Teenage Pregnancy and Possible Strategies to Prevent It - Research Proposal Example

Teenage Pregnancy In The UK And Possible Strategies To Prevent It Table of contents Sl no Particulars………………………………………………………… Page 2 Chapter 1 Introduction 3 1.1 Aims and Objectives 4 Chapter 2 Literature Review 4 2.1 Possible causes 4 2.2 Need for School based education 5 2.3 Strategies for reduction 6 2.4 Second Birth 7 2.5 Primary level efforts 8 2.6 Government initiatives 8 2.7 Family support 9 2.8 Cultural or health problem? 10 2.9 View of a voluntary organisation 10 2.10 Conclusion 10 Chapter 3 Research Methodology –Research Design 11 3.1 Aims and Objectives 11 3.2 Sources of information 11 3.3 Inclusion and Exclusion Criteria 12 3.4 Data Extraction System 12 3.5 Quality Assessment System 12 3.6 Expected outcomes 12 3.7 Conclusion 12 Chapter 4 Conclusion 13 References 14 Availability of information 16 Abstract Teenage pregnancy and its prevention in the U.K. have been engaging the attention of the Government and International agencies as a factor affecting the youngest productive population of the country. A brief literature review conducted for the dissertation proposal has brought to the fore several issues underlying the problem. Teenage pregnancy should be avoided for all its negative outcomes to both the mothers without fully matured bodies and babies born to ill nourished mothers. They are bound to be a heavy burden to themselves and to the society because unprotected sex is vulnerable to sexually transmitted infections and HIV/AIDS infection which are fatal. It is for these reasons a policy was evolved in early 1990s to reduce the rate of teenage pregnancies progressively and to reduce it by at least half by the year 2010. The brief literature review shows teenage pregnancies do not show any signs of abating and the problem is exacerbated by the tendencies of the teenagers giving a second birth before they reach 20 years. There are also fears that babies born to teenage mothers will themselves become teenage mothers due to built-in culture developed over generations. Systematic literature review is the sole research methodology adopted for the dissertation. The above results of literature review conducted justify a detailed secondary research further on the issue of teenage pregnancies in the U.K. Key words- UK -Teenage pregnancy- adolescence- contraception- strategies- prevention Research Proposal Teenage Pregnancy In The UK And Possible Strategies To Prevent It Chapter 1 Introduction, This proposal is for a dissertation as part of the researcher’s B.Sc. Health field curriculum at the University of East London at the end of the degree in level III. The chosen topic is “Teenage Pregnancy In The UK And Possible Strategies To Prevent It” on which the researcher is required to make a systematic literature review as a secondary research. Teenage pregnancy worldwide is causing concern as it is associated with girls’ health mostly as unwed mothers susceptible to mortality as child bearers at the adolescent age without full grown body and HIV and Sexually Transmitted Infections (STI) Half the world population comprises of people, less than 25 years of age. People between the ages 10-19 are adolescents. The adolescents in their second decade of life contract STIs, HIV/AIDS more than any other age group. This target population is the hope for governments to substantially reduce the incidence of the said diseases. Only a very few countries have achieved limited incidences of STIs and HIV mainly by teaching their adolescents safe sexual practices. Among U.S., Canada, France and the U.K., the U.K. has the highest percentage (69%) of teenagers not using contraceptive pills, injectables, implants and intrauterine devices during their sexual activity.(Bearinger, Sleving, Ferguson and Sharma,2007) Teenage pregnancy not only affects mother and child but also affects community. One way of avoiding pregnancy in teenagers is encouraging them to use contraception rather than abstinence. WHO literature says that due to contraceptive uses during the periods between 1991-2000, teenage pregnancies have declined by 27 % in developed countries including the U.K. Teenage pregnancy gains significance because adolescent sexual behaviour is associated with increased incidence of pelvic inflammatory disease, infertility and ectopic pregnancy etc. The decline of 27 % is a small achievement and the literature indicates that newer preventive methods against both pregnancy and STIs are not likely to be developed in the near future. Hence it becomes all the more essential that existing intervention measures should be intensified. (French and Cowan, 2009) The dissertation will examine causes of teenage pregnancy and strategies to prevent its incidence in the U.K. in order to overcome the negative health, economic and social outcomes associated with it. 1.1 Aims, Objectives In view of the problem of teenage pregnancy seen above, aims and objectives of the proposed dissertation are (more detailed under methodology) a) Trace the history of incidence of teenage pregnancies and causes and consequences of teenage pregnancy world wide in general and U.K. in particular. b) Measures undertaken to prevent the incidence of teenage pregnancy in developed countries with special emphasis on the U.K. c) Creating bench mark for preventing it totally with positive outcomes. Chapter 2 Literature Review 2.1 Possible causes In early 1995, Lancet dt March 4, 1995 carried a few letters in response to its earlier editorial in January on abortions in Romania where there were no birth control measures available for women. One letter to the editor from Margaret Thomas, St Michael’s Hospital, Litchfield, Staffordshire, UK said that unwanted pregnancies were bound to occur in spite of availability of ideal family planning services due to nature of human sexual behaviour and for that reason that no contraceptive could be foolproof. At the time, 1 in 5 pregnancies was being terminated in the U.K. irrespective of age groups as against 1 in two for women under 20. Services for abortion were not of high priority since unwanted pregnancies was not even in the curriculum of doctors, nurses and other health professionals despite legalisation of abortion in U.K. in 1967 itself. Three cases the letter reported to Lancet were quite indicative of unintended pregnancies beyond one’s control. A single mother under 20 with one child already by mistake, conceived again but had not the required funds of £ 150 to terminate at a private clinic. After some failed attempts to raise money, she decided to end the pregnancy herself by a crude method of overdosing herself with paracetamol in order to induce abortion. Fortunately her friend helped her approach family planning clinic of the NHS where she got her abortion done without difficulty and without any cost. In another case, a teenager conceived despite consuming oral contraceptive pills. She had been experiencing withdrawal bleeding which she mistook as normal and had not been aware of pregnancy. The NHS family planning clinic insisted she should have the baby as it was too late. But she had the abortion at a private clinic funded by NHS. The third case relating a teenage girl who wanted to end her 14-16 weeks pregnancy. Since she used to have long cycles, she had no idea of her pregnancy. Again this was refused to be done by the NHS clinic and she had no money to foot the bill at a private clinic. Fortunately a private clinic funded by NHS came to her rescue. The letter said that the three cases displayed the power of imbalance between the said women and the service providers who were lacking the required will, though it was the policy of the British Medical Association for doctors unwilling to conduct abortion for ethical reasons to refer the patients to others who were ready to terminate. Besides, in spite of Royal Commission’s recommendation way back in 1980 to fund at least 75 % of the terminations, NHS had not funded even to the extent of 30%. (Thomas, 1995) 2.2 Need for school based sex education Even after several years, UK still finds it difficult to contain teenage birth rate which is the highest in western Europe. (UNICEF, 2001) Lancet is reported to have recommended to learn from the experience of other developed countries having lowest teenage births where there is school based sex education including making available contraceptives and teaching teenagers about post coital methods and letting them have abortion services. (Wilkinson et al, 2006 & Narring et al, 1996) 2.3 Strategies for reduction U.K. planned to duplicate these efforts in order to reduce the teenage pregnancies by 50 % by the year 2010. With this aim, the project to recruit teenage parents was funded as early as in 1999. The result was, teenage conceptions which were at their highest in 1998, fell by 3.2% in 1999-2003. Abortions increased by 7.5%. Birth rates reduced by 10.6%. The Lancet report claimed these data showed a positive trend towards achievement of the national strategy on teenage pregnancy.(Galavotti and Green, 2006) In U.K., there are socially deprived areas and new deal community (NDC) areas where teenage pregnancy rates are twice as high as national average which is a worrying factor. Every year 90,000 teenagers turn pregnant and about of 8,000 of them are under 16. This indicates that teenage mothers drop out of school and they are unlikely to find good jobs. They will remain single mothers and live in poverty for the rest of their lives. Besides they will live in poor health and their children run the risk of becoming teenage mothers themselves. While other European countries have shown better results in containing teenage pregnancies, U. K’ s record is the poorest of all the countries in Europe. The NDC areas prone to teenage pregnancies are considered to have developed a built-in culture of teenage pregnancies for several generations. Four such areas selected for case studies were East Manchester (Beswick and Openshaw), Derby (Derwent), Nottingham (Radford and Hyson Green), and Knowsley (North Huyton) In East Manchester areas, people complained of housing and crime problems rather than health issues and problems of teenage pregnancy. It did not reflect as a community problem and remained at individual levels. The teenage pregnancy coordinator connects with other key service providers in the area and work towards achieving the following objectives. (Blank, Goyder and Peters, 2003) “Better education about sex and relationship in schools, involving parents in prevention, effective advice and contraception for young people, prevention work for those most at risk, access to training and education, support for teenage parents and housing for teenage parents” (Blank, Goyder and Peters, 2003) Main findings of the above said case studies are that many NDCs have the objective of reducing teenage conceptions, teenage pregnancy does not appear to be an issue in these areas attributed to the built-in culture for several generations, services must be delivered locally as the community members are not likely to travel to receive any help or support, prevention strategies should be by giving the community members improved access to services and give them information regarding contraception provisions and other information without pre-judgement, there has been slow progress in the evaluation projects for teenage pregnancy prevention, funding of voluntary sector should continue for a continuous engagement with the communities who may not be trusting Government agencies, and the short term nature of projects funding do not give sufficient motivation for the NDC staff and lack of community buildings in the NDC areas act as barriers for sustained implementation of prevention strategies. (Blank, Goyder and Peters, 2003) 2.4 Second birth Collier (2009) states that there are teenagers having second birth before the age of twenty but their number is difficult to be ascertained. However national abortion statistics is the only way of finding the number of teenagers presenting for repeat pregnancy. The study of Collier has concluded that repeat teenage pregnancies are evident enough and hence contraceptive advice must be intensified and the teenagers with previous conception record must be targeted. The study says that teenage pregnancy and abortion rates do not show any signs of abating in U.K. This is attributed to unplanned pregnancies bound to end in abortions. Teenagers once conceived are eight times more likely to conceive again than other teenagers. The Department of Health has found that teenagers giving birth at the age of 17 and 18 years happen to deliver their second babies. Figures show that abortions by under-20 women have increased from 36,728 in 1991 to 43,995 in 2007. And 5067 of the figure for 2007 has the history of previous birth. (Collier 2009) 2. 5 Primary level efforts As early as in 1999, Scally wrote in Lancet that achievement of the goal of reducing pregnancies by half by the year 2010 depended upon the efforts at local level. The above said report of 2003 has indicated the goal is not likely to be achieved. Scally says that even the high income area of England have high rates of teenage pregnancy. Quinilvan, Box and Evans (2003) say that teenage pregnancies in the U.S and U.K. have some what stabilised and not been declining and that the £ 540 million Sure Start programme of the U.K intended for home visits within 3 months of birth has already begun but the trials have found such visits have not been effective in bringing out clinical outcomes. The authors suggest that instead of one home visit, five home vists should be made at high risk mothers and that instead of para professionals, nurses should be made to participate in home visits. 2. 6 Government’s initiatives Latest post by the Department of Health, UK on 26 February 2009 says that £ 20.5 m package has been allotted for promoting contraception targeted at areas with high pregnancy rates. An extra £ 20.5 million will be spent for young people gaining access to contraception and creating awareness among them regarding high risks of unprotected sex. It says that data for 2007 showing high rates of teenage pregnancy is due to conceptions ending in abortions rather than in births. It also says vigorous implementation would show results as happened in Oldham where teenage pregnancy rates have dropped by 29 %. Government wants this to be replicated across the country. However the worrying factor is new teenagers enter every year with pregnancies undoing the efforts achieved with existing teenagers discouraging them from having repeat pregnancies. In this connection, Government have also announced that a compulsory sex and relationship education (SRE) will be brought in schools by September 2009. Ten key factors have been identified for successful prevention of teenage pregnancies. They are, 1) parents should be advised to talk to their children openly about sex relationship and sexual health, 2) SRE implementation in school with coordination of local authorities, 3) publication of high standard regarding contraceptives and sexual health related advice, 4) making local authorities accountable, 5) advising young people to resist peer pressure for an early sex and for using contraception on becoming sexually active, 6) strongly focussing on young people with the greatest risk coming from the group of Looked After Children and those who leave carers., 7) SRE training in connected organisations apart from schools, 8) making use of local data to identify high risk teenagers, 9) giving support to young people with low self-esteem and help them have higher aspirations and 10) A youth service to address important issues of sexual health and substance misuse. (More cash for contraception) 2. 7 Family support As regards the role of family support to teenage mothers, a study says American experience is equally applicable to Britain also. In America, teenage mothers are retained at their parents home where their mothers and grand mothers take care of them and the babies. The teenage mothers feel trapped at their homes and also feel they remain burdensome to their mothers and grand mothers. On the other hand, partner’s support is totally absent. (Bunting and McAuley, 2004) As part of the above ten key factors for prevention of teenage pregnancies, “The Teens and Toddlers Programme” of the Government aims at youth development by raising their self-esteem, aspirations and educational goals. The programme is already functional in 13 boroughs in England. Through this programme, young people with children are given a sense of responsibility with privilege of having to rear a child and helped to develop alternative goals to find work and relationships. They are made to acquire positive opinion of themselves through work experience and by having one to one relationship with a small child. (Cater, 2008) 2. 8 Cultural or health problem? Analysis of researches conducted on teenage pregnancy shows that researches from the U.S.A and U.K. found teenage pregnancy differently. Out of 36 research papers analysed, majority of them from the U.S.A. treated it as a cultural problem and those from the U.K., as an economic problem. Few others from the U.S.A viewed it as a welfare expenditure problem, while the U.K. papers saw them as a health issues. (Bonnel, 2004) One particular study though not in the above study, views it as both a health and social problem. It points out that U.K.’s official statistics only gather data on teenage pregnancy and not on teenage mothers. This study says there were about 30,000 teenage mothers in 2001 in U.K. It urges that statistics should include teenage mothers too as otherwise the twin policy halving the pregnancy rates by 2010 and reducing their social exclusion as teenage mother will not be meaningful. (Shaw & Lawlor, 2007) 2. 9 View of a voluntary organisation Brook is a national voluntary organisation started in 1964 mainly for providing free and confidential sexual health advice and services for young people under 25, says that open acceptance of teenage sexual practices, sexual education and easy access to contraceptives alone can contribute to reduction in teenage pregnancy as achieved by other countries. It attributes poverty, deprivation, low education and low self esteem are the contributing factors for high rates of teenage pregnancy in the U.K. (Brook) 2.10 Conclusion The above brief literature review gives a birds eye view of teenage pregnancy in the U.K. It should be seen as a problem requiring more serious attention keeping in view its negative long term impact on health and well being of future generation. Chapter 3 Methodology-Research Design Systematic review of literature has been adopted for the study on prevalence of teenage pregnancy in the U.K. and strategies for its prevention. This is a kind of secondary research aimed at extensive coverage of the subject in the absence of own primary data. Articles, trials in the field of medicine and nursing in the leading academic journals mainly of the U.K. such as Lancet, Contraception, British Medical Journal and other scholarly journals sponsored by leading publications of Science Direct, Sage Publications, and Willey Interscience etc will form part of resources earmarked for the study. It will also be ensured they are peer reviewed and have no conflict of interest with the authors. 3.1 Aims and Objectives of the study being, a) Trace the history of incidence of teenage pregnancies and causes and consequences of teenage pregnancy world wide in general and U.K. in particular. b) Measures undertaken to prevent the incidence of teenage pregnancy in developed countries with special emphasis on the U.K. and to examine whether they are valid and what are the deficiencies present and how they can be removed and c) Creating bench mark for preventing it totally with positive outcomes. This is not to set a tentative target which is the outlook for policy makers but to predict the possible levels of teenage pregnancy beyond 2010. 3.2 Sources of information Articles, trials in the field of medicine and nursing in the leading academic journals mainly of the U.K. such as Lancet, Contraception, British Medical Journal and other scholarly journals sponsored by leading publications of Science Direct, Sage Publications, and Willey Interscience etc will form part of resources earmarked for the study. It will also be ensured they are peer reviewed and have no conflict of interest with the authors. 3.3 Inclusion and Exclusion Criteria Teenage pregnancy was recognised as a major problem in 1990s and the data that happen to have been collected from 1995 are purely incidental and not due to any exclusion criteria for ignoring data prior to the year 1994. It will be worthwhile if earlier data becomes available later for the actual dissertation. Similarly, information on teenage fathers and even older males and comparative data from other countries have not been deliberately excluded. These data also will be considered for the main dissertation since lessons can be learnt from the experience of other countries as also the attitude of teenage and older males (fathers) very much relevant for the prevalence of teenage pregnancy. Hence there is no purposive exclusion adopted since every bit of information regardless of time will add to the knowledge. 3.4 Data Extraction System Data extraction system will be made available for the main dissertation. At this proposal stage, it may not be essential. 3.5 Quality Assessment System As no primary or secondary data studies are conducted except systematic literature review, quality assessment system in the format prescribed is not applicable. However, a suitable system will be formulated to justify the quality of the literature reviewed in the main dissertation. 3.6 Expected outcomes The proposed study not being a primary data research but only a systematic review of the literature, expected outcomes will not be original. Moreover, this being a proposal, outcomes will not be conclusive one but only an indicator for the expected results. 3.7 Conclusion The systematic literature review would be sufficient enough to go to the root of the problem and addressing it for positive outcomes as the studies concerned are all comprehensive each with different outlooks having undergone collection of primary data and statistical testing. Chapter 4 Conclusion This brief literature review of teenage pregnancy and teenage motherhood outlines causes, preventive and reduction measures taken. It justifies a full fledged study by systematic review of literature available on the problem so that syntheses of various researches with different outlooks would make a comprehensive study to serve a reference for tackling the problem in the near future. The only bench mark of halving the pregnancy rates by 2010 by the policy makers rather than totally avoiding it by any other date indicates the enormity of the issue and this makes it even more compelling to proceed with the study. References Bearinger H Linda, Sleving E Renee, Ferguson Jane and Sharma Vinit. (2007) “Global perspectives on the sexual and reproductive health of adolescents: patterns, prevention, and potential”, Lancet 369: pp.1220-31 Blank Lindsay, Goyder Elizabeth, Peters Jean. (2003) “Research Report No 7, Teenage pregnancy prevention initiatives in the New Deal Communities” Bonnel Chris. (2004) “Why is teenage pregnancy conceptualized as a social problem? A review of quantitative research from the USA and UK”, Culture, Health & Sexuality, May-June, vol6 (3) pp.255-272 Brook, “Policy and research, Brook’s position of teenage pregnancy”, Available fromhttp://www.brook.org.uk/content/M6_4_teenage%20pregnancy.asp[Accessed on 15 April 2009] Bunting Lisa and McAulay Colette (2004) “Research Review: Teenage Pregnancy and motherhood: the contribution of support”, Child and Family Social Work, 9, pp.207-215 Cater Suzanne. (2008) “The Teens and Toddlers programme: an innovative and practical youth development and teenage pregnancy prevention programme aiming to raise self-esteem, aspiration and educational attainment”. Education and Health, vol 26(1) Collier Jacqueline (2009) “The rising proportion of repeat teenage pregnancies in young women presenting for termination of pregnancy from 1991 to 2007, Contraception” Vol 79 pp.393-396. French S Rebecca, Cowan M Frances, (2009) “”Contraception for adolescents, Best Practice & Research Clinical Obstetrics and Gynaecology, Vol 23, pp.233-247 Galavotti Christine and Green Dianne. (2006) “Comment, England’s national Teenage Pregnancy Strategy” vol 368, Nov 25. More cash for Contraception. February (2009) Department of Health, Available from [Accessed 15 April 2009] Narring F, Michaud P.A, Sharma V. (1996) “Demographic and behavioral factors associated with adolescent pregnancy in Switzerland”. Fam Plann Perspect, Vol 28: pp 232-36 Quinlivan A Julie, Box Helen, Evans F Sharon. (2003) “Postnatal home visits in teenage mothers: a randomised controlled trial”, Lancet Vol 361, pp.893-900 Scally Gabriel (1999) “Tackling teenage pregnancy in the U.K”. The Lancet, June 26, vol 353, p 2178 Shaw E Mary & Lawlor A. Debbie. (2007) “Why is teenage pregnancy conceptualized as a social problem? A review of quantitative research from the USA and UK” Critical Public Health, December, Vol17 (4):pp.311-316 Thomas Margaret (1995) Letter to the Editor, The Lancet, March 4, Vol 345, p 587 UNICEF (2001) “A league table of teenage births in rich nations. Innocenti report card no 3. Florence: UNICEF Innocenti Research Centre”. Wilkinson P, French R, Kane R et al. (2006) “Teenage Conceptions, abortions, and births in England, 1994-2003 and the National Teenage Pregnancy Strategy” Lancet, 368: 1879-86. Availability of information Running head First author Journal Publication year Study 1 Global perspectives on the sexual……. Bearinger H Linda Lancet 2007 2 Contraception …. French S Rebecca Best Practice & Research Clinical Obstetrics and Gynaecology 2009 3 Letter to the Editor Thomas Margaret Lancet 1995 4 A league table of teenage births…. UNICEF A league table of teenage births 2001 5 Teenage Conceptions, abortions…… Wilkinson P Lancet 2006 6 Demographic and behavioral…… Narring F Fam Plann Perspect 1996 7 England’s national Galavotti Christine www.the lancet.com 2006 8 Teenage pregnancy prevention..... Blank Lindsay Research report 2003 9 The rising proportion of …..repeat Collier Jacqueline Contraception 2009 10 Tackling teenage pregnancy Scally Gabriel Lancet 1999 11 Postnatal home visits in…… Quinlivan A Julie Lancet 2003 12 More cash for Contraception Website nds.coi.gov.uk Department of Health 2009 13 Research Review: Teenage Pregnancy…… Bunting Lisa Child and Family Social Work 2004 14 The rising proportion of repeat teenage… Cater Suzanne Education and Health 2008 15 Why is teenage pregnancy…… Bonnel Chris Culture, Health & Sexuality 2004 16 Why is teenage pregnancy….. Shaw E Mary Critical Public Health 2007 17 Brook’s position of teenage www.brook.org.uk Brook ….. Read More