Consultation on the Pregnancy and Parenthood in Young People Strategy: Analysis of Responses

3. Pregnancy in Young People

The aim of this strand of the Strategy and its associated actions is to ensure that young women who have conceived are provided with objective and non-judgemental information and the support they require to be able to make an informed choice regarding how they proceed with their pregnancy.

Question 5: What ways of working, within and between agencies, will help ensure that there is a co-ordinated approach to take forward the actions in section two in your area?

Thirty-four respondents addressed this question, however six of these simply referred to their response given previously for question one. Several dominant themes emerged and are reported below.

Existing integrated frameworks

A common theme across several respondent categories was that existing integrated frameworks provide the structure for inter-agency working to take forward the actions on pregnancy in section two. CPPs were mentioned as providing broad supporting structures, whilst more targeted partnerships such as the FNP or a local authority teenage pregnancy working party were also cited as providing facilitating structures for inter-agency working.

Other frameworks identified in this regard were GIRFEC, Integrated Care Pathways (seen as providing person-centred frameworks), the legislative vehicle of the Children and Young People (Scotland) Act 2014 and the inclusion of inter-agency activity within ICSPs.

Regular joint meetings bringing together education and NHS agents were provided as an example of a local way of working in one local authority which would help to ensure co-ordination in delvering the section two actions.

Shared information and communication strategy

Respondents from a range of sectors considered that sharing information (on local services available and on young people) between agencies is essential to enable co-ordination in working. They emphasised the need for information to be up-to-date, relevant and readily accessible across agencies. The need for formal communication strategies across agencies and in local areas was raised by two NHS respondents.

One respondent (Third) suggested holding joint information events for young people and parents, with input from across professional services, including local police and social services.

Joint training across agencies

Inter-agency joint training was recommended by several respondents across different categories as a way of co-ordinating approaches. One respondent (Third) emphasised their view that such training should be delivered at all levels, including school support staff and school nurses. The importance of high quality training for those implementing these actions was stressed (Prof Rep).

Shared understanding and approach

A common approach and understanding was viewed as particularly important in executing the actions at section two. Key themes were ensuring confidentiality and not stigmatising young parents. One respondent remarked:

“Confidentiality will always remain an issue for young people. Again there are discrepancies in how different agencies operate and view matters” (Action for Sick Children Scotland).

One respondent (Joint) commented that communication between staff working with young people and the young people themselves could be improved; another (Prof Rep) called for more open and encouraging approaches. One Faith respondent envisaged that their congregations could provide a place where young people can feel safe, listened to and properly supported in a non-judgemental manner.

An NHS respondent emphasised the importance of confidential pathways for reporting concerns about child protection issues.

Other themes to emerge

Several other suggestions were made for ways of working to enable a co-ordinated approach across agencies:

• Adequate resourcing of inter-agency work (3 mentions).
• Clear lines of responsibility for different actions (1 mention).
• Strong local guidance and leadership (1 mention).
• Effective signposting to appropriate agencies (1 mention).
• Clear monitoring and reporting systems (1 mention).
• Use of user feedback to inform local inter-agency strategy (1 mention).

Question 6: Are there local systems in place to take forward these actions?

This question was addressed by 28 respondents although two just referred to their previous responses; one (Joint) stated simply that local systems are in place; and three (two Professional Representative Bodies and one Third Sector respondent) considered that the existence of relevant local systems varied by authority or school.

Six respondents across several sectors highlighted integrated local frameworks and structures which they considered faciliated joint working between agencies in taking forward the actions. These partnerships were viewed as having the potential to support joint arrangements for training, referrals and so on. One respondent (LA) described a one-off seminar on teenage pregnancy, attended by relevant agencies in which evidence, frameworks and actions were discussed.

Five respondents including three local authorities highlighted systems set up in local schools which they perceived as suitable for delivering the actions on pregnancy. Effective referral pathways and links with NHS services were identified in particular, with a few suggesting that by formalising the Named Person service, such systems would be strengthened.

Examples of local systems and services

Examples of local systems and services which respondents considered would support implementation of the actions included:

• Sure-Start (involving both young mothers and fathers) (LA).
• Special needs in pregnancy service in which young people with complex needs can get co-ordinated support (Joint).
• Local multi-agency Teenage Pregnancy Pathway which supports access to services (NHS).
• Sexual Health website with access from school premises (NHS).
• Dedicated midwife for vulnerable families (NHS).
• Community-based support programmes co-ordinated with midwifery services (Joint).
• Support for local implementation of the FNP (Joint, LA).
• Arrangements for prompt referral outwith area where local abortion services are not available (e.g. due to number of weeks of gestation) (Joint).
• Prompt referral from sexual health nurse to hospital for termination, which does not require doctor referral; prompt referral to midwife if a young person is continuing with their pregnancy (LA).
• Local mandatory training on child protection for all NHS staff (NHS).
• Clear child protection pathways to be followed (NHS).
• Deployment of voluntary “befrienders” for young people with mental health issues to provide emotional support through their pregnancy and beyond (Third).

Challenges to local systems in taking forward actions

A recurring view, largely amongst Joint respondents, was that whilst local systems are in place, some need to be strengthened to make them more effective. Enhanced local leadership and guidance underpinned by adequate resourcing was called for (Joint, NHS); and more efficient referral mechanisms were recommended, for example between schools and GPs, Sexual Health Clinics and maternity services (Joint).

One respondent (Third) considered that effective communication and engagment of all relevant organisations was challenging in their area. Another commented:

“We are aware that there are links in place across a range of services however we feel that there is scope to improve these to fully ensure young people can access the full range of appropriate support should they find themselves potentially pregnant. There is work to be done around associated stigma for young people, and also scope to strengthen networks of peer support and community based youth networks. We know that young people in those environments often have very strong support and one good adult who they know who may and who will support them in a non judgemental way” (East Renfrewshire Community Planning Partnership).

A Third Sector respondent focused on a potential situation whereby a couple wish to be supported together but they attend different educational establishments. In this situation the respondent considered that alternative arrangements for support should be in place locally, such as youth workers being involved.

One respondent (Joint) suggested that large Health Boards with both centrally and locally managed systems may find it challenging to implement some of the actions on account of geography and distances to travel to access services.

Taking forward actions in local schools was viewed as dependent on the agreement of the relevant headteacher and parents, according to one respondent (Joint); another (Ind) recommended an inspection model in schools to ensure improvement objectives relevant to the actions are met.

Question 7: Do you think the actions meet the outcomes in the logic model?

Thirty-two respondents addressed this question. Of these, 14 across seven different categories considered that the actions broadly met or contributed to the outcomes in the logic model. A further three respondents felt that the actions had potential to meet the outcomes, but only if supported with appropriate leadership, funding and organised implementation. One respondent (Joint) expressed difficulty linking the actions with the outcomes.

Other respondents perceived there to be gaps in the actions. Two recommended more focus on vulnerable young people or those those not in mainstream education (both Joint respondents); another (NHS) perceived a gap to be supporting pregnant young people within school. Two respondents (LA, Prof Rep) called for actions relating to postnatal contraceptive support; one respondent (LA) considered that the actions should include more emphasis on the input from the Third Sector.

One view (Joint) was that hurdles exist for some young people in accessing the services planned. Examples were provided of difficulties accessing services due to geography and cost of travel and also the additional challenges faced by young people whose English is an additional language in booking ante-natal services.

The action on page 18 of the draft Strategy relating to information on pregnancy being available in venues frequented by young people attracted attention. Three respondents (two Joint, one NHS) identified social networking and media as requiring explicit mention as potential “venues” for information. One (NHS) recommended that the positives of “seeking support” should be emphasised rather than using the word “disclosure” .

Question 8: Is there anything missing in this section?

This question was addressed by 41 respondents. Of these, one (Acad) considered nothing was missing from the section; all but one of the others highlighted general or specific areas which they perceived as either missing altogether or which required to be strengthened or amended.

General views

One respondent (Acad) considered that the inter-agency and multi-agency work required to enact the Strategy is potentially complex and should be underpinned with frameworks of working with clear Lead Professionals and guidelines on information sharing amongst Named Persons and Lead Professionals.

Reference to resource implications was highlighted by another respondent (Prof Rep) as having been omitted in their view.

Two respondents (Third, Prof Rep) recommended that on-going consultation with young people over the relevance and appropriateness of materials and access to information and services should be built into the Strategy.

Two respondents (NHS, Oth) considered that widespread workforce training may be required to address the attitudes of healthcare and other staff towards young parents (including fathers) and to avoid discriminatory practices.

More explicit action was requested by NHS respondents to accommodate the specific issues relating to young parents with additional support needs, learning disability, physical disability, mental health problems, cultural differences and looked after children Two respondents (Ind, NHS) considered that the needs of LGBT parents should receive greater attention in the section.

Information on abortion

Twelve respondents across a range of sectors considered that more information on aspects of abortion was needed within the Strategy. One academic called for the meaning of abortion within the context of the Strategy to be made clear. A local authority respondent identified what they perceived to be the need for a specific action to address misunderstanding and myths surrounding abortion. An NHS respondent suggested that strictly speaking it is inaccurate to state that the earlier an abortion is performed the lower the risk of complication (p. 19 of the draft), as there are drawbacks to being referred too early for abortion (< 4 weeks).

Concerns were raised by some that not enough attention is given in the draft to the potential impact of abortion on the physical and psychological health of the mother and services available to support her through this. One respondent (Faith) highlighted mention of education and support for young fathers regarding abortion as missing in this section.

A few respondents (two NHS, one Joint) requested a national-level action addressing access to late abortion; one (NHS) called for an action on increasing action to early abortion.

Two respondents (Third) considered that reference to the rights of the unborn child have been omitted from the section.

Greater reference to wider support frameworks

Three respondents (LA, Joint, Ind) considered that the potential role of the Third Sector required to be strengthened within the Strategy at this section. Likewise, one respondent (Prof Rep) referenced Community Pharmacy as offering potential as a health and social care information hub, which could be tailored to the local population and accessible to young people.

The role of Allied Health Professionals was understated in this section according to one respondent (NHS), who cited physiotherapists and dieticians in particular as playing potentially key roles in supporting young people through pregnancy.

One respondent (Joint) recommended greater recognition of the contribution of NHS Education Scotland (NES) as a relevant resource and called for more consistent referencing to NES at appropriate parts of the Strategy.

More respect for the role of parents and wider family as “trusted sources” was requested (Third).

More information and emphasis on the FNP approach was recommended by one respondent (NHS), as a major Scotland-wide intervention to support young people through pregnancy.

Greater reference to financial and other practical assistance

Third Sector respondents requested actions relating to making young people more aware of their maternity rights relating to employment, welfare and housing. A local authority agreed that the section should make more of the financial challenges facing young people who are asked to leave their parental home when pregnant.

Some respondents expressed concern over ensuring young people not in education, employment or training receive relevant information and help, including a Named Person; it was felt that maintaining young women in education and training and supporting them to return to this following birth requires more emphasis in the Strategy (NHS). One respondent (NHS) requested an action aimed at maintaining young fathers in education.

Identification of more specific omissions from this section

A few respondents identified more specific topics which they considered had been overlooked in the draft. These included:

• Support available in relation to miscarriage or other pregnancy complications (Joint).
• Adoption as a viable choice post pregnancy (NHS).
• More consideration of ensuring young parents can access ante-natal classes and support (NHS).
• Action on access to pregnancy testing, including by voluntary organsations/ youth workers (NHS).
• Mention of social media and social networking as vehicles for communicating information to young people (four respondents).