and discuss their recommendations with service providers.
South Essex have asked young people involved
in the community health council to undertake a project to
design and deliver a semi structured questionnaire about services
to local young people.
Coventry used the mystery shoppers approach
to test out their GP condom scheme. Young men were involved
in visiting services, which were part of the scheme. They
feedback their reactions and recommendations for improvement.
In Dudley midwives are working with a young
mothers group to produce a news letter for teenage mothers,
and young people in care and young offenders are being approached
to undertake mystery shopper visits to a range of services.
Plymouth students at the local IT community
college designed a website of local services as part of their
A number of directories are linked to youth
councils. In Sandwell the Young People's Council are involved
in producing a magazine 'Voice 21' and service information
will be included. The Greenwich and Bexley filofax was developed
by young women and a young mothers group and linked with the
Young People's Council. The group helped promote the filofax
by visiting schools and talking about their experiences.
In combination with a youth directory or service checklist,
it may be relevant to consider specific situations and opportunities
to promote services.
Coventry have produced a small laminated card on emergency
contraception and where it can be obtained. A club goodie
pack was produced for clubbers which contained information
about contraceptive and sexual health services, condoms and
Rotherham worked with local pharmacies to offer free pregnancy
tests and an information card. The card folds outwards to
direct the person to various services depending if the result
was welcomed or not.
Linked to discounts
Coventry pioneered the discount idea as part of their 'Hands
on' card for under 21s. It contained a list of participating
shops on one side and information services for counselling,
mental health, sexual health, alcohol and drugs, homelessness
and national numbers were on the other side.
Use of logos
As part of a drug prevention initiative, South Essex Mental
Health and Community NHS Trust produced a credit card for
young people with a variety of phone lines for different services
e.g. health/advice services, leisure centres, social services,
housing and homeless support, sex and drug services and the
benefits agency. Local Virgin shops paid for the printing
of the card, with the Virgin logo and distributed in its shops
in Thurrock and Basildon
Attaching a condom
Nottingham included a condom on their leaflet which was given
out in cinemas, the condom was detached when distributed in
Eggar, Gary, et al (1993) Health Promotion and the Media,
McGraw –Hill, Australia Pty Ltd. ISBN 0 07 4700006 £21.95
from Blackwells bookshops www.blackwells.co.uk
Skinner, Steve (1995) Directories and Resource
Guides – how to produce them, Community Development
Foundation publications, education training Unit, ISBN 0 902406
88 4, available from Community Development Foundation , 60
Highbury Grove London N5 2 AG
Research findings on young people and service access
Research about young people and services, when
and how they make contact is limited. When asked very few
young people reported direct publicity as their primary source
of information about services. Other studies identify sources
including articles or adverts in newspapers magazines, leaflets,
visiting speakers to schools or youth clubs and telephone
In 1995 the Health Education Authority (now
the Health Development Agency) commissioned Brook Advisory
Centres and the Centre for Sexual Health Research University
of Southampton to undertake a study to identify effective
pathways through which to promote sexual health services for
young people. Interviews with eighteen single-sex focus groups
of young people aged 15-21 years were conducted in urban,
semi-urban and rural areas throughout England. The participants
were selected from a range of social and demographic backgrounds
and differed in terms of sexual experience, the frequency
with which they used services and the types of services they
Know it all?
The research drew together a number of studies to confirm
that young people generally 'report a low awareness of basic
information regarding sexual health services. Where knowledge
is evident, it often consists of substantial flaws, gaps and
misapprehensions. Levels of knowledge amongst young people
appear, at best, to be insufficient and, at worst, non-existent,
and young men have less knowledge about services than women
The research findings however are often at odds
with the image young people, and particularly young men, project.
Professionals are often presented with young people who dismiss
discussing sexual health issues, saying that they have 'done
it in school'. Experienced workers are aware that some young
people present a sophisticated, knowledgeable and confident
image characterised by the 'know it and done it, got the tee
shirt' image as a front for insecurity, confusion and uncertainty.
Getting to know?
Young people identify a range of sources which inform them
about services, however the primary source of information
about sexual health services for young people is the same
as for information about sex – friends. Young people
rely upon word of mouth for information about services. Information
about a service, once on the grapevine can be hard to influence
or correct. One young person's reported experience is likely
to be influential in encouraging or discouraging others from
The HEA research reported important gender difference
in talking with friends. Young men were much less likely to
use friends as a source of advice and information, and less
likely to seek advice from sexual health services and ask
for help generally. It is important therefore that information
about services is perceived as relevant by young men.
Research reveals that young people entering and continuing
sexual relationships frequently delay seeking contraceptive
and sexual health advice. Some of these reasons are because
they are concerned about the type of service offered and also
lack of basic information about the services available.
When young people do make contact they tend
to be in crisis. The HEA research identified that young people
make an assessment of their situation or problem. Only serious
situations warrant a visit to a service and seeking professional
Young people also report that unless they are
facing a relevant practical issues at the time they are unlikely
to be receptive to information about services.
The young people involved in the HEA research
reported a high recall of visiting speakers and that this
helped make a judgement about the service.
Implications for producing information about
Directories and checklists can play a part in
countering negative stories on the grapevine by including
young people's views of the service with endorsement as well
as recommendations. Directories need to communicate a clear
message of reassurance, welcome and security regarding confidentiality.
Information about services must clearly
• Services are free and confidential
• Welcomes all young people and especially young men
• Don't have to wait until crisis
Information should be:
• Available and accessible on regular and casual basis
• In a format young people can keep, discreetly and
with out fear of embarrassment
• Linked to visiting speakers and outreach workers and
group visits to services
'Promoting Young People's Sexual Health Services' report commissioned
by the HEA and Brook Advisory Centres, November 1996