Evidence-Based Practice

Annual Review of Education, Communication and Language Sciences, Volume 2, 2005

EVIDENCE-BASED PRACTICE IN REDUCING THE RATE OF TEENAGE CONCEPTIONS IN THE UK

MING-CHIN, SHINE, HSIN

Abstract

UK is facing the crisis of having highest rate of teenager conceptions in Western Europe while Taiwan is also in the same

situation. There have been many approaches carried out in order to tackle this problem. This research is about applying

Evidence-Based Practice in the issue of high teen-pregnancy rate in the UK. Evidences come from documents and reports in

government, journal articles, and books. The background information, causes, and the strategies are analyzed with the

evidences. Approaches practiced in other countries are seen as examples for reflection. Reasons of success and failure are also

explained. The practice is applied in the Taiwanese context to discuss different cultural factors. Finally, emerging issues are

indicated to seek the solutions.

Keywords

Teenage, conception, evidence-based practice, UK, Taiwan

Introduction

The UK has the highest rate of teenage pregnancy in Western Europe (Aggleton et al, 1998, 2000, 2003; TPU, 2001).

According to the report of Development of Health (2003), there has been a fluctuation in the proportion of pregnant teenage

girls since the 1970s but it is still too high. Therefore, the government has been aware of the importance of sex education and

seriously considered tackling the rate of teenage conceptions. The authorities have started to promote prevention schemes for

reducing unintended conceptions, in local organizations and schools. The Department for Education and Skills (DfES) and the

Office for Standards in Education (OFSTED) also take responsibility for enhancing the Sex and Relationship Education

practiced in campuses (2003).

Those young pregnant people face a higher risk of health, education, and social-economic problems (Aggleton et al,

DoH, Janet, et al, 1998, 2003). Some recent studies (DoH, 2003) show that the young mothers are more likely to suffer

hypertension, anaemia, obesity, depression and isolation. The babies face a high risk of early death and developmental

problems. Young pregnant girls usually do not return to school if they decide to have their baby. Their dropout is likely to result

in poorer opportunities for employment and a lack of knowledge about parenting. Moreover, teenagers from lower social

classes or living in areas of poverty have an obvious trend to be teenage parents, and have problems with low achievement in

schools, unemployment or low self-esteem.

There have been many schemes tackling teenage pregnancy rate (Jane & Catherine, 1998) and education is the key point

for prevention. Since 2000, there have been policies of providing sex education and making contraception services more

accessible to young people (DoH, 2003). The situation is getting better due to a slight decline in the teenage conception rate

during 1998-2001. The target set by the NHS plan is to reduce the number of teenage pregnancies by 15 % by 2004 while the

Social Exclusion Unit’s Report on Teenage Pregnancy aims to halve the conception rate by 2010 (DoH, 2003).

Recent data shows that teenagers’ sexual behaviour and attitudes have significantly changed (Kaye and Kirsti, 1998).

School staff and teachers need to become aware that sexual issues have taken a greater role in teenagers’ lives. Pregnant

adolescents and teen parents also face further living challenges, and might result in social problems. Based on research related to

teenage pregnancy, its causes and effects and approaches for tackling teenage pregnancy will also be examined.

This study will focus on the efficiency of these schemes for both prevention and support, and examine how these plans

benefit young people. The problems emerging with these schemes are also stated.

Question

How could prevention and intervention schemes in schools help to reduce the rate of teenage conceptions in the UK?

Background and context

The UK has the highest rate of teenage pregnancy in Western Europe (Aggleton et al, 1998, 2000, 2003). Those teen

parents are facing challenges of employments, lower self-esteem, and lower social-economic status. The babies of teenage

mothers have a higher infant mortality rate with a higher tendency to be vulnerable.

Although the teenage conception rate has slightly fallen according to the report from National Statistics (2003), the public

health minister indicated that the rate remains too high and projects are still working.

The national teenage pregnancy strategy has invested in improvements to support for young people. In schools, Sex and

Relationship Education (SRE) has been implemented, and promotes the return of teenage mothers into schools. Enhancing the

decision-making ability could help to reduce the chance of unsafe sexual activity. Besides the GP surgery offering teenagers

advice, some supported housing schemes and alternative homes have been established to offer teenage parents support and

shelter (DoH, Janet, 2003). These plans help the teenage parents back into community and try to prevent those at-risk from

pregnancy.

The Department of Health (2003) has reported that better education is seen as one of the most effective methods to

reduce teenage pregnancy rate and has been implemented for some years; however, the rate still remains high. Therefore,

teachers and staff are facing challenges in promoting the scheme.

List of evidence

The report

1. Background situation

With the highest teen conception rate in the Europe; the teenage birth rate in the UK is 3 times as high as in France and 6

times the rate in the Netherlands (TPU, 2001). A higher proportion of young mothers under 20 are not married (Isobel and

Shirley, 1998). This suggests that attention needs to be given to those young people and the society is influenced.

Medical abortion has become frequently used to terminate pregnancy in unplanned and unwanted pregnancy. Based on

the investigation of Teenager Pregnancy Unit (2003), almost half of the pregnant teenagers aged 16-17 choose abortion. The

abortion rate is showing a steady increase especially for girls under 17 (Isobel and Shirley, 1998).

Teenage parents face higher risks to physical and mental health. They are still growing and developing themselves, and

both mentally and physically may not be ready to become parents. Aggleton et al (1998) have mentioned teen mothers more

likely to have anaemia, obesity, and hypertension and a higher rate of depression, anxiety, and negative feelings (Sara and Nona,

2003). Their babies have problems not only in health and mental development but also social adaptation which may influence

their future lives. Even worse, the infant death rate is higher.

Health inequalities have existed since the children of teenage parents are more likely to become teenage parents

themselves (DoH, 2003). Poverty and social exclusion also affect the economic and educational situations for the children.

2. Causes

Teenagers are not the only factor for high conception rate; there have been many reasons contributing the high rate.

2.1 Family

Some parents lack knowledge and skills (DoH, 2003). Those people brought up in poverty or lower social class may

have incomplete education, and their myths and incorrect knowledge about sex and contraception may pass on to the children.

Moreover, the adults are afraid that given information might encourage the young’s sexual activity (DoH, 2003). This is a

common situation seen in some conservative families.

The attitude of family also affects young people’s opinions of sex. Aggleton et al (1998) suggest that family background

and environment are also factors influencing teenagers’ concepts. Moreover, young people grown up in a “talking-about-sex-

openly” environment are likely learn more than those in “moral-focused” families (Ruth et al, 2001 and Jane et al, 1998). In

Netherlands, although the atmosphere is quite open in society, the teenage pregnancy rate is still under control (Ruth et al,

2001).

2.2 Teenage

Difficult access to information is one of the factors causing higher teenage pregnancy rate (DoH, 2003). For teenagers, it

is hard to openly ask about sex or relationships due to lack of trusting relationships with parents, teachers or GPs. They are

afraid that adults might be angry when they talk about sex. Younger people are more reluctant to seek contraception services

because having sex under 16 is against the law (Ruth et al, 2001).

Teenagers are worried about being judged (DoH, 2003). According to Erikson’s theory, peer group has become the key

social agent for teenagers. Their friends’ opinions have an essential impact in group and peer influence cannot be dismissed. A

programme produced by channel4 called “Adult at 14”, showed a typical example of peer pressure. If their friends already have

sexual experience and talk about it, they may also have sexual activity to get the sense of belonging. However, if they have not

found a person they like, they might have one-night-stands. Moreover, “love” is another reason to unsafe sexual activities; some

girls take sexual activity as expressing love.

With low achievements and expectation in education and employment, teenagers are likely to become teen parents (DoH

2003 and TPU, 2001). Further education or employment is difficult for them; they usually have low self-esteem and lack self-

confidence. They might think having a baby is the only thing they do well, and make them feel needed.

Young people are eager to achieve “adult status” (DoH, 2003). Peter (1998) also states that young people have a strong

desire to be adult. This is a common reason for them to leave families. Building a family and having their own children could be

their image of an adult.

2.3 Society

The welfare system may be problematic for young people living in poverty and they have a higher chance of pregnancy

(DoH). They have little opportunities for higher education and usually have lower self-esteem and self-expectations. There is a

cycle of inequality since the children of teenagers are likely to become pregnant (DoH, 2003).

These young people feel socially, culturally and economically unaccepted (DoH, 2003). With economic problems, behaviour

problems and lower social status, they are likely feeling unable to integrate into society.

Cultural influences raised expectations about sex and teenagers are curious to experience (Kaye and Kirsti, 1998). Through

Internet, TV programmes, and the press, teenagers obtain a lot of fantasy information about romance and love. They also want

to imitate their idols in their dress, appearance and behaviour.

3. Strategy

There have been schemes carried around the country. Some already have significant results in cutting down the teenage

conception rate while some are uncompleted. Aggleton et al (1998) have stated that image, access, and confidentiality are

important for young people as regarding sexual and health services. Among these strategies, the approaches might differ

according to various local needs, but the goals and directions are all focused on education and contraception.

3.1 Initiative - announced by the Department of Health (2003).

1. National media campaign

2. Education in school

3. The use of contraception and advice

4. Education for parents

3.2 Schemes practiced nationally

Liam (2003) has stated that there is no simplistic method to reduce the teenage pregnancy rate, and it requires focusing on

giving young people the “means” and the “motivation”. There have been many schemes executed in many areas; for example,

TPU (teenage pregnancy unit), M2M, 20SSP (sure start plus), SEP (sex education program), Bodyzone, and MAC’s place.

SEP, M2M, and Bodyzone have achieved a significant success in certain areas (DoH, 2003). These programs are ongoing and

the full results will not been seen in the short term.

3.3 Education

Education has been targeted as one of the most efficient ways to tackle teenage pregnancy (DoH, 2003). Liam (2003)

also indicated that SRE linked with a contraception service would be effective. There are many projects held on campuses, for

example, MAC’s place, SRE, and Abstinence Education are widely practiced.

Sex and Relationship Education (SRE)

The teenage pregnancy rate should have declined significantly since SRE has been practiced in schools for some years.

However, the rate still remains high. Obviously, the original sex education in schools has not enough influence on today’s

teenagers (Ruth et al, 2001). The information teachers give might not be what teenagers actually need. Making the proper

information accessible should be one of the goals.

SRE given at an early age should be appropriate for young people according to different levels of maturity (DoH, 2003).

The reason for this is the significant fall in the age of first intercourse (Kaye and Kirsti, 1998). Prevention is much more important

than further treatment; therefore, the proper sessions need to be addressed earlier. School-based education also needs to be

linked to skills such as postponement of sexual activity and contraception service (Ruth et al, 2001). The information and

knowledge need to be available before young people become curious about sex. And the content of SRE should be appropriate

to age (Ruth et al, 2001).

Schools need to hold open discussion and video sessions. Students should be encouraged to talk and enquire about

sexual issues in a non-judgmental environment and have their decisions respected. Moreover, some video programmes about

pregnancy, childbearing, even abortion could give students some ideas. The video session has successfully influenced some

college students in Taiwan since they discovered the harm occurs to the bodies. Thus, self-awareness could be raised and

teenagers could realize the importance of their health.

Teen mothers are welcome to share their experiences (Ruth et al, 2001). The guests would offer them an opportunity to

hear the stories of what they have been through. Students are also likely to ask questions without feeling embarrassed since they

might have no chance to meet these guests again.

Advice for contraception and sex health issues should be provided in schools. Some students might approach teachers or

school nurses they trust. It would be a good opportunity for the staff to establish a trusting relation with them. Most importantly,

the information the staff give is linked to local services so that students could also seek support from other sources, such as GPs,

or family planning clinics (Ruth et al, 2001).

Abstinence Education

Just say no - abstinence education has been promoted in the United States for years and has postponed sexual activity

(Blake and Frances, 2001). Therefore, this scheme has been recommended and adopted into the National Curriculum in the

UK. However, abstinence education has not achieved remarkable results since there are still blocks within the relationships

between adult and teenagers. Blake and Frances (2001) identified that some students show that abstinence education is nothing

to do with their lives since they usually behave in front of parents but lead another life with their friends; therefore, it would be

difficult for adult to recognize what they really need.

Another factor in the failure is that the abstinence education does take into account young people’s experiences and

sexual diversity (Blake and Frances, 2001). The objective for abstinence education is limited. Some young people may already

have sexual experience would not obtain effective information, neither do homosexual people.

Communication skills

Decision-making and negotiating skills are addressed in the curriculum (Janet et al, 2003). Teenagers are easily influenced

by peers, but they need to have the final say no matter how they are encouraged. They have to make the decision and no one

should make decisions for others. It is very difficult to deal with this idea for teenagers since they feel only peers really

understand and listen to them.

Decision-making about pregnancy is essential for pregnant teenagers. Teenagers need more help to think over their future

once they know their pregnancy. Many young people have had abortion; their body could be harmed if they have a number of

abortions. Having a baby is a difficult decision for young people since they need to think about their finances and where they will

live. Therefore, advice on how to manage their lives would be very important for them.

The stereotyped image of male and female needs to be challenged (Ruth et al, 2001). The gender issues are necessarily

discussed since girls often believe the myth that the female needs to please the male. Moreover, the myth about love is one of the

reasons result in unplanned sexual activity. They need to know that they have the right to refuse if they do not want to.

3.4 Teenage parents

Teenage parents should be provided with the chance for education. Some girls drop-out when they are pregnant, and

they are seldom able to finish their study (Janet et al, 2003). This may well result in low employments. Therefore, teenage

parents should be encouraged to complete their education, or take higher education if possible, so that they can increase their

employment opportunities.

In some schools, teenage parents are given training for employment (Janet et al, 2003). Most of the teenage parents have

low-achievements in studies and become unemployed, thus teaching them living skills and providing them opportunity to find a

job will help them to manage their lives independently.

Learning how to prevent repeated pregnancies is also important for teen parents (Janet et al, 2003). Young mothers are

likely to become pregnant again since they do not use proper contraception or find parenting is the only thing they do well (DoH,

2003). When young people have not obtained necessary living skills or job to cover their living expense, they need to stop

having more children.

Counselling services are offered to young parents (DoH, 2003). Janet et al (2003) mentioned that teenage parents need a

comfortable and confidential environment to discuss their worries. School counsellors can provide emotional support and

practical advice. Moral support and guidance about their future are also needed.

3.5 Limitation

There are limitations in the programmes practised in schools to reduce the teenage pregnancy rate since the protection of

young people needs to be considered. However, these limitations reveal that some teenagers find no assistance to support and

provide them with advice.

Some schools do not help pregnant teenagers to continue their studies (Ruth et al, 2001). Such pregnant teenagers are

usually unable to attend school. It would be difficult for schools to follow up.

4. A Review of the Taiwanese Evidence

Since Taiwan also has the highest teenage pregnancy rate in south-east Asia, evidence from there could be a useful guide

to reducing the rate. According to the report from Central News Agency (2003), the numbers of pregnant junior high school

students has risen more than threefold since 1996. Among the pregnant teenagers, half decide to have abortions and only a few

end up in marriage. The dramatic increase also has raised awareness of teenagers’ development. Having been a teacher in junior

high school in Taiwan, I had witnessed pregnant students facing struggles and difficulty with their futures.

The education about sex and relationships has been known as the key prevention method for teenagers; however, it

would not be easy for schools to promote. First, the pregnancy issue challenges the relationship between teachers and students

(Li, 2003). Teachers are the first persons that students tend to talk to about their relationships and they commonly ask teachers

to keep secrets. Hence, teachers have a conflict in minds about whether they should report to the social welfare organization or

not since the borderline between confidentiality and regulations is very ambiguous. If they talk with the parents, the students

would feel betrayed and would not talk again. On the other hand, if teachers maintain confidentiality, they would worry about the

students and that it might be against the laws designed to protect the young. I had witnessed a case where the teacher was asked

to keep a secret for a teenager but eventually told the parents. The parents were very angry at both. Unfortunately, the teacher

was sued for “concealing the fact” and “a breach of duty”. This case ended as the girl had abortion and the teacher felt very

frustrated about young people’s problems.

Secondly, the campus atmosphere in Taiwan is still very conservative. It is not common to see pregnant girls or teenage

mothers in schools. The survey done by Li (2002) has revealed that once the student is pregnant, she is suggested to leave

school or attend a “halfway house” school set up for young people do not normally attend school. Some teachers, even school

counsellors, have no idea how to deal with students’ sex and relationships problems, and they would rather let them dropout. A

rejecting attitude makes students reluctant to approach teachers and the atmosphere becomes more closed. While I was a junior

high school teacher in Taiwan, I saw some teachers label those students as “problematic ones” and ignore them.

Even worse, some schools ask those pregnant students to leave in order to maintain good reputation of the school so that they

can continue to attract students (Li, 2003). In this climate, students could hardly ask for help about sex and relationships from

teachers, and it is also difficult to establish a trusting relationship. Of course, those drop-out students do not come back and the

schools do not follow them up.

Thus, schools have a problem with accepting the reality that students have sexual and relationships problems. It would not

be easy for school staff to promote sex and relation education and abstinence education. Before practicing such schemes,

schools need to reform and set up a respecting environment.

On the other hand, since class teachers are the first persons young people want to approach, the potential of education

should not be dismissed and this could provide a powerful resource for social workers. However, it has a long way to go.

The schools in Taiwan have started to organize some sessions for teaching young people negotiation skills in relationship and

self-defence (Gao, 2003). Also, a respect attitude is addressed in the education for young people and will be a powerful

influence on teenagers’ sexual activity. Pon (2003) has indicated that students need to learn to respect themselves and others,

including their minds and bodies. Moreover, respect for unborn life should give them the idea to avoid unsafe sexual activity.

Emerging issues in the UK and Taiwan

First, it is very important to ensure the teachers are trained about sex and relationship education both in the UK and

Taiwan. Not all the teachers realize how to answer or deal with young people’s sexual problems and not all have the skills to

communicate with young people.

Moreover, confidentiality issues are a concern for young people and teachers or staff need to let young people understand

that discussions between them will not be disclosed. Teachers’ training need to be addressed: teachers should have relevant

information skills, confidence, resources, and support which they need to communicate with students (Ruth et al, 2001).

Moreover, listening and communication skills which can help to build the relationship between teachers and students are

required.

In some cases, education in school cannot meet the young people’s needs. Sex education has been widely practiced in

many schools in the UK, but some young people feel the sessions are not useful. Even though the school are keen to help the

young people with their sexual problems, the young people still could not discuss with some teachers since they worry about the

disclosure and embarrassment. Moreover, the content of sexual education sessions should focus on the students’ needs instead

of what the teachers want to tell. In Taiwan, those issues should be addressed in school education.

Teenage pregnancy is not only a public health problem; it is also related to educational, economic, and cultural issues

(Debbie & Mary, 2002). Therefore, it is important that networks are in working. If schools alone promote sex education but

local authorities do not cooperate to provide proper services, the results will still be limited.

The financial supports for the young mothers and their family have been highlighted (McGuire and Hughes, 1995).

However, some women have started to rely on benefits and have become dependent (Isobel and Shirley, 1998). Financial

support is necessary but the situations of applicants need to be examined carefully. There is an old saying, teaching people to fish

is better than giving them fish, these young people need to learn living skills rather than receiving social benefits.

Since emergency contraception is easily obtained in the UK, the young people might start to have sexual activity

frequently because the solutions are easy to get. However, the risks of sexual activity should also be seriously indicated such as

transmitted disease, or HIV/ AIDS (Jane and Catherine, 1998). Emergency contraception might influence their body and is only

for emergency situations and should not be taken lightly.

In Taiwan, abortion is one of the most widely taken decisions for pregnant teenagers since emergency contraception is not

approachable. The medical service is very easy to obtain so that some have had an abortion several times. It could cause injury

to their body, for example, having difficulty getting pregnant in later life. However, some people ignore the risk and insist having

abortion instead of using contraception.

The prevention and intervention schemes need to be carried on continuously in the UK and Taiwan, and need to fit in the

present circumstances. In Denmark, a programme using multi-faceted community approach had resulted in a remarkable success

in reducing the teenage pregnancy rate; however, the rate returned to high level when the programme ended (Jane and

Catherine, 1998). In order not to repeat the same mistake, the different approaches are issued in accordance with various

contextual factors. There have been various programs tackling teen pregnancy practiced in different areas in the UK with

remarkable results, although the results differ in gender and living areas (TPU, 2005). The schemes will also go on and be

amended to fit the coming generations.

References

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About the author

Ming-Chin, Shine, Hsin (Ming-Chin.Hsin@ncl.ac.uk) is a second year Integrated PhD student in Education. She has a M.ED. in

Counselling and guidance from University of Newcastle upon Tyne. Her research interests are issues about adolescents’

development and their relationships.