Dr Nona Dawson - University of Bristol  The Educational Needs of Young Mothers

The UK is presented as having the highest teenage pregnancy rate, including the highest rate of pregnancy to under 16 year olds, in the European  Union.  This statistic is rather misleading because in fact it is England and Wales that have the highest rate, Scotland is consistently lower, and Northern Ireland, although not producing accurate conception rates on account of that province’s abortion legislation, is lower still. 

Whether these differences are a result of education, moral climate or the weather we do not yet know.  This paper is presented on the basis of research that the University of Bristol has completed on the provision of education for pregnant schoolgirls and schoolgirl mothers in all the national regions of the UK.

For the purposes of today I shall mainly be using the position of school-aged mothers in England and Wales.  In this case I mean young women who are still of statutory school-age i.e. up to 16 years.  How many people are we exactly talking about?  Comparatively a very small number.  Indeed since 1990, a bumper year for young women’s conception, the absolute number of young women in England and Wales who have become pregnant has been consistently under 8,000;  of that group under 4,000 girls have become a mother since 1991 to 1994 (latest figures).  To help put these figures in context, in academic year 92/93 there were 1,434,000 school girls in secondary school.  7,243 schoolgirls became pregnant, 3,287 had a termination and 3,757 had a baby.  We really must keep all this in proportion.  The image I would like to give you is from my own town of Bristol, where we have the lovely Avon Gorge, on which cliff face we have a number of climbing accidents each year.  Proper education and training helps to reduce the accidents on the cliff however we still need to provide an ambulance service for the few who experience accidents.  PSE can be a fence at the top of a cliff but surely we much also make provision for when accidents do happen.

More usefully we can consider rates of conception and the rates of termination and maternity.  Although it is of course a concern that the rate for 1994 has gone up a little, particularly in terms of the target in ‘Health of the Nation’, nevertheless when we look at the rate for young women who deliver babies - that still is on a downward trend.

It is this group of very young mothers who have been receiving adverse criticism in the past year or so on account of being ‘drains on the state’ and for producing problem children.  This notion needs to be severely knocked on the head.  If it is the case that we wish the young mothers to have an opportunity to come off state benefit, to become taxpayers, then access to education and vocational training is paramount.  Research based both here and in the States tells us that this is precisely what young mothers want.  Indeed a mature State would be working towards exactly that position.  Any simple cost benefit analysis would indicate that it would make economic sense if not moral sense.

If it is the case that the children of young mothers are disadvantaged (as noted by the literature and current research with which I am involved investigating a large cohort of teenage mothers and their children) then concurrent support with parenting is also essential.  However, it really must be emphasised here - we are not talking about an homogenous group although we describe general trends.  As with any group, young mothers are an heterogeneous group and when you examine any group individual differences are clear.  Like Ann Phoenix, I support an non-pathological view of teenage pregnancy and parenthood.

It is the case that all young people up to the age of 16 should be receiving some sort of schooling.  During adolescence the vast bulk of young people are attending main stream schools however small groups are not, for a variety of reasons - including pregnancy and motherhood.  The first major study into this type of provision for these young women in the whole of the UK was completed by the University of Bristol in 1994 and 1995.  Today we shall talk about what is happening here, in England and Wales.

It is certainly the case that recognition of the educational and social needs of this type of school student has been an increasing concern for local education authorities.  This has resulted in an increase in special centre provision for pregnant girls and young mothers, with some including child-care facilities.  Although the main form of education supplied to young mothers in England and Wales is an average of five hours home tuition per week.  (for further discovery of the position read the reports).  The meaty question that is raised here is not whether LEAs are fulfilling their statutory duty by supplying some form of education for these young women, but how would one begin to describe the quality of such education.  This is an absolutely fundamental question.

Home Tuition

While taking into account the undoubtedly committed work supplied by home tutors, nevertheless receiving on average only 5 hours of tuition in your own home, with only one tutor, will mean that the curriculum open to you is severely limited.  Indeed the DFEE recognises this and recommends home tuition only for a short time - towards the end or pregnancy and only during a very short time in motherhood, before the girl returns to school.  Except, in England and Wales she does not return to school (like her sisters in Scotland).

Mainstream school

Some girls do of course return to school and continue to have access to the full curriculum.  However, many more do not for a range of reasons.  These include primarily lack of child-care.  the Grandmother will probably be working as well and will be unable to care for her grandchild while her daughter is at school, and there is no statutory provision of other types of child-care for schoolgirl mothers.  The only way that a girl could get help with child-care, apart from paying for it, would be to be deemed a ‘problem’ by social services.  Another reason some young women give for not wanting to go back is not that the school itself is unwelcoming but that there can be a lot of unwelcome peer attention, particularly from boys.

Special Centres

Special centres are no longer called ‘special centres’.  The name of the off-site that houses pupils who are being educated otherwise than in mainstream school is Pupil Referral Unit or PRU.  No doubt you have heard mention of them in the news in relation to the education of disruptive children.  The same term now applies in England and Wales to units for pregnant schools girls and schoolgirl mothers.  What is significant about this is that for the first time PRUs are open to inspection by OFSTEAD along with mainstream provision.  Also there are clear guidelines laid down for the type of curriculum that should be provided.  The SFEE recognise that the full National Curriculum is not possible in most PRUs, however it requires PRUs to supply a core curriculum which includes English, maths, science, IT and modern languages.  This is laudable however it has caused an economic headache for LEAs.

My own view is that the educational side has not been emphasised enough by many off-site units for pregnant schoolgirls and schoolgirl mothers.  There is absolutely no doubt that social, emotional, physical and psychological support is very important but I believe we do the girls and their children a disservice if we do not give them every opportunity to gain further knowledge and skills to enable them to be productive workers and good parents.

What I want to do here is raise a number of points for consideration:

*  Should better attempts be made to educate young mothers in main stream school?  Although English and Welsh LEAs agree with the DFEE that that is where young mothers should complete their schooling, they identify lack of child-care facilities as a major problem.  The underlying view at the DFEE is that all school students should have an equal opportunity to experience the National Curriculum:  and indeed that they have an entitlement to it and LEAs should be looking towards supplying the access. 

 *  Should clearer routes to part-time accredited courses be made available for young mothers of very young children?  Some view this as a start in taking into account the huge demands of babies and would allow the young mother more family time as well as giving her an opportunity to increase her knowledge and skills.

*  Following on from this, should we, like a very small number of LEAs, allow access to further education colleges for young mothers aged between 14 and 16?  We saw in the press not long ago the case of a young mother, aged just under 16, being refused permission by her LEA to attend an accredited hair-dressing course at her local FE college, which also had child-care facilities.  The alternative for her was going to be home tuition.  Those who feel that FE colleges would be appropriate for educating young mothers put forward the following reasons: 

1.  the students range in age and are therefore more suitable as learning companions to the young mother who feels herself as older than her peers on account of her responsibilities

2.  there are part-time accredited courses available that will allow a young mother both to experience more of her little child and to gain a qualification

3.  many of the courses are vocational and will have a better chance of helping a girl on the job market than a limited number of GCSEs

4.  many FE colleges have crèche facilities.

*  Should more emphasis on supporting her parenting be given in the early years of motherhood, and opportunities for further education be offered at a later stage?  Working mothers, at whatever age, face the tension between the needs of their children and their own needs.  It is certainly the case, generally speaking, that the position of the child of young parents is not terribly good.  Much qualitative research indicates differences between how young mothers and older mothers relate to their children to the detriment of the children of the younger mothers.  And much quantitative research indicates a gap downwards on literacy scores, emotional well-being scores etc.  for the children of the younger mothers.  And much quantitative research indicates a gap downwards on the literacy scores, emotional well-being scores etc.  for the children of very young mothers.  However other work, particularly in the States, has shown effectiveness in enhancing mother-child relationships through parenting programs.

*  What support should be given to young women post school-leaving age?  It is certainly the case that the education and training position for young mothers aged 16 and over has had minimal research attention in the UK.  The well-known American study of the Baltimore cohort indicates quite clearly that most young women will attempt if not succeed to gain additional qualifications and jobs.  In this country a small number of groups are working to provide vocational training for this particular group of young women.  For example, at the Bournemouth and Poole College of Further Education Project MATERNAL is now well under way.  (this project has received major funding from the European Union).

*  What are the structures that we ascribe to school-aged mother that gives it its particular characteristics here?  How would viewing young motherhood differently change how it is seen as a problem or not?  We will have read Diana Birch’s first study of young motherhood in which she clearly describes how points in history make a difference, for example, she tells us that Henry VII’s mother was 14.  We know that in 1973, when the raising of the school-leaving age from 15 to 16 took place, all of a sudden there were a group of pupils whom we had never to consider in a special and different way.  We can also look to our European neighbours for contrasting structures which will have an affect on how dependent or independent you view these young people.  (We have a research bid in with 4 other partners from Europe to investigate educational and training opportunities for very young mothers in Europe).  For example we may look at age of consent as it applies to heterosexual women.  We will see that it ranges from 14 to 17, and indeed within our own state there are differences - in Britain it is 16 and in Northern Ireland it is 17.  What does this lead us to ask about how we view young mothers.

*  This leads us to question whether a young mother is a child and therefore dependent on the adult world, or whether she should be view as a young adult who in any case is seen as responsible for a child no matter her age.  How would our view of her affect how we see her development into an adult with adult responsibilities including a job and the fact of being responsible for a growing child?  Taking that any society should be examining credible measures to prevent early unplanned pregnancy in the first place, what should a mature society do for that increasingly contrasting group who have a baby while still very young?  (the average age of first childbirth is now 28)

I wish to end by quoting one LEA’s summary comment to our 1994 Survey of educational provision for pregnant schoolgirls and schoolgirl mothers in the LEAs of England and Wales:

There are difficulties for some girls when the time comes to return to school - some are virtually unable to do so.  This could be overcome if tuition could be provided with Crèche facilities.  Present tuition arrangements provide for at least some of the girls’ educational needs but their very specific needs (on a personal and parental level) would be better met if they could work together in a group where their social and emotional needs could be professionally addressed.  Many girls are isolated in overcrowded homes with only tacit support from the child’s father.  Group tuition would provide mutual (‘hands on’) support and ante-natal care and counselling could be part of the routine.

 

Diana Noble and Dr Gillian Vanhegan -  ‘What young people want’

Diana Noble is the General Manger at the London Brook Advisory Centres - Talking first about what young people have indicated they want from sexual health services from some recent research work.

The first bit of research that I would like to talk about is a bit of research commissioned by Avon Health Authority and carried out by the department of sociology at the University of Bristol.  They did some in depth interviews with 147 14 to 21 year olds and they did a survey of 403 questionnaires over 8 young people’s clinic sessions in the Bristol area.  The findings were quite similar from both of the methods used, so the researchers were quite confident about what was said. 

The first thing that I thought was quite interesting was that young people were saying in terms of family planning clinics that they were rarely perceived as appropriate places to get advice on sex and related matters.  One wonders whether that has something to do with the term ‘Family Planning Clinic’ and how well young people relate to that.  Are young people planning families at 13, 14 and 15?  The sort of family planning idea is also very off putting for gay young men and lesbian young women.  Two thirds of those interviewed that were sexually active, only 50% knew where their local service was.  I think that if we think we are very good at are getting away from the term ‘family planning’ by using the term ‘sexual health’, it was all quite interesting that the term ‘sexual health’ was totally meaningless to the young people. 

So a number of factors emerged which constrain young people from making more use of services that are available.  The fear of anonymity and confidentiality is obviously key.  Young people looking for advice on sexual matters don’t particularly want that to be public knowledge.  The importance of clinic location, which links with the previous concern of anonymity and also important issues about location and travelling to local centres.   Waiting times and conditions - the sort of physical environment, and particularly the reception and waiting room area are thought to be really important, and certainly young people use the term welcoming an awful a lot.  And very important is the anticipation of judgmental attitudes.  I think that it is quite fair that for a lot of young people their experience of adults is of disapproval and it is of lack of respect, and they are going into a clinic were they actually don’t know what those adults are actually going to be like.  So, if your experience is of not receiving respect, then one can understand how you might anticipate that it might be judgmental.

So specifically in this particular piece of research work, what young people said they wanted from clinic services:-

Ease of access.  The service being near was seen as essential and again this is often linked to travel - particularly with regard to the cost of travel, but also that they might have quite limited geographical knowledge outside their immediate home and school area.

Anonymity - again linked to access.  50% of young people said they did or would feel embarrassed about going near a clinic. 

Offering a wide range of service - that helps with the anonymity and ease of access.  Young people also say that they want particularly the services of counselling and someone to talk to.

Appropriate publicity - frequent, casually and anonymously available are what young people are asking for.

Open every day or/and at least once over weekends.  This was in particular linked with emergency contraception and that fact that unplanned sexual activity is often at weekends, and one doesn’t want to wait for a one session per week clinic which does not open until next Wednesday. 

Able to drop in - being able to drop in was particularly important to under 17s, and there was a general feeling that appointments can be a hassle, so being able to just drop in was very important.

A telephone help line - especially important that if there is only a one or two day per week clinic in their area that there is some back-up in-between.

The comfortable and welcoming reception and the confidentiality issues were impressed more strongly by young people.  What happens at the reception area was is definitely seen as vital.

I think that there is one very clear message to remember from that work it is that if young people feel that there is confidentiality and that this isn’t disapproval, what you will get is trust, and when there is trust, then young people will be open to the services on offer.  That particular report makes 22 specific recommendations around clinic services for young people, which I clearly do not have time to go through, but I would be happy to let people know where to get hold of the report.

The second piece of research I want to talk about is something that we did at London Brook Advisory Centres as part of a service review, where we commissioned some independent research to run a series of focus groups.  These focus groups were not with current Brook Service users and they took place in schools and youth centres in North, South and East London.  We were particularly interested in the specific views of different groups of young people and from that work today I am looking specifically at aspects which effect access to clinic services.

So, first of all a group of young heterosexual women under 25.  In terms of factors effecting access, the travel issue comes up again - not prepared to travel.  Also apprehensive about staff attitudes and embarrassment.  So already we are starting to hear the same words, and this is continue because this work reflects the work of the Avon report.  What they wanted was a more personal image from services.  Discretion and integration, again anonymity by integration with other services.  They wanted a balance between something that is discrete, but also they wanted to avoid the kind of back street dingy image that some services have.    The under 16 showed always the main point as confidentiality, trust.  The focus group there was pretty split about services being available to young men at the same time.  They again wanted integration, with a particular emphasis on a need for the opportunity to discuss emotional family issues, and they wanted anonymity. 

Two groups of men.  Under 25s said that there was some embarrassment which made accessing services difficult, but generally speaking they didn’t see themselves having problems as such, and saw that services were really more for women and very much related the idea of a clinic service to a problem - and I think this is an issue worth much more exploring.  Having said that however, they did want more publicity.  Under 16 young heterosexual men, again apprehensive, embarrassment, fear of disapproval, they wanted more publicity, they wanted longer opening times.  Also, I think was particularly interesting, they wanted a specific area in reception for drop-in, so they could actually prepare themselves before approaching the service, and I think some of that is the kind of the sussing out, to see what it looks like, what’s happening etc. which is part of the finding out if there is a non-judgmental attitude.

We had a focus group with young lesbians, and again factors effecting access included the fact that clinic services have a very strong heterosexual image.  Again needing to travel was an issue.   What they said they wanted was sex education, and what they really needed to talk about the specific risks attached to lesbian sex, to talk about the developments of smears to lesbians, and there was a very strong feeling from this group that what they wanted was a service and that their needs were not being met by anybody.

There was another focus group with young gay men and young men unsure of their sexuality.  Access issues here were for safety, really on two levels, one of the kind of physical safety of using services and being out on the street, but also safety in terms of being able to explore the issues around their sexuality.  Confidentiality was very important.  In terms of image they felt that services had both a strong female and a strong heterosexual image.  There was a keenness to have general services for gay teenagers, because not all felt that they may be wanted to identify with a gay men’s service at that stage.  Peer support was very important here, good publicity, extra strength condoms, and this raises the question of what services we are offering in some clinics for some groups of people.  They wanted to be able to identify that there were gay staff, and counselling was also seen as being very important. 

We ran other focus groups with young people - young people with learning difficulties, young people who’s family language wasn’t English and young physically disabled people.  There isn’t time really to get into the detail that I could with the work with all the groups, but what I wanted to end by saying was that having a young people’s clinic is just the start, and it is issues such as confidentiality, and attitude and trust that really make the service accessible to young people.

Gillian Vanheagan is the senior doctor at London Brook - translating Diana Noble’s research in terms of service delivery and in particular what is staff are doing at London Brook Advisory Centres.

I would like to describe for you  the London Brook.  There is a waiting area that young people really wanted to be welcoming and hospitable. Normally this area is fairly jam-packed with young people sitting on the floor cushions.  We also have all the coffee making facilities for them, the radio that they can play and of course leaflets and posters.  Most importantly is the suggestions box, because we feel that we need a lot of feed-back from young people about the sort of service that they need, and over the last week I have been dipping my hand into the suggestions boxes as I go around the clinics.

They have all been very positive about the service that we give, but there have been requests for very material necessities.  Such as wanting a pay-phone in the waiting area so that they can contact their friends and tell them how long they will be, and perhaps that is because they sometimes have to wait a little while before they can be seen.  Also they wanted snack machines so that they could supplement the coffee.  But all very reasonable requests I think.

Brixton is very much one of those local centres where young people wanted to go locally, so that they didn’t have to travel, they didn’t have to explain why they were away from home for a certain length of time. A very large number of the young people using the Brixton centre, black British, west-Indian, mix-race, African, adds up to about almost half the number of clients that we see that the local population are very much using Brixton as their local centre.  And at Hayes and Redbridge on the outskirts of London where there is a very high Indian, Pakistani and Bangladeshi population there are using the centres there.  When young people come in they did ask for welcoming, non-judgmental staff, and obviously the first person that they see as they come into the clinic is the reception worker, and I know that all our reception workers are well trained to be non-judgmental and to be welcoming, as you can see, to the young people as they enter the service.  They are also able in most cases to take the young person into a room at the side to register them at the centre, so that they don’t have to stand in a big reception area with other people around, and talk about why they have come to use the service.  I think one of the things I would say is that as well as being non-judgmental is treating the young people with respect.  And that is what young people wanted.  They felt they had been criticised, they had been judged by parents, by teachers and so on, but when they came to use our service they really wanted not to be criticised but to be treated with respect. 

After being registered, they then use the centre, and we work in teams of nurses, doctors and counsellors.  Counselling is very important to the Brook service and because people come with a multitude of problems, it is important that they have access to all members of the team.  In this case you see one of our doctors working with our ‘posed client’.  Obviously here she is talking about contraception, but what we hope is that during a young persons travels through the centre, they are going to be well informed, to be given plenty of information about whatever they have come about, so that they are able to at the end of their visit make whatever choices they need to make around their sexual health, as Fay and Diane were saying ‘sexual health’ doesn’t mean much to young people, but we know what we mean by it, and we know that’s what we are helping them with and  whatever they bring to us, we hope to be able to advise and inform so that the young person is able to understand when they leave the centre.

I have mentioned the counsellor as well, and the counsellor has a very important part in the team.  She will generally see all under 16s when they first come along to the centre, and will see all the girls who are pregnant, and she will also talk to anyone who has relationship, emotional, or family difficulties, and anything else that may be worrying the individual.  So that at the end of the visit they may be able to make their choice.  As Fay was saying it may be ‘double dutch’ she may be using the pill but wanting to use some condoms as well and these will be given to her in a bag so that she can leave the clinic without everybody knowing exactly where she has been and what she has been there for. 

Diane was saying that young men felt that Youth Services had very specific female/heterosexual angle to them.  We have tried to develop (and quite successfully) in the London Brook Centres, young men’s drop-ins, and I could give a whole talk about how we have gone about developing a service for young men, we did try giving them their own separate centre at one stage, but that wasn’t what they wanted.  They wanted to come along as partners to young women, but they also wanted their own space within the clinic, and over the last week since these photos we have actually now got a completely separate area for them within the centre, and this is the major touch-screen system which breaks the ice.  They can come in, they can use this, they can access information and they can talk to members of the male team.  They get the idea about all the different things they can talk to our members of staff about, I don’t know whether you can see this, on the screen it says ‘safe sex’, ‘keeping safe’, ‘contraception’, ‘conception and pregnancy’, ‘HIV’, ‘AIDS’, ‘Confidentiality’, they can tap into information on any of those aspects of sexual health.  Most importantly, contraception, because contraception does involve young men.  It is extremely important if his girlfriend happens to be on the pill, that he knows simple things like anti-biotic stopping the pill working, if she forgets the pill it’s not going to work, so he knows he has to use his condoms.  Contraception is not just the domain of young women. 

We developed a special consultation card for young men because like in most clinics, we had a very specific gynaecological card about periods and so on, so we now have this card for young men, because it is more suitable to be talking to them about lifestyle, about drugs, about diet, and as Fay was saying, the very important advice which must be given around testicular self-examination.  To talk to them about AIDS, HIV, and STDs. 

So that is what we have achieved in our local centres.  This is how we publicise them, this is our map of where they all are.  We do have a central city centre which is in Tottenham Court Road, because although most people want to go to their local centres, some of them want to come to Tottenham Court Road for anonymity.  I come from West Wales and I was sitting at work in Tottenham Court Road one day when a young girl came trough the door, and she had travelled 220 miles to seek anonymity, and you have probably guess it, our parents live in the same street back home!  But some people really will travel a long way.

As well as our local centres, we go out to young people.  When Diane was presenting her information, she was saying how people wanted very easy access, they didn’t want to travel far, so the best thing we can do is go to them, and this is one of our newest outreaches in West London - Brook Out West.  As you can see we are there at weekends for them.  There are 14 youth workers in the team and three administrating nurses.  Administrating nurses may be a term you are not aquatinted with.  We have trained this nurses so that, working to a specific protocol, they can give emergency contraception, they can give the contraceptive pill, to a young person who comes to these outreach projects and then within a few days and then have the prescription countersigned by a doctor.  This increases access to emergency contraception and contraception for young people.

Another terrific outreach project, is going into inner city, into Islington College, where once a week we go in and have a very devoted clientele who just don’t have to travel because we are there on the spot, which is just what young people wanted.

I have been saying for some years that we really needed to go to the young people, and my favourite outreach project is Camden and Islington Health Bus, which we use this bus for three hours every Monday afternoon from 3 to 6pm.  We take the Health Bus and we park it near to one of the big North London Schools, Parliament Hill Fields or Highbury Fields.  And when I was working on the health bus a few Monday’s ago we had 50 young people who came in to access the information that we were giving in the three hours.  It is hard work, but extremely valuable work.

Young people didn’t see themselves as actually knowing what information they needed to access.  This came out of the Bristol survey.  So on the Health Bus we have all the information about alcohol abuse, about drugs, about diet, we get asked all kinds of questions about acne, about smoking, and also at the back of the bus, is a small room, a medical room, so that if somebody needs emergency contraception, or the pill or condoms, we can take them in there and the doctor or administering nurse can talk to them absolutely privately.  It was interesting the other Monday as well, I was working with a male outreach worker, and when the boys came onto the bus they tended to gravitate towards him and the girls gravitated towards me, and we did see really quite young 11 or 12 year olds, which as Fay was saying, before they are sexually active when so much good work can be done with young people at that stage.

In all surveys what young people want when they come to services is confidentiality.  We know that the duty of confidentiality owed to a person under 16 is as great as that to any other person.  I was absolutely horrified in the group I was in at lunchtime today to hear somebody say they had actually seen on the wall of a  waiting room of a general practice a notice which said ‘no 16 year old will be seen without their parents’.  I hope that that is a very rare event.  Doctors are bound by the General Medical Council, and we know that patients are entitled to confidentiality, but that runs through all workers with young people in Brook.  And it is no good just us knowing it is a confidential service, we have to let the young people know it is a confidential service, and this is a very useful leaflet for any of you who have contact with young people, and I will be putting them out on the table in a moment. 

And so to finish up on a lighter note.  These are some of our members of our outreach team demonstrating just how much a condom will stretch and if you don’t put a condom on the right way you put your foot in it..... Thank you.