Consultation on the Pregnancy and Parenthood in Young People Strategy

Background and Rationale

Pregnancy in young people is often a cause and a consequence of social exclusion^[4] and therefore should be seen as wider than a sexual health issue or even a health issue. This strategy looks at the fundamental causes of pregnancy in young people with actions focused on how we can impact on the wider environmental and social influences and individual experiences which effect inequalities. Young people face a wide range of challenges and opportunities in their lives and therefore require support that is responsive and holistic to match their life circumstances. By using an integrated interagency approach and looking at an individual holistically, outcomes can be improved for young people, i.e. for those under 18 or still at school a Getting it right for every child (GIRFEC) approach.

Universal services, across all agencies, have an important role to play in identifying and supporting the needs of young people and these responsibilities will be strengthened through the commencement of the provisions and duties in relation to the Named Person Service in the Children and Young People (Scotland) Act 2014. The Institute of Fiscal Studies report^[5] concluded that to significantly reduce levels of teenage pregnancies you cannot concentrate on high risk groups alone. Whilst this is important, we also need a particular focus on those who are most vulnerable. This 'proportionate universalism' approach is described by the Marmot Review^[6] as being actions that must be "universal but with a scale and intensity that is proportionate to the level of disadvantage". This is the focus of actions in this Strategy.

Why young people need extra support

After the early years, the adolescence years are the next most influential period for improving an individual's outcome^[7]:

• Youth is a unique and critical period of life, a major developmental transition from childhood to adulthood.
• Young people experience key biological, cognitive, emotional and social changes which bring challenges and opportunities for both the individual and society.
• Young people who are looked-after are particularly vulnerable, it is common for them to leave their care placement at a significantly younger age than their non-looked after peers for whom the average age of leaving home is 25, and they therefore lack the family support experienced by their peers.
• Young people are prone to risk-taking and experimentation as they learn to manage new capabilities and greater freedom.
• Common patterns of risk taking behaviour start during youth.
• Young people are influenced by social, economic and cultural factors which are different to those experienced during the early years.
• Young people are tomorrow's workforce, parents and leaders. Any limitations on the potential of young people in Scotland will impact on their ability to contribute productively as citizens, family members and employees/employers.

Who is at risk of early pregnancy?

The majority of young people who become pregnant do not have specific risk factors, but these are the risk factors for those who are most vulnerable. The most vulnerable groups include, but are not exclusive to;

Young people…

• living in poverty and/or areas of deprivation
• who are looked after and accommodated and or Care Leavers
• who are, or at risk of, homelessness
• who have poor attendance at school
• who have low educational attainment
• who are disabled
• who have learning disability
• who have experienced abuse and violence
• who are in contact with the justice system
• whose parents had children under 20

Most young people have multiple risk factors which increases their chances of having children in their teenage years. It is essential that all young people are supported to be healthy, achieving, nurtured, active, respected, responsible, included and above all, safe^[8].

Why young parents need extra support

Parenthood can be daunting at any age and is often seen as a expected life event rather than a choice. Providing young people with the ability to consider their aspirations and ambitions for the future can increase their opportunities and choices; and help achieve their potential as an individual. Parents under 20 tend to have poorer perinatal health outcomes (later engagement with services, lower birth weights, higher infant mortality and higher rates of postnatal depression^[9]). The circumstances and experiences of mothers aged under 20 compared with older mothers, show that younger mothers face significant socio-economic disadvantage in terms of lower educational qualifications, lower employment levels and lower income^[10]. Young fathers have double the risk of being unemployed aged 30, even after taking account of deprivation.

Young mothers also experience poorer mental health in the first three years after giving birth than do older mothers, are less likely to breastfeed, and the children themselves are more likely to become teenage parents. Young mothers are at a higher risk of mental health issues, and postpartum depression than average, which is associated with feelings of isolation and low self-esteem. Postpartum depression, if unchecked, can have long-term consequences for both the mother and her child. In addition, a lack of support with mental health difficulties can have negative effects on parenting practices and can affect the mother's ability to bond with her child. A lack of support with daily stress, family difficulties and emotional issues can impede adjustment and the development of good coping abilities. Young mothers often experienced problems in their relationship with the father of their child; these problems sometimes led to the involvement of police, legal advisors and social services.^[11]

These disadvantages underlie many of the additional issues that young parents face. Taking action on these issues will have particular impact in addressing the inequality that exists between older and young parents^[12]. Younger mothers who exhibit child nurturing behaviours, such as reading to their child/children, promoting a healthy lifestyle and who provide a secure and stable environment have similar chances of raising children with positive outcomes as older mothers who do the same. Whilst mothers aged 20 - 24 are relatively advantaged when compared with their younger counterparts, they are still at a significant disadvantage when compared with older parents (25+). This is why this Strategy looks to support young parents aged up to 26, with a focus on those who are most disadvantaged.

Research with young fathers has shown that those who are co-parenting their children highly value the experience; however young fathers tend not to engage with health and social services as well as young mothers. This can be for a variety of reasons however; key to the progression of support to young parents will be to highlight the role of fathers both as a partner and as a father, helping them to feel welcome to engage with services^[13].

Whilst the needs of each young parent will vary and such needs should be considered on an individual basis, there are some groups that professionals should be aware of as requiring additional and likely on-going comprehensive interagency support. This may particularly include young parents who are:

• Living in social/economic deprivation
• Homeless
• Looked after
• A Care Leaver
• involved in the criminal justice system
• Not engaged with education/employment/training

These risk factors are virtually the same as those who are at risk of early pregnancy. As ever, putting the young person at the centre of any decision about their needs will enable the provision of support that is necessary and appropriate together with the young person concerned.

Aim of the Strategy

This strategy aims to drive actions that will decrease the cycle of deprivation as associated with pregnancy in many young people under 18 and provide extra support for young parents, particularly those who were looked-after up to age of 26 in line with the Children and Young Peoples (Scotland) Act 2014. For some, this may be with little or no additional support, for others this might be intense, targeted support. For all, it is essential we continue to put the young person at the centre to help them achieve their potential both as individuals and where appropriate, as parents.