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The knowledge exchange

4 July, 2013

The knowledge exchange

Alison Hadley talks teenage pregnancy and the issue of sex and relationship education with Hollie Ewers.
Midwives magazine: Issue 4 :: 2013

Alison Hadley talks teenage pregnancy and the issue of sex and relationship education with Hollie Ewers.

Alison Hadley 2

The topic of sex education often creates shock-inducing headlines such as ‘sex lessons for five-year-olds’ and ‘free condoms for 13-year-olds’. But a recent inquiry by the Scottish Parliament suggested that sex education at a younger age and free contraception for people as young as 13 are what is needed to bring down Scotland’s high teen pregnancy rates. One woman who couldn’t agree more is Alison Hadley.

‘The evidence behind reducing teenage pregnancy rates and improving young people’s sexual health is really clear,’ she tells Midwives. ‘You need comprehensive relationships and sex education from a young age – primary school level – combined with easy access to contraception services for teenagers if and when they choose to have a sexual relationship.’

Alison is the director of the Teenage Pregnancy Knowledge Exchange at the University of Bedfordshire. Prior to this she had led the implementation of the previous government’s Teenage Pregnancy Strategy for England. This strategy reduced the under-18 conception rate by 34% to the lowest level for 40 years, and also helped improve maternity and postnatal support for young parents.

‘The teenage pregnancy rates for England have been historically very high with no downward trend, so the last government decided to take a comprehensive look at the issue and developed a 30-point action plan, which was the Teenage Pregnancy Strategy. In my opinion, the goal and the decision to have a concerted effort over that 10-year period was absolutely key to the strategy’s success.’
Alison believes so firmly in the strategy that it forms the crux of the Teenage Pregnancy Knowledge Exchange at the university, which provides teaching input about teenage pregnancy on numerous courses, including midwifery.

‘Understanding teenage pregnancy policy and practice is relevant to many of the faculty’s undergraduate and postgraduate courses I’m teaching on. The aim is to build upon the success of the Teenage Pregnancy Strategy and ensure lessons are learned and transferred to new leaders and commissioners and embedded in the training of relevant practitioners.

‘The most important thing for me is to help make students understand why teenage pregnancy matters, what the data says, why young parents and their children are more at risk and the health, emotional wellbeing and economic outcomes.

‘It’s a combination of providing a lot of information from research and sharing practice to make students understand how important this group is and then linking them to local services, so that when they actually start practising, they’ll be able to work in a multi-agency way with other services in their patch.’

A whole systems or multi-agency approach is what Alison believes is crucial to tackling teenage pregnancy and is what helped with the strategy’s accomplishments. ‘We understood quite early on that no one agency or service was going to have an impact on its own. You have to have schools working effectively, local contraceptive services well-publicised and youth workers and health practitioners have to be well-trained and confident to talk about the issues.’

She continues: ‘Different services are dealing with different aspects of care. You can have a fantastic maternity service with really good antenatal care and get someone to the point at which they’re being handed over to a health visitor and children’s centre, but if that handover doesn’t go well, young parents can fall straight through the gap.’

This point was recognised in the serious case reviews published by Ofsted a couple of years ago called Ages of concern (Ofsted, 2011), which looked at babies dying under the age of one, over a six-year period. The report revealed that both teenage mothers and fathers and their children were disproportionately represented, partly because they fell through the gaps between the different services.

For Alison, the aim of improving the outcomes for teenage parents and their children in similar situations to those mentioned in the Ofsted report was a really important factor of the strategy. ‘What I really welcomed was that where previous attempts to cap the rising teenage pregnancy rate in England had only focused on prevention, the Teenage Pregnancy Strategy also aimed to improve outcomes for teenage parents and their children.’

Through the pilot programme Sure Start Plus, the strategy team understood the key ingredients of successful support, one of which was to have a dedicated support worker, from booking in onwards.
‘We made sure there was always somebody working closely with a young parent; someone they could turn to for advice and support, and that started in the maternity service often with a specialist teenage pregnancy midwife. We realised it was very important for teenage parents to trust the antenatal service they were going to, especially young fathers, who often said they felt excluded.’
When considering maternity services, Alison recognises the strain midwives are under. ‘Resources are tight in the areas I’ve visited recently. There’s a shortage of midwives and their time is very stretched, which can cause problems because teenage parents – particularly the more vulnerable ones – need that dedicated support worker. If they don’t have somebody who they trust, then problems can escalate.

‘There are some fantastic midwives out there still doing specialist work with young parents, but what needs to happen is for commissioners to understand the importance of this and make sure that the rest of the midwifery team has sufficient training and support to do a really good job too.’
Alison adds that an example of good practice from the midwives she has met includes discussing contraception options with teenage parents during the antenatal period.
‘We’ve learned that you can’t leave the question about contraception until the postnatal ward. Young mothers need to have that choice sorted before the baby’s born, so that they can start using the method immediately.

‘What can happen is young parents go home and they’re told that they’ll have a chat about contraception at the postnatal check-up but, before they get there, they’ve had unprotected sex, and sadly we know that second babies born to teenage mothers are at a much higher risk. So delaying the second pregnancy until the young parents are coping is imperative. Getting the contraception decision sorted during the antenatal period is really important.’

Looking to the future, Alison wants to be involved with more research to help improve services, covering prevention of teenage pregnancy and support for young parents.

‘I want to build the Knowledge Exchange into something that is useful and an asset to the university – giving the students high-quality information and knowledge so they go on to be excellent practitioners in their local areas.

‘My main aim is to retain a national source of information and advice around teenage pregnancy and to confer the learning that we’ve collected over the 10 years, so that it’s built upon to make further progress.’

As for the goal to reduce England’s teenage pregnancy rate, Alison admits there is still more to do. ‘The job is not yet done. In terms of where we want to be on teenage pregnancy, we’re about two-thirds of the way towards our original ambition to bring the rate down to the Western European levels. So it’s critical that we stick on the journey and build on the progress made to try to achieve our original aims, and that includes changing the disproportionately poor outcomes for young parents and their children.’

Alison is keen to hear from midwives with examples of effective practice. Email: alison.hadley@beds.ac.uk

All about Alison
► Trained as a nurse at Middlesex Hospital and worked as a health visitor in Brent from 1980-82
► Started at Brook in 1983 as a family planning nurse and was the national policy manager when she left in 2000
► Worked for the government in the teenage pregnancy unit from 2000-12
► Received an OBE for services to teenage pregnancy in the New Year’s Honours, 2010
► Received an honorary fellowship, UK Faculty of Sexual and Reproductive Health – RCOG, 2010
► Started her role at the University of Bedfordshire in February 2013.


Ofsted. (2011) Ages of concern: learning lessons from serious case reviews. Ofsted: Manchester. See: www.ofsted.gov.uk/resources/ages-of-concern-learning-lessons-serious-case-reviews (accessed 5 July 2013).

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