NHS Health Scotland

 

Evidence
 

Enabling young people to access support for their health, social and economic needs.

Link through the outcomes (4a)

Actions to understand the health, social and economic needs of young parents in the locality will contribute to the development of needs-lead services. This will contribute to greater awareness of, and confidence in using, services by young people and ultimately to greater engageement and uptake of a wider range of services. . In the longer term, this will contribute to reductions in subsequent unintended pregnancies in young people and improved health and social outcomes for both the young parents and their children.

Summary

Supporting the social, economic and health needs of young parents

  • Young parents experience a range of problems in relation to housing, childcare, finances, education, training and employment. Common themes include diverse needs and lack of choice; stereotypes of teenage mothers; reliance on family; consideration of the cost and benefits of education and employment; and continuation of social problems prior to pregnancy. (1)
    Actions to meet these needs may contribute to improved life courses for teenage parents.

  • A number of actions for social inclusion have been proposed on the basis of the available qualitative and quantitative evidence. (1)

  • There is evidence that enhanced home visiting is effective in increasing maternal employment as well as reducing use of welfare, number of arrests and convictions. (2, 3, 4)

  • There is limited highly processed evidence about the experiences of young fathers and how to effectively and appropriately engage them in services to improve outcomes for themselves, their partners and their children. There is promising evidence from evaluations of Family Nurse Partnership (FNP) and Sure Start Plus which begin to address this area. (5, 6)

 

Support to control reproductive health and pregnancy spacing

  • There is strong evidence that Long Acting Reversible Contraception(LARC) is the most effective and cost-effective form of contraception. (7) NICE Clinical Guidance 30 provides recommendations about the provision of advice and effective contraception in maternity services for young people. (8)
    Chief Medical Officer (2015) 19 letter is a key driver for the provision of advice about effective contraception (including LARC) for women, particularly vulnerable women, prior to discharge from maternity services in Scotland. (9)

  • There is evidence that enhanced home visiting beginning antenatally and extending up to 18 months by professionals (such as the Family Nurse Partnership) can reduce rapid repeat pregnancy and births and increase the spacing between first and second births.(4) FNP (based on studies of the Nurse-Family Partnership model) can have a range of positive short-, medium- and long-term benefits for mothers and their children, in particular cognitive and language outcomes for children.( 2, 3,4, 10)

  • There is mixed evidence about the effectiveness of community based interventions in reducing repeat pregnancy. Some studies of home visitor programmes and peer support programmes showed a positive impact on reducing repeat pregnancy, while others found no effect on repeat pregnancy. There is evidence from single studies that sibling pregnancy prevention programmes and generic programmes may be effective in preventing repeat pregnancy and subsequent birth. (11)

  • There is good evidence that intensive care management, a school-based programme delivered by culturally matched social workers as part of a multicomponent intervention, may have a positive impact on reducing repeated pregnancy.(12)

  • There is good evidence that curriculum interventions which include community outreach may be effective in reducing pregnancy rates and some evidence that this may be particularly the case for teenagers who are already parents. (12)

HIIA note:

The reviews of effectiveness of interventions to reduce repeated pregnancy among young mothers under the age of 25 included interventions which target socially disadvantaged young women.

References:

  1. Harden A, Brunton G, Fletcher A et al. Young people, pregnancy and social exclusion: A systematic synthesis of research evidence to identify effective, appropriate and promising approaches for prevention and support. London: EPPI-Centre, Social Science Research Unit, Institute of Education, University of London; 2006.

  2. Geddes R, Haw S, Frank J. Interventions for promoting early child development for health: an environmental scan with special reference to Scotland. Edinburgh: Scottish Collaboration for Public Health Research and Policy; 2010. Available at : http://www.scphrp.ac.uk/wp-content/uploads/2014/03/1454- scp_earlyyearsreportfinalweb.pdf (accessed 3 June 2015).

  3. Scott E. Briefing on the Family Nurse Partnership. Edinburgh: Health Scotland; 2013. Available at: http://www.healthscotland.com/documents/6089.aspx (accessed 3 June 2015).

  4. Family Nurse Partnership National Unit. FNP evidence summary leaflet. London: Department of Health; 2011. Available at: https://www.gov.uk/government/publications/evidence-base-for-family-nurse- partnership-fnp (accessed 3 June 2015).

  5. Barnes J, Ball M, Meadows P et al. Nurse-Family Partnership Programme: first year pilot sites implementation in England. Pregnancy and post-partum period. London: Department for Children, Schools and Families; 2008. http://fnp.nhs.uk/research-and-development/published-research (accessed 3 June 2015).

  6. Wiggins M, Rosato M, Austerberry H et al. Sure Start Plus National Evaluation: Final report. London: Social Science Research Unit Report, Institute of Education: 2005.

  7. National Collaborating Centre for Women’s and Children’s Health. Long-acting reversible contraception: the effective and appropriate use of long-acting reversible contraception (update 2013). Commissioned by the National Institute for Health and Clinical Excellence. London: RCOG Press; first published 2005. Available at: hhttp://www.nice.org.uk/Guidance/CG30/Evidence (accessed 3 June 2015)

  8. National Institute for Health and Care Excellence. Long-acting reversible contraception: NICE Clinical Guideline 30. Available at: http://www.nice.org.uk/guidance/cg30 (accessed 3 June 2015).

  9. CMO letter (2015) 19. Health Promoting Health Service: action in secondary care settings. Edinburgh: Scottish Government; 2015.Avaialble at: http://www.sehd.scot.nhs.uk/cmo/CMO(2015)19.pdf (accessed 3 June 2015).

  10. Robling M et al. Effectiveness of a nurse-led intensive home-visitation programme for first-time teenage mothers (Building Blocks): a pragmatic randomised controlled trial. The Lancet 2016; 387 (10014): 146–155. Available at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00392- X/abstract (accessed 3 June 2015).

  11. Blank L, Payne, N, Guillaume L et al. A review of the effectiveness and cost- effectiveness of contraceptive services and interventions to encourage use of those services for socially disadvantaged young people: services and interventions in community settings. Sheffield: University of Sheffield School of Health and Related Research (ScHARR); 2010. Available at: http://www.nice.org.uk/guidance/ph51/evidence (accessed 3 June 2015).

  12. Blank L, Payne, N, Guillaume L et al. A review of the effectiveness and cost- effectiveness of contraceptive services and interventions to encourage use of those services for socially disadvantaged young people: Services and interventions in educational settings. Sheffield: University of Sheffield School of Health and Related Research (ScHARR); 2010. Available at: http://www.nice.org.uk/guidance/ph51/evidence (accessed 3 June 2015).