Health Education Research, Vol. 16, No. 4, 509-510,
August 2001
© 2001 Oxford University Press
BOOK REVIEW |
Tackling Teenage Pregnancy: Sex, Culture and Needs
Ruth Chambers, Gill Wakley and Steph Chambers Radcliffe Medical Press, Abingdon, 2001 211 pp. ISBN 85775 497 2
Research Officer, Faculty of Health, University of Brighton
Tackling Teenage Pregnancy: Sex, Culture and Needs is a refreshing guide to a highly topical subject area. The authors take an holistic approach to the issue, and encourage professionals from the health service, education and voluntary sectors to work together to achieve the goals set out in the latest report from the Social Exclusion Unit (Department of Health, 1999
).
It is aimed particularly at those working in primary care, but is also relevant to social workers, PSE teachers and parents—anyone working or living with young people.
What is impressive about it and makes it different to other books on the same issue is its involvement and consultation with young people. One of the listed authors (presumably related to another one of the authors from the surname) is a 14-year-old girl. A significant amount of the Preface is written by Anna Brown, a 16-year-old schoolgirl, whose views on contraception, sexual health information, risk-taking, peer pressure and Roman Catholic schools introduce the reader to the topic from a young person's perspective.
Before analysing in more depth the content of the 14 chapters, I should like to comment on the readability of this book. It is set out very much like a school textbook, with an above-average font size, text interspersed by reader-friendly titles, with examples in shaded boxes and some great cartoons!
Chapter 1, the Introduction, covers the background to teenage pregnancy, including the statistics, which show that the UK still has the highest teenage pregnancy rates and teenage abortion rates in Western Europe. The chapter also begins to examine the risk factors for teenage pregnancies and why the rates in the UK are so high. Not only are we presented with the latest research on the aetiology of teenage pregnancies, but also the last part of this chapter gives us a selection of young peoples' views. These assist the reader to understand what the real issues are: peer pressure, lack of openness and information about sexual matters, and a reluctance or difficulty of accessing contraceptive services. The young people also seem to have a strong sense of the same dilemma mentioned by a teenager in the Social Exclusion Unit Report that `sex is compulsory, but contraception is illegal' (Department of Health, 1999).
The second chapter on `Effective interventions and practical initiatives' describes the importance of targeting those who are most at risk and taking account of the local context. The authors describe a range of country-wide initiatives to combat the high teenage pregnancy rate, giving examples of best practice, such as the local strategy developed by Leicester City multi-agency group and also the Health Action Zone Innovations project based in Stoke on Trent. The emphasis is on partnership working which involves all key stakeholders, including young people. The 14-year-old author, Steph Chambers, points out that there is still a great deal of ignorance about family planning clinics—they need to target young people more effectively when they are advertising their services. The chapter ends with the conclusions from a workshop of health and education professionals from North Staffordshire, which emphasize the need for a complete culture change.
In Chapter 3, the authors discuss how to use clinical governance to tackle teenage pregnancy rates and improve access to and availability of contraceptive services for young people. They provide a framework that emphasizes the links that are required between the clinical governance programmes of individual practices, primary care groups/trusts, NHS trusts and the district as a whole. The ultimate aim is a seamless service provision where contraceptive services are complemented by both abortion services and GUM services, and the sexual health needs of all the population including teenagers are met.
Chapter 4 concentrates on reaching young people, trying to create a more open culture as they have in the Netherlands and also stresses the importance of genuinely consulting young people about service provision, not in a tokenist manner.
Young people in the UK remain deeply concerned about their parents finding out about their sexual activity. Chapter 5 provides a comprehensive guide to confidentiality and young people, referring to the guidance from the Department of Health, which came out last year (Department of Health, 2000). The authors clearly explain the exceptions to the rules on confidentiality.
The next chapter covers all the contraceptive methods, including emergency contraception, with particular reference to young people. The authors use simple, non-medical language.
The Social Exclusion Unit report (Department of Health, 1999) mentioned previously does not stop at preventing teenage pregnancy, it also stresses the importance of providing support and provision for pregnant teenagers and young parents including good antenatal care and continuing education. The following chapter follows on from this example, drawing attention to the reality of being a teenage parent, many of them living on benefits in poor housing without sufficient support, often isolated from family and friends.
Chapter 8 looks at the options open to a teenager with an unplanned pregnancy, including in brief, adoption and keeping the baby. There is a more lengthy section on abortion, including contact information for charities such as British Pregnancy Advisory Services, Marie Stopes and the Brook Advisory Services.
There are also chapters on misconception and myths about sex and contraception; sexually transmitted infections; and how to meet the needs of teenagers with learning or physical disabilities, which provided plenty of relevant information.
Chapter 12 on `Culture, religion and beliefs' tries to cover too much. Some issues which might fall under the heading of `cultural', such as the sections on gender and sexuality, regretted sexual intercourse, and on youth culture, would have been better in a separate chapter to the discussion of different religious attitudes to sex, sexuality and contraception. As it stands, it feels `cobbled together'.
The chapter on `Abuse and teenagers' is brilliant, clear and extensive. It compares the emotional and physical symptoms of rape victims to those of a child who has suffered sexual abuse. It alerts health professionals to the signs of abuse by certain problems presented by adolescents, including truancy, anorexia and emotionally withdrawn behaviour.
The final chapter on the influence on teenagers of peers, the media and the press is interesting and up-to-date. It describes the role that TV, the Internet and teenage magazines can have in providing information for young people on sex, contraception and relationships.
Call me old-fashioned, but I would have liked a conclusion at the end of this book. Alternatively we could have been given a final comment from one of the young people so admirably involved in the writing of the book.
Apart from a few very minor criticisms, this book is superb and I would recommend it to anyone who has an interest professionally and to parents with adolescent children.
References
Department of Health (1999) Teenage Pregnancy. Social Exclusion Unit, Department of Health, London.
Department of Health (2000) Contraceptive Services for Under 16-Year Olds: New Guidance for Health Professionals. Health Services Circular. Department of Health, London.
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