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Tackling teenage pregnancy: the Maybe Baby? project

Suzanne King
RN RM BSc(Hons)
Community Health Nursing
Teenage Pregnancy Lead Heart of Birmingham Teaching Primary Care Trust
E:suzanne.king@hobtpct.nhs.uk

Birmingham has the highest numbers of teenage pregnancies in the country.(1) Despite the many young mothers prepared to go into schools and talk about their experiences as teenage parents, and who all state that if they could have their time again they would do things differently, there are still teenagers who see parenthood as an easy alternative to education and employment.

The project
The "Maybe Baby?" project was developed as part of an innovation in practice module within the Community Nursing Degree.(2) The project took a holistic approach to school-based sex and relationship education, included parenting in the package. The focus was around making informed choices regarding sexual health and parenting. Work was multiagency between health and education. The project won an innovation in practice award from the Queen's Nursing Institute in 2000, which allowed it to be funded for the duration of the pilot.
The school chosen for the pilot was a girls' school in Longbridge, the area with the highest rate of teenage pregnancy in the city.(3) The school recognised that there was a local issue and was keen to work in partnership with us. Year nine pupils were chosen as the focus (aged between 13 and 14). A programme was developed that included:

  • The existing sex and ­relationship sessions, which were in themselves fairly innovative in their approach.
  • The "Baby Think it Over!"(4) programme - this uses infant simulators to give the young women an opportunity to experience caring for a "baby" for a weekend.
  • A positive parenting roadshow.

When the "babies" were returned (in the "Baby Think it Over!" section of the programme), several parenting issues were highlighted, such as shaken baby syndrome, cot death, breastfeeding and smoking. These topics and others became the basis for workshops at the positive parenting roadshow. The roadshow took place in the school in July and was open to all pupils in year nine, not just those who had taken part in "Baby Think it Over!". The topics covered addressed not only issues raised by the young women, but also those issues highlighted by government policy with regard to public health and social policy concerning teenage pregnancy.(5,6) A multiagency team of health visitors, a specialist midwife, nursery nurses and school nurses ran the roadshow.
A session on contraception and sexually transmitted infections was also included, with a further opportunity to learn and consolidate in year eleven, with a sexual health awareness day. A similar day was also run at the boy's school in year ten. The school nurse also ran a weekly drop-in session where pupils were able to go to access information on a range of topics.
The programme ran for an academic year, with nearly 100 girls taking part in the "Baby Think it Over!" section. Students completed a pre- and postexperience questionnaire. One interesting result was that the age at which they wanted to have children had risen slightly on the postexperience questionnaires - the most common ages being between 23 and 25 compared with 20 and 21 pre-experience. It was evident that the experience had met the project aims by introducing them to the reality of parenthood. Following the experience, they realised how difficult it would be to have a child as a young single parent, with 47% saying it was essential to have a long-term partner, compared with 19% beforehand. The impact on their lives was clearly evident, and they recognised that they would require help and that having a baby would affect their families - 85% said that they would definitely need help, compared with 28% before the experience. Their ability to financially support a baby on their own had also changed, with 38% agreeing that they could not support a baby, compared with 15% before.
On collection of the babies they would be very excited - many arrived with their own baby clothes and even knitted items that family members had made. Several commented on how their mothers were looking forward to the experience, as it would be "nice to have a baby in the house again". The school's Personal Social and Health Education Coordinator observed that many of the girls were themselves born to teenage mothers, and therefore many of their mothers were also almost normalising teenage parenthood.

Project evaluation
The entire project was evaluated through a questionnaire and focus groups carried out 6 months after the end of the pilot year. A random selection of 30 students attended the groups.
All of the young women said that they felt the project had been a success and that it should be continued every year. When asked what aspect had had the most impact on them, 75% said the school sex education programme. This was interesting, as during the discussion they said that they felt the timing of sex education, especially contraception information, was not appropriate to their needs. They felt that they should have information in year seven or eight and the sexual health day to consolidate in year ten. They felt that the current year eleven format was too late and that it should be in line with what was happening at the boys' school. When asked whom they would like to deliver sessions they said that they preferred "strangers". By this they meant someone like the school nurse, who in their case they could not identify. Only three of the young women said that they had heard about the school nurse drop-ins, but they were not aware that they could go for advice about sexual health. When asked whether they would like to see the school nurse providing pregnancy tests or emergency hormonal contraception, they all said yes.
The majority of the girls felt that being able to talk to their parents about sex and relationships was important, as they were the best source of information. This appears to back up current research that states that young people would prefer to get their information from their parents.(7) Only 10% said that they could not speak to their parents. The girls felt that getting information from girls' magazines was the least use to them. They said that the "problem page" format was too false and they didn't believe that the items were real problems or issues.
A total of 55% of the young women said that, although they felt that the "Baby Think it Over!" programme had been really good, sex education had had a bigger impact. Their feelings regarding when they wanted to have a baby were the same as the results of the postexperience evaluation. They said that the experience had shown them how difficult it would be to have a baby as a teenager. Several of the girls had experienced negative reactions from members of the public when out with their babies. One girl was even called a "slag", while another said that she had heard people saying that she looked too old to be playing with dolls. When asked if this had made them think what it would be like on a daily basis with a real child, they said it had. All girls who had experienced hostility said that it had had an impact on them.
All of the girls said that the hardest thing about the experience was the tiredness, due to lack of sleep. They had not realised how demanding a baby can be. They all said that at some point during the experience they had felt frustrated and even angry with their babies.
The students had very little knowledge of local sexual health services and some of the legal issues around consent and contraception. This was obviously an area that needed developing within the programme.
Although the young women felt that the parenting day had had the least impact on them, they were all able to give detailed descriptions of what they had learnt: 53% said that "cot safety and shaken baby syndrome" had been the workshop they had found most useful; 30% said that they thought "the importance of play" was the least useful; and 50% said that they felt all of the sessions were useful and that they could not say which was the least useful. The most vividly remembered examples from sessions were from the "Home safety" workshop. All of the girls felt that both "Baby Think it Over!" and the parenting roadshow should be run again.

Conclusions
There were several conclusions drawn from the project. "Baby Think it Over!" is quite a novelty and is very good at introducing young people to parenthood, making them think about the effect a baby would have on their lives. However, it does not put them off having sex and therefore it will not help those young people who do not plan to get pregnant. It is vital that there is a comprehensive sex education programme that supports its use. The project is also very expensive to set up and maintain and therefore needs recurrent funding.
By introducing the roadshow, the messages within "Baby Think it Over!" around the practicalities of parenthood had been reinforced, but had also given the students an opportunity to learn about issues that are not generally part of education, such as the importance of preconceptual care and breastfeeding. This equips them with knowledge for whenever they choose to become mothers.
Some of the feedback from students regarding the contraceptive education and local services has been taken back to the school management and the local teenage pregnancy champion.
The programme has been running at the school now for 2 years and there has not been a pregnancy that we are aware of. This is compared with up to two or three a year before its start. The school is extremely pleased with the success of the project, and we are currently looking at ways of funding its continuation. Several other coeducational schools are also keen to adopt the project. The Teenage Pregnancy Unit is currently carrying out an evaluation of "Baby Think it Over!", and the final report for the project has been forwarded to it for possible inclusion.

References

  1. Birmingham Teenage Pregnancy Partnership Ten Year Strategy; 2001. Available from URL: http://www.tpdatadepot.com
  2. King S. "Maybe Baby?" project final report. London: Queen's Nursing Institute; 2003. Available from URL: http://www.tpdatadepot.com
  3. Office of National Statistics. Birmingham teenage pregnancy rates per ward. London:?ONS; 2000. Available from URL: http://www.tpdatadepot.com
  4. Baby Think it Over! Available from URL: http://www.virtualparenting.co.uk
  5. Department of Health. Teenage ­pregnancy strategy. Social Exclusion Unit Report. London: HMSO; 1999.
  6. Department of Health. Our healthier nation. London: HMSO; 1997.
  7. Ofsted (Office For Standards in Education). Sex and relationships. Parents and other sources of information and advice. London: Ofsted; 2002. p. 27-8. Available from URL: http://www.ofsted.gov.uk

Resources
Teenage Pregnancy Unit This website contains ­information about the government's teenage ­pregnancy ­strategy, including guidance issued by the Teenage Pregnancy Unit as well as relevant publications from other government departments. There is also information about local ­implementation of the strategy and details about the Independent Advisory Group on Teenage Pregnancy
W:www.info.doh.gov.uk/tpu/tpu.nsf