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The issue

Bethany Britney Platt will be two this June. Her mother will be 15. Sarah-Louise conceived the first time she had sex; it was five months before she realised she was pregnant. Sarah-Louise, the daughter of a working-class Lancashire lass with a chequered past, is a stereotypical teenage mum - as the scriptwriters of Granada's Coronation Street well know.

Health minister Yvette Cooper has used the soap's award-winning storyline to bolster the Government's drive against teenage pregnancy. It is an issue that guarantees media attention; the tabloids cannot resist "gymslip" mums. Their salaciousness is a comment on a country ill at ease with its attitudes to teenagers and to sex. And the losers are too often those who stumble into early parenthood.

How many teenagers get pregnant?

More than 97,000 teenagers became pregnant in England and Wales in 2000, according to the Office for National Statistics. Of these, 41,000 were under 18; 8,100 under 16; 1,890 under 15; and 395 under 14. Roughly half of all these pregnancies ended in abortion.

Reported teenage pregnancy rates have increased steadily since the late 1950s, rising steeply following the liberalising 1967 Abortion Act. In 1998, teen conceptions fell by 6 per cent or 4,000 pregnancies. They fell again in 1999 and 2000, though under-age conceptions rose slightly.

International perspective

The UK's level of teen pregnancy is the highest in western Europe, and we have the greatest number of single teenage mums in the world. (The US has a higher teen pregnancy rate - 97 per 1,000 - despite the popularity of "abstinence education", but more young mothers there marry, so there are fewer single parents.) Roughly 40 per 1,000 women under 18 become pregnant every year, a rate that is twice that of Germany, four times that of France and 10 times that of the Netherlands. The UK was level with these countries 25 years ago. It fares better in comparison with other English-speaking nations such as Canada, the US and New Zealand.

What happens in the Netherlands?

Dutch teenagers tend to start having sex a year later than their British counterparts, research by Southampton University in 1999 showed. Three girls in four are on the Pill the first time they have intercourse and going "double Dutch" - using a condom as well - is common. They are encouraged to talk about sex at home and at school, where teachers have considerable freedom about how they teach the subject. Young Dutch people are urged to think before they act, and then act responsibly. Most will be told about the pleasures of sex - even materials produced by the Dutch Catholic church emphasise the positive aspects of making love. In the UK, sex is often portrayed as "dirty" and illicit - and therefore desirable.

Early to bed

Low self-esteem, ignorance, and the problems of growing up in a society that mixes Page 3 with prudishness make teenagers vulnerable to pressure to have sex. And they are having it earlier than they used to, and with more partners. In the early 1950s, the average age of first intercourse was 21; now it is 16. One in four women and one in three men have sex before they are 16, although most women who had sex at 13 or 14 say they wish they had waited, as do almost half of the men.

Who gets pregnant?

Teen pregnancy affects all social classes. The UK's most affluent areas have pregnancy rates that are high by European standards. Promising job prospects are a good birth control - pregnancies rise during a recession.

Girls from deprived backgrounds, with little education and less hope of work, are 10 times more likely to become pregnant than the offspring of professional parents. They are likely to be from broken homes and to have a history of truancy. Many will have been brought up in the inner city by their own teenage mums. In Southwark, south London, the conception rate in the 1990s was five times higher than in the affluent Chilterns - 85 per 1,000 under-18s compared with 15 per 1,000. But research has failed to prove the popular belief that single mums got pregnant to get a council flat; few have any idea what benefits they are due.

Girls growing up in care are also vulnerable. A quarter of girls leaving care become pregnant before they are 16, with another quarter conceiving within two years, according to the National Children's Bureau. Bangladeshi, Pakistani and African-Caribbean teenagers are also at greater risk than their peers, though there are no reliable statistics.

Contraception and confidentiality

One teenage mum told the Government's social exclusion unit (SEU), when it was putting together a report on early pregnancy in 1999, that it seemed as if sex was obligatory, but contraception was illegal. Unsurprisingly, about three out of four teenage pregnancies are unplanned. Half of under-16s and a third of 16 to 19-year-olds use no protection the first time they have sex. Many carry on using no contraception or using it erratically. If they do use any, they tend to choose the Pill or condoms.

But, says the teenage pregnancy advisory group, a Government body set up in the wake of the 1999 SEU report, new long-acting contraceptives, including injectables and implants, may suit disorganised 16-year-olds. GPs are not paid to offer implants - or dispense free condoms.

Teenagers worry about being "found out" when using vending machines, the local chemist, or their family GP to get contraceptives. But where they have been able to go in private for free to a young people's service, conception rates have fallen. The advisory group wants all teenagers to be able to do this - in their town or their secondary school.

The advisory group says preventive work in schools is vital to reduce teenage pregnancy rates. School nurses, often the first people teenagers turn to, have a key role to play and some schemes allow them to prescribe emergency contraception.

Under-16s are legally entitled to confidential advice and contraception in line with government guidelines that say, broadly, if a child understands the advice, he or she is mature enough to act on it.

Some schools are using noticeboards to tell pupils where to get information and contraception. Teachers also need to be clear about what they can do if pupils come to them afraid they are pregnant or wanting contraceptive advice. Unless the head says otherwise, they can advise pupils, even if they are under 16, without telling their parents.

Simon Blake, of the National Children's Bureau's sex education forum, says a good school policy should enable teachers to "get alongside" teenagers and work out what they want. But he worries that teachers are still fearful of answering questions such as,"Why do people have sex?" (The answer, he suggests, is,"Because it feels nice.") Under-16s cannot buy the "morning-after" pill from pharmacies, though they can get it free from clinics. There are fears that the pound;20 cost of this pill is too high for many teenagers, anyway.

Abortion

Roughly half of all teenage pregnancies end in abortion - a smaller proportion than in many European countries. The better-off the family, the greater the likelihood of the girl terminating a pregnancy. In West Surrey, 50 per cent of teenage pregnancies end in abortion, more than double the ratio in Barnsley. Young women in poorer areas tend to disapprove of abortions, considering them the province of the well-off "who have something to lose", according to the social exclusion unit. They were also more likely to fear being stigmatised. The Government is being urged to ensure that all pregnant teenagers can have an early NHS abortion, if that is what they want.

Medical issues

Babies born to teenage mothers tend to be lighter and more likely to die than babies born to older women. Pregnant teenagers need good antenatal care, but often fail to get it. They frequently fail to seek help for weeks. Sometimes their periods have not settled down and they do not know they are pregnant. Sometimes they worry that their boyfriend will be prosecuted for having under-age sex, or fear that the pregnancy is the result of an incestuous relationship. Once the baby is born, four out of 10 teenage mums suffer from postnatal depression.

Why is teenage motherhood a problem?

Traditionally the future for teenage mums has not looked bright. While some manage well, they are more likely than other lone mothers to get by on benefit. Last year, only one teenage parent in three was training, learning or working - a huge improvement, nevertheless, on the 1997 figure of 16 per cent.

Research cited by the social exclusion unit found that by the age of 33, women who had given birth in their teenage years were more likely to have no qualifications, to be poor, to be divorced or separated, to be living in social housing, and to have a large family. Their children are similarly at risk.

What is the Government doing?

When the SEU published its report, it estimated that teen pregnancies cost taxpayers pound;10 billion a year. A pound;60 million campaign was launched, aimed at halving the rate of conceptions by 2010 and supporting teenage parents at school and in training. But a report from Unicef released last month shows that Britain still has "alarmingly high" rates of birth to women under 20. The Government has tried to encourage young people to behave responsibly. It insists that improved sex education is essential and that it does not promote promiscuity - rather the opposite. Fresh guidance was released in 2000 which is making an impact, according to Ofsted. Its report, Sex and Relationships, published in April, said schools needed to move beyond the bare facts of life and teach about parenthood, relationships, and prevention of infection.

Increased emphasis is being put on teacher training. A teenage pregnancy unit has been set up with a national network of staff. Helplines, such as Sexwise and RUthinking (see Resources), have been supported, as have various advertising campaigns.

The Government insists that pregnancy and motherhood are not grounds for exclusion from school, and has spent about pound;10 million on getting young mothers back into education. It is not easy. Many say they were forced out, and cannot go back because of the stigma and lack of childcare. Others say they were treated insensitively by their teachers and bullied. Some get places in special units, but no one seems to know how many such places there are. Even good practice is under threat. The Genesis project, run by the Mothers' Union in Wakefield, provides support, equipment and, crucially, a creche. The local authority wants to close the unit. Most of the girls say they will not go back to school if this happens.

Teenage dads

"There are few ways in modern society where boys and young men can demonstrate maturity and achieve social status among their peers. Sex has become an important rite of passage to them." So says the teenage pregnancy advisory group, acknowledging that boys have been neglected. Many have felt alienated from the basic biology that passed for sex education, usually taught by women.

Like young mums, teenage dads usually come from deprived backgrounds. They are more likely than their peers to have been in trouble with the police - around one young male offender in four is thought to be a father. But not all stereotypes hold true. Last year the Prince's Trust reported that three-quarters of young dads thought fatherhood was "good" or "very good" while those who had lost touch with their children felt great pain.

Sex and relationship education

So how do teenagers find out about sex? The answer has often been that they don't. Teenagers last year told Doctor magazine that a Coca-Cola douche would stop pregnancy, as would standing on a phone book. Sex education has been seen as too little, too late and too biological, with too little discussion of emotions, relationships, self-respect - and how to be assertive. And innovative schools with good sex education have been reluctant to boast, for fear of attracting media attention. News last year that a pregnant 12-year-old in Rotherham did not know which of five men was the father of her child prompted the charity Barnado's to call for sex education in primary schools. This is in line with what the Government suggests, but does not enforce. Similarly, it has still to make personal, social and health education - through which most sex education is taught - a statutory part of the curriculum.

But the situation is improving. Simon Blake, of the National Children's Bureau, says the latest guidelines are "the best we have ever had". The tone has changed, the subject is less frightening for teachers. Previously, the politicisation of sex education undermined their confidence. Teacher-training is also improving. Ultimately, PSHE should be taught by a specialist rather than a young teacher with a few hours to spare and, says the forum, it should start with four and five-year-olds.

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