Pregnancy and Parenthood in Young People Strategy

Strand 4: Parenthood in young people

Although parenthood is a positive experience for many young people, it is associated with increased risk of a range of poor social, economic and health outcomes for some. Good quality, integrated support for young parents and their families will contribute to better engagement with support services and in the longer term greater engagement in education, training and employment. This in turn will contribute to improved health and social outcomes for young parents and their children. Young parents need^[34].

• Tailored information and advice about opportunities for education, training, employment and careers, childcare, money and benefits and housing
• Individualised plans for return to education and employment which consider the wider costs and benefits of such a return (including flexible childcare)
• Advocates to help young parents approach services and/or co-ordinate cross agency support to better match young parents needs
• Interventions to reduce domestic abuse and improve relationships

Promoting positive attitudes to young parents

Young parents have expressed that one of the greatest challenges they face is the stigma and judgemental attitudes that they experience because of their age^[54]. This is from professionals, friends, peers and even from their own family. All young parents and their babies should be provided with person-centred, safe and effective postnatal care. Such care should ensure that effective communication and liaison processes are in place across agencies (maternity teams, primary care staff, health visitors and local authority services) to ensure the holistic needs of young parents are taken into account (action 4.1).

Age and pregnancy are protected characteristics under the Equality Act (2010) and therefore it is prohibited to discriminate against or treat someone less favourably than their peers. Experiencing negative attitudes is harmful to young parents and can also prevent them feeling that they can ask for help and support. Young parents told us "if I ask for help I am seen as weak and they will use it against me", "they think I'm stupid" and "they don't listen". For many young people the fear of having their child removed from their care if they are seen not to be coping or because of their previous care-history, can act as a significant barrier to seeking early advice and support.

As part of the Children and Young People (Scotland) Act 2014^[39], coordinated support through a child's plan, ensuring that both the parent (if under 18) and child have a separate plan, will ensure both needs are met. If a child is considered to be at risk child protection procedures will be instigated to protect that child and actions integrated into the holistic Child's Plan. For those whose child requires to be accommodated away from home, support should be in place to address the circumstances that led to the child being accommodated and consider what support the mother/father may require in order to cope. Careful consideration needs to be given to accommodation needs and how the young person can be positively supported, particularly in the ante-natal period, to understand the stages of pregnancy and how they can begin to prepare emotionally and practically for the arrival of their baby. For some young people who have had a care-history, becoming a parent may raise particular issues about their own upbringing and how they were parented. Professionals should be mindful of this and provide appropriate counselling / emotional support.

During our engagement work with young parents, relationships with professionals were frequently and particularly mentioned. Whilst some relationships were positive and valued, others were identified as problematic and which prevented them accessing services, "[it's] hard to build a trusting relationship with professionals in the community". Professionals working with young parents should be aware of this and consider how to adapt practice to inform and reassure potentially anxious young people. Continuing professional education programmes using local data for frontline staff should address these issues and assist in planning services to meet the needs of young people (action 4.2).

Antenatal Support and Maternity Services

For young pregnant women and their partners, maternity services are often their first experience of statutory services as a potential young parent. Young pregnant women are more likely to have complex social needs including socio-economic deprivation, current or recent experience of being looked-after, homelessness, poor engagement with education and involvement in crime. Such factors are also associated with lower levels of access to and use of services^[34]. Young parents are less likely than older parents to access maternity care early on (average gestation at booking is 16 weeks), and are less likely to keep appointments. They can feel discouraged from accessing services due to a range of factors including:

• Unfamiliarity with care services
• Practical problems making attendance at antenatal services difficult
• Difficulties communicating with healthcare staff
• Anxieties about the attitudes of healthcare staff

Young fathers specifically may not attend due to:

• not knowing about maternity services or thinking they are only for mothers
• fear of being judged, ignored or not taken seriously by health professionals
• feel embarrassed about their knowledge
• feel like they will be blamed for the pregnancy (especially if under 16)

The Refreshed Framework for Maternity Care in Scotland^[47] is designed to address all care from conception throughout pregnancy and during the postnatal phase. It aims to get maternity care right for every woman and baby in Scotland - including young mothers. A named professional in maternity services who provides continuous care through pregnancy and beyond has been shown to have particular benefits for young mothers^[34]. Some young mothers particularly value the provision of a 'link midwife'. Such support can ensure that young parents are more likely to access and maintain contact with services and have their needs met. Young mothers report that they often don't know what support services are available in their area. Statutory and Third Sector agencies should work together to inform young parents about available services and help young parents to access such services (action 4.6).

NHS services should use local data to understand numbers and characteristics of births in young women in their area and ensure that services provided are relevant and supportive to the particular needs of young mothers and fathers. By working closely with other agencies, including the Third Sector, local areas should be able to provide services that address the needs of young parents, providing them with health and social support.

Peer support can also be a valuable tool. Evidence from practice across Scotland and from young parents themselves has indicated the positive benefits that come from peer support or peer mentorship, for the parents as well as the mentors themselves. Peer mentors can provide support during pregnancy and beyond, supporting new parents to negotiate the challenges of parenthood, providing advice, support and experience.

Family Nurse Partnership (FNP) is a preventive programme for young first time mothers under 20 in Scotland^[48]. The programme offers intensive and structured home visiting, delivered by specially trained nurses, from early pregnancy until the child is two. FNP has three aims: to improve pregnancy outcomes; child health and development; and parents' economic self-sufficiency. Some young parents may be offered support through Family Nurse Partnership (FNP). For those who choose not to take up this offer, and for the general population, the Universal Health Visiting Pathway will be available. The Universal Health Visiting Pathway^[36] promotes progressive universalism but also supports communities, parents and families in need of additional support, achieving equity, addressing early identification, intervention and reducing inequalities. Health Visitors have an important role in supporting all parents. All young parents in Scotland will be supported further through the implementation of the National Parenting Strategy^[38] and the Children and Young People (Scotland) Act 2014^[39].

Support to control reproductive health and pregnancy spacing

Rapid, repeat pregnancy (i.e. within two years) is associated with an increase in adverse health outcomes, and inter-pregnancy interval of less than one year is particularly associated with preterm birth and neonatal death^[4].

Scottish data (2011) show that approximately 25% of mothers aged under 20 will have a subsequent conception within two years (with around 7% conceiving again within one year). Percentages for under 18s are similar (24.9%) however, rapid subsequent pregnancies amongst those aged under 16 are notably lower (5.9%).

Ensuring that young women and their partners understand how quickly fertility returns after giving birth, and have access to contraception post-partum, will help young mothers to control their reproductive health (action 4.3). Contraception should be discussed with young women and their partner in the antenatal period to enable them to consider their options, and whether contraception post-partum is acceptable to them (action 4.4). Their preference should be recorded in their notes, and where acceptable/feasible, contraception should be provided prior to discharge from hospital^[42]. Whilst vital, provision of post-partum contraception is not the only intervention to help young women and their partners avoid unintended rapid repeat pregnancy. Enabling young mothers to stay/re-engage in education, attend college and find fulfilling employment are important interventions for helping to address family spacing.

Education, training and employment

The Scottish Government is committed to ensuring that all young people achieve their potential, and are able to access learning, training or work. For most young people, S4 is the last compulsory year of schooling. Through Opportunities for All^[43], all young people aged 16 - 19 are entitled to an appropriate offer (or more than one offer if necessary) of learning or training. This applies equally to young parents, as to all young people, and is particularly vital for ensuring that young mothers and fathers are enabled to build a future for themselves and their families. The entitlement to support from a Named Person under the Children and Young People (Scotland) Act 2014^[39] should help many young people under 18 obtain the advice, support and help that they need to secure appropriate and desirable education, training and employment.

Career and educational interventions are particularly appropriate to the needs of young parents as they improve access to relevant and tailored information about options. They also raise the employment and career aspirations of young people, increasing positive long term outcomes for themselves and their families.

Young mothers and young women who become pregnant should be supported to remain in school or college until at least 18 years of age, where they should be able to access education that fits with their skills and aspirations (action 4.8). Flexible and appropriate childcare is central to this and evidence suggests that those programmes with support for childcare (both education and career development) are the most effective.

It is vital that young parents have a positive educational experience as their child will be entering the education system within four years. There is good evidence that such experiences and values are passed from generation to generation. A whole family approach to increasing educational aspiration is also important as a mother's low educational aspirations for her daughter aged 10, is a risk factor for pregnancy before 18. For those young women (and their partners) who become parents whilst of school-age, a positive school environment is essential in allowing them to remain in education.

In the first instance, both before and after the birth, young people should be encouraged to remain in their own school where they have established relationships with teachers and peers and have a chosen course of study. Local Authorities should develop guidance for schools to ensure that support and planning processes are in place to allow this to happen (action 4.9).

Where a young person cannot or will not re-engage with their current school, alternative learning provision needs to be identified. In some areas there is the option to attend a school that has an integrated young parents' support base on-site. Currently, Scotland has three such schools where young mothers can access education with on-site childcare and parenting support;

• Smithycroft High School, Glasgow
• The Wester Hailes Education Centre, Edinburgh
• Menzieshill High School, Dundee

These centres are situated in areas where higher than average rates of young parenthood enable such centres to be established. This Strategy does not recommend such models as the only option, and services need to be planned dependant on local circumstances and need. However, it is strongly recommended that young mothers are actively enabled to stay in the school of their choice (some may wish to stay at their local school and not to go to a unit for young mothers or may chose an alternative one to fit their circumstances) and that across Scotland, Local Authorities consider the most appropriate model of childcare for their young people.

Evidence suggests that a focus on employment and provision of jobs and higher earning for young mothers is associated with improved long-term self-sufficiency. There is no published data currently as to how many young mothers remain in education, training and employment, but our ambition is that no young mother has to leave education, training or employment as a direct consequence of a pregnancy.

A focus on young fathers continuing with education/training is important given their high risk of later unemployment. Services report that once they find out they are becoming a father, young men often feel they should bring money into the family and drop out of education. Often this means entering low paid work which then contributes to family and child poverty.

Childcare funding

Where young women have expressed a desire to remain in their current school, flexible childcare is essential for the young women to finish their education (action 4.10).

Colleges are allocated childcare funding annually by the Scottish Funding Council (SFC) as part of college student support funds. This funding has two elements; the Lone Parent Childcare Grant (LPCG) and the Discretionary Childcare Funds. Young parents have identified that accessing funding for childcare when in college can be challenging. Work will be undertaken to provide information to young parents on the funding which will help them to complete their time at College. This information should be provided to young parents locally via statutory and Third Sector services.

The Children and Young People (Scotland) Act 2014^[39] has increased, early learning and childcare entitlements. From August 2014, children are eligible for 600 hours/ year (the equivalent of around 16 hours/ week during term time) early learning and childcare. Once a child becomes entitled to early learning and childcare, they will stay entitled even if their parent becomes employed, or their situation with parent or carers changes.

Housing

Pregnant young women and young mothers make up about one in twenty of all applications for housing and homeless assessments in Scotland^[35]. For young people, leaving home is associated with greater autonomy and freedom to act as they choose^[3]. For some young parents, particularly those of a younger age, staying in the family home offers a secure environment for parent and child. However, for many young parents (be they as lone parents or as a couple) independent living enables them to develop self-efficacy and skills they require. They often need help and support to learn independent living skills. Secure, permanent housing that is situated in their community is essential in enabling young parents to build a network of support and to provide a positive family environment for themselves and their child/children.

In Scotland, all those assessed as unintentionally homeless by local authorities are legally entitled to settled accommodation. A person should be treated as homeless even if they have accommodation, if it would not be reasonable for the person to continue to occupy it (for example, if it is an unsuitable environment for a family or pregnant woman).

The Scottish Government is working with partners from local government, health and the Third Sector to put in place policies, guidance and legislation to prevent and alleviate homelessness and to ensure that every homeless person is able to receive information, advice and support according to their needs. For Corporate Parents involved in housing and homelessness, this follows earlier work on the guidance on Housing Options Protocols for Care Leavers^[40]. This will continue to be a good practice tool and will be refreshed in light of the provisions in the 2014 Act.

Young pregnant women / young parents may not always understand how to access housing "I went down the homeless route but I did not have the right information or support when I went through it" and thus should have the help and support they need to understand their rights in this area (action 4.5).

Income Maximisation and Support

Young mothers under 20 are considerably more reliant on state benefits and tax credits than older mothers - a position that remains the case as the child ages^[3]. Through our work with young parents, it is clear that many find accessing the welfare and income to which they are entitled confusing and difficult.

On-going work in the Scottish Government to ensure income maximisation will be essential in providing support for young parents. However, it is clear that the situation that young parents find themselves in is extremely complex, and depends on a variety of personal circumstances. In light of this, the Scottish Government will work with professionals and young parents to build resources to provide the information they need in the language and media they prefer and understand (action 4.7).

Overview of actions:

Parenthood in young people
Link to short term outcome: Young parents have increased knowledge about local services and are confident using them
4.1	Ensure everyone working with young parents communicate effectively, across multiple services, putting the young parent(s) and their needs at the centre.	Community Planning Partnerships
4.2	Use local data to understand local population and ensure the provision of local services are relevant to the needs of young parents.	Community Planning Partnerships
4.3	Understand more comprehensively the factors that may have influenced a rapid subsequent birth.	NHS Boards
4.4	Ensure all pregnant women aged under 20 are consulted about their contraception preferences antenatally and that these preferences are provided early in the post-natal period.	NHS Boards
4.5	Local data is used to map if young parents have the health and support they need to ensure relevant and secure housing appropriate to their need.	Community Planning Partnerships
4.6	Agencies (national and local) webpages aimed at young people or young parents have information on support for young parents around social and health needs.	Local Authorities Third Sector NHS Boards
4.7	Develop a resource for young parents which provides up to date information and support on accessing welfare and includes help and support to understand their housing rights.	Scottish Government Local Authorities Third Sector NHS Boards
Link to short term outcome: Young parents are supported to stay in education, training or employment
4.8	Assess that all young parents' choice to continue in education is supported and in an appropriate education setting.	Community Planning Partnerships
4.9	Local Authorities should develop guidance for schools to ensure that support and planning processes are in place to allow young people who become pregnant to remain in their own school.	Local Authorities
4.10	Educational and training agencies can demonstrate acknowledgement of the impact of parenting and support flexible childcare for young parents staying in education, training and employment.	Local Authorities Third Sector NHS Boards