Walsall Council and Walsall NHS Trust have a dedicated teenage pregnancy team, funded by Walsall Public Health, with more than twenty years’ experience of providing both support and prevention initiatives across the borough.
In comparison to national, regional, and statistical neighbours, Walsall has an historically low proportion of under-18 conceptions leading to abortion. This posed a question of whether the young women were making a positive choice to continue the pregnancy or facing barriers to accessing abortion care. Local data also found significant numbers of second subsequent pregnancies. To ensure all pregnant teenagers received the right care at the right time, the multi-agency teenage pregnancy strategy meetings developed new processes and referral pathways with key stakeholders.
The Walsall Teenage Pregnancy Team is well established and has strong partnerships with schools and partner agencies across the local authority. Schools, colleges, and other agencies notify the team for early support to ensure any pregnant young person receives unbiased advice and support, including from a trained pregnancy counsellor, so they can make their own well-informed choice at the earliest stage of conception. Confidential sources of pregnancy testing and pregnancy options advice are publicised as part of wider sexual health promotion to young people in education and community settings.
For those who choose to continue the pregnancy there is a ‘parents to be’ pathway for 16 to 19-year-olds with holistic care from support workers within the Health in Pregnancy (HIP) service. The Teenage Pregnancy Team receives notification from the midwifery service of all registered pregnancies under 20 years, and to ensure any vulnerability is identified early, works together with the HIP service Lead to triage cases monthly and arrange additional support. Those of school or college age also have a dedicated teenage parent worker, a specialist midwife, and a named Education Welfare Officer. A dedicated fathers worker supports young fathers through the HIP programme. At thirty-two weeks of pregnancy all under-20s see a sexual health adviser to discuss post-pregnancy contraception options, with their chosen method provided post-delivery at the hospital or within the community.
For young women who decide not to continue the pregnancy, Walsall Teenage Pregnancy Team have a strong partnership with BPAS, the abortion provider. An abortion referral pathway for schools, colleges and other agencies provides access to a named contact within BPAS which supports professionals when advocating for young people to secure timely local appointments. BPAS also has a representative on the Teenage Pregnancy Reduction Strategy group who can be contacted if there are specific access difficulties such as an appointment being offered too far from the young person’s home or helping to accelerate an early appointment to enable medical abortion. This has proved invaluable in providing bespoke support for young women in Walsall.
Post-abortion contraception is offered as part of the BPAS contract, either provided at the end of the abortion process or through referral to WISH, the Walsall sexual health provider. Post-abortion support is also available through BPAS, via phone or face to face, and from a counsellor in the Teenage Pregnancy Team.
Following the establishment of the new pathways, there has been an increase in the proportion of young women choosing not to continue their pregnancy and a reduction in second subsequent pregnancies. The strong partnership between the Teenage Pregnancy Team, maternity service, abortion provider and Walsall sexual health service has not only ensured smooth referral pathways but also provides the Team with real time conception data which helps inform targeted prevention work.
Lessons learned
- Early support and clear referral pathways are essential in supporting young people to navigate unbiased, timely interventions to support decisions based on informed choices.
- Direct links to professionals like midwives, health workers, and BPAS representatives have facilitated smoother transitions between care services, reducing waiting times and barriers to access.
- Local 2nd subsequent pregnancy data collection has provided the evidence base for the post pregnancy pathway and to continue the contraception offer on maternity wards.
- The intervention strategies, particularly the focus on supporting young women who have already experienced pregnancy, have led to a decrease in repeat pregnancies, suggesting that the care provided is helping to address underlying issues such as lack of contraception or sexual health education.
- Teenage fathers need to have access to the same professional support as mothers to ensure that they can thrive in their parenting roles and provide the best possible environment for their children.