In Hull, teenage pregnancies have reduced by 35 percent over the course of the life of the 12-year strategy. Ordnance Survey digital maps were used to plan its contraception and community-based services as well as increasing the targeting and impact of services.
Just over a decade ago, national statistics singled-out Hull as having one of the highest teenage pregnancy rates in the country, with 384 reported pregnancies among females below 18 years of age in 1998 – equating to a rate of 84 per 1 000 conceptions. The statistics made grim reading, being almost twice the national average. Repeat pregnancies among teenage girls were also high; over 20 percent of all under 18 conceptions – again, well above national figures. Teenagers in the city were failing to heed warnings about under-age sex and local policymakers agreed that new action was needed to tackle the problem.
On the back of a government strategy to reduce soaring numbers of unplanned pregnancies among teenagers nationally, Hull City Council launched an initiative with Hull Primary Care Trust (PCT) to cut rates locally, focusing on improving sex education and increasing access to contraception services through mapping. With 20 out of 22 wards in Hull recording higher than average levels of deprivation – often an indicator of high conception rates in females less than 18 years of age – it was a challenging task.
Data on conceptions among those under the age of 18 was initially poor and it was some time before the council and PCT were able to breakdown the information to postcode and ward level, in order to look for trends and achieve a city-wide view. Presenting the information, visually on a map immediately revealed the hotspots to target, with high teenage pregnancy rates emerging in a number of different postcodes and at 6 of the 14 local schools.
Analysis revealed that while there were known problem areas north and east of the city centre, when the data was broken down by postcode and presented on a map it showed that teenage conception rates were also high on one estate to the west of Hull. It was clear that services had to be targeted to all of these areas.
Further investigation showed that while 14 000 young people were receiving advice on contraception in schools and youth centres, only 2 000 of them were making it to clinics because they were concerned about confidentiality or there were barriers to them accessing the clinics in their current sites. Other research revealed that teenage boys preferred to discuss sexual health issues with men rather than women.
As a result of these findings, the council and PCT jointly funded contraception outreach nurses to visit young people at a range of locations – apprentice centres, youth clubs, children’s homes and schools – in effect, taking the service directly to them. A service specifically aimed at boys and young men was also commissioned including a street-based outreach programme and work with vulnerable young men and boys displaying sexual behaviour in schools.
Further analysis of data revealed that repeat conceptions among teenage girls in Hull were also higher than the national average. Seeing this as a significant issue, the local authority and PCT also commissioned the contraception outreach nurses to work in partnership with midwifery and to visit young mothers at home within four weeks of having their baby, to prevent repeat conceptions. The service proved to be successful and repeat conceptions among those under 18 years of age are now down to 8.9 percent in the city, compared to 20 percent nationally.
Both the local authority and PCT have put substantial effort into collecting the correct information from a variety of sources, helped by the Public Sector Mapping Agreement (PSMA), which allows all public sector organisations across England and Wales to use centrally funded digital maps provided by Ordnance Survey. By showing the maps to young people to obtain their views on the proposed locations of services they were able to tell us more about the unofficial boundaries that exist in the city and where they would go to access contraception advice.
Using the information from the mapping exercise, the council and PCT decided to adopt a ‘hub and spoke’ model for teenager contraception services. This included a more anonymous drop-in centre at Conifer House, in the heart of the city, and a selection of outreach services located in schools, youth centres and other venues the teenagers frequented on a regular basis.
While there is no magic solution to tackling teenage pregnancy, the strategy has had a major impact on reducing rates locally. Figures recently published by the Office of National Statistics show that Hull recorded a 35 percent drop in conception rates among those less than 18 years of age, compared to 24 percent achieved nationally. Five out of the six schools the council has been working with have seen a reduction in rates, with the sixth remaining static.
- 35 percent drop in conception rates among those under 18 years of age, compared to 24 percent achieved nationally.
- Five out of the six schools involved in the programme saw a reduction in teenage pregnancies, with the sixth remaining static.
- Savings of more than £8 million by reducing teenage pregnancy rates and preventing children from going into care (based on Department of Health calculation of cost efficiency saving).
- Improved partnership working.
- Visual tool for decision-makers to see quickly where services are having an impact.