Young fatherhood challenges for policy and practice University

Young fatherhood: challenges for policy and practice University of Leeds: 30 September 2015 Alison Hadley, Director, Teenage Pregnancy Knowledge Exchange, University of Bedfordshire and Teenage Pregnancy Advisor to Public Health England Alison. hadley@beds. ac. uk

Unplanned pregnancies: positive choices and positive futures starts with prevention The benefits of getting support right Young fathers experience of support services Making the case for young fathers support Winning hearts and minds!

Positive choices and positive futures starts with good prevention

Unplanned pregnancy is highest among teenagers 29/31 of the young fathers in the study didn’t plan the pregnancy Unplanned does not mean unwanted or diminish the later joy and excitement but is associated with poorer outcomes for parents and their child With the benefit of hindsight, young fathers would have delayed entry into parenthood… “The problem is I am still growing up. I am discovering who I am and what I want to do. If I was 25, 26, I’d know who I am a bit and would have a more established life”

Teenage pregnancy rates: up or down?

Under 18 conception rate | 1998 -2013 a 48% reduction! 6

All LAs have reduced rates but large variation across the country Teenage conceptions: progress 1998 -2013 7

Positive choices require knowledge and skills: a reminder of the evidence on prevention Provision of high quality comprehensive sex and relationships education in school, at home and in the community, for boys as well as girls, including healthy relationships, consent, contraception, abortion, parenting, combined with… Easy access for young women and young men to free, confidential youth friendly contraceptive services and condom distribution schemes Universal and targeted for young women and young men. SRE and contraception provision for all, with more intensive support for young people at risk, combined with building self esteem and aspiration – providing ‘means and motivation’ to delay parenthood . . Delivered through a ‘whole systems’ approach

Delivered through a ‘whole systems’ approach: 10 factors for an effective local strategy SRE in schools and colleges Co-ordinated support for teenage mothers and young fathers Strong use of data for commissioning and monitoring of progress Youth friendly contraceptive/S H services and condom schemes Strategic leadership & accountability Targeted prevention for young people at risk Support for parents to discuss relationships and sexual health Consistent messages to young people, parents and practitioners Advice and access to contraception in non-health youth settings Training on relationships and sexual health for health and non-health professionals

Where do young men get information about sex and relationships?

Where would young men like to get information about sex and relationships?

The benefits of getting support right for young fathers: good support improves outcomes

Poor child health outcomes • 21% higher risk of preterm birth and 93% higher risk for second pregnancies • 15% higher risk of low birth weight • A third higher risk of stillbirth, 41% higher rates of infant mortality and double the risk of sudden unexpected death in infancy (SUDI) Affected by … • Late booking for antenatal care (on average 16 weeks) • Three times higher rate of smoking during pregnancy • A third lower rate of breastfeeding • Poor maternal nutrition

Poor emotional health and well being • Three times the rate of post-natal depression of older mothers • Higher rates of poor mental health for up to 3 years after the birth: parental depression is the most prevalent risk factor for poor child development outcomes • Higher risk of partnership breakdown and isolation • More likely to live in poor quality housing Affecting the well being of their children and contributing to: • Higher accident rates - such as from falls and swallowing substances • More behavioural problems - conduct, emotional and hyperactivity problems

Poor economic well being • 21% of all young people not in education, training or employment are teenage mothers or pregnant teenagers • By age 30, 22% more likely to be living in poverty than mothers giving birth aged 24 or over • Much less likely to be employed or living with a partner • Young fathers twice as likely to be unemployed at age 30 – even after taking account of deprivation Which also affects the economic well being of their children who have: • 63% higher risk of living in child poverty • Lower academic attainment • A higher risk of unemployment and low income in later life

Poor outcomes may be influenced by existing vulnerabilities Factors associated with early motherhood: Free school meals eligibility Persistent school absence by age 14 Slower than expected school progress between ages 11 -14 Looked after children and care leavers: 3 times rate of motherhood <18 Young people who have experienced sexual abuse and exploitation Young people with conduct disorders and mental health problems

Poor outcomes may be influenced by existing vulnerabilities Young fathers are more likely than older fathers, and than other young men: • To have been subjected to violent forms of punishment at home and are twice as likely to have been sexually abused • To have pre-existing serious anxiety, depression and conduct disorder • To have been in contact with the police or in a YOI/prison • To drink, smoke and misuse other substances • To have poor health and nutrition • To have double the risk of being unemployed at age 30 – even after taking account of deprivation

Poor outcomes are not inevitable with dedicated support and effective partnership working Solution to improved outcomes rests with a range of services working together – health, education, social care, youth support services, housing, the voluntary sector and Local Enterprise Boards Key ingredients of effective support are: early identification and needs assessment in the antenatal period, dedicated support from a lead professional – coordinating and drawing in specialist services as necessary Family Nurse Partnership: intensive support for first time young mothers (and young fathers) from family nurse, from no later than 28 weeks of pregnancy until child reaches two.

The importance of involving fathers The vast majority of young fathers want to be involved! 75% of babies to teenage mothers are jointly registered with the father; only 20% are sole registrations Young fathers have a strong influence over young mothers’ attitudes and decisions about smoking and breastfeeding, so contribute to reducing the risk of infant mortality, SUDI and childhood asthma A good relationship with the baby’s father and supportive behaviour by him is a protective factor for postnatal depression • Highly involved fathers (even if the couple don’t remain together) is associated with better outcomes for the child - emotional, behavioural and educational • Fatherhood can be a catalyst for young men to fulfil their own potential, promoting personal growth and re-engagement in education and reducing the risk of adult and child poverty

Dedicated, coordinated support, inclusive of young fathers recommended by Ofsted Pre-birth assessments are crucial to identify problems early Teenage parents are sometimes children in need in their own right, with their own needs under-estimated (e. g. mental health, DV, alcohol and drugs) Assessment of pregnant teenagers must take into account their family background with the young father and grandparents key Transfer of care is critical between maternity, health visitors, children’s centres and GPs, with on-going coordination vital to keep in close contact during frequent housing moves Young parents need to be supported in an environment in which they feel comfortable and supported The role of father is too often marginalised; fathers need support to become good parents

So no doubt about the benefits, but what is young fathers’ experience of support

Barriers to accessing services: potential apprehensions of young fathers Young fathers: May have a number of vulnerabilities and never had a trusted adult in their lives May anticipate judgmental attitudes from staff May mistrust confidentiality and the overlap with social services May worry about asking for advice in case practitioners think they can’t cope. . and their apprehensions are compounded by practitioners’ assumptions that young fathers are ‘a problem’, lack of awareness of the importance of their involvement and a lack of confidence and training in positive engagement with young fathers

Which can lead to approaches that exclude young fathers from the support they need Surveillance of young fathers – which, without support to address their needs, undermines confidence and potential for change ‘I feel like I’ve got to act perfect…do what they say and if I don’t then summat bad is gonna happen. . ’ Sidelining – which, if accompanied by judgmental staff attitudes fosters mistrust and cements young fathers disengagement from services ‘It was like I wasn’t there. They didn’t speak to me. They didn’t involve me…’ ‘I said (to the midwife), how come you never address me? When you’ve got something to say about my son you never tell me…and she just said it’s easier and she’s mum after all…’ ‘When we showed them our birth plan and I was going to be there, the midwife said, ‘I expect you’d rather be out with your mates. ’

…but good universal and specialist services, can provide very different support Universal maternity services: ‘ [The hospital staff] involved both of us…There was a lot of laughing and joking. . The staff and scans…they was all fantastic…They explained what the pregnancy’s going to be like and giving birth…. It was really good. ’ Specialist support worker: “[It was] the best support you can have really. … I didn’t have a clue what I was doing, like, I was skiving school … but he got me referred onto college, and that got me back into education, right. ‘Someone I could talk to as a friend, but wasn’t a friend cos he was a professional. It helped me sort of stabilise myself’.

Re-framing support for young fathers Moving from a presumption that young fathers are a problem… …to a starting point in all services that young fathers’ involvement is beneficial to the young mother, their child and the young man himself Identifying and including young fathers in all early help assessments, with tailored support to meet individual needs Ensuring the small minority of serious safeguarding cases are not perceived as the norm Using dedicated practitioners to provide specialist support for young fathers and model effective working for non-specialist practitioners. No silo working!

Making the case for young fathers support: to councillors, Health and Wellbeing Boards and CCGs and frontline practitioners

Young fathers contribution to improving local public health and NHS outcomes Infant mortality and stillbirth rate (44% & 33% higher risk for babies born to women under 20) Incidence of low birth weight of term babies (25% higher risk for babies born to women under 20) Maternal smoking prevalence (including during pregnancy) (Mothers under 20 are twice as likely to smoke before and during pregnancy and three times more likely to smoke throughout pregnancy) Breastfeeding initiation and prevalence at 6 -8 weeks (Mothers under 20 are third less likely to initiate breastfeeding and half as likely to be breastfeeding at 6 -8 weeks) Children in poverty (63% higher risk for children born to women under 20) Rates of adolescents not in education, employment or training (NEET) (21% of the estimated number of female NEETs 16 -18 are teenage mothers)

The contribution to Local Authority priorities of improved support for young fathers ▪ Giving every child the best start in life – a priority for 83% of councils ▪ Reducing child poverty ▪ Narrowing educational inequalities and improving skills and employability: Raising the Participation Age, increasing young people in education, training and employment ▪ Address safeguarding issues by getting early help services right for teenage mothers and young fathers Include young fathers in Joint Strategic Needs Assessments, Health and Wellbeing Strategies and commissioning of maternity, child health and youth services

Raising awareness and practical advice for universal services and practitioners Getting maternity services right for pregnant teenagers and young fathers. Practical guide for midwives and maternity support workers. PHE, RCM, DH. 2015

Positive images and messages in universal settings: maternity, children’s centres, general practice …

In summary. . . Supporting young fathers: - gives them and their children a positive future - narrows inequalities - reduces child poverty - invests in the future health and prosperity of the local area, and - reduces long term demand on health & social services Shrinking budgets and growing poverty pose huge challenges, but the Following Young Fathers briefings and resources and other effective practice can help share solutions

For more information: Teenage Pregnancy Knowledge Exchange www. beds. ac. uk/knowledgeexchange If you would like to be on the Teenage Pregnancy Knowledge Exchange contacts list, or have any follow up questions, please email me: alison. hadley@beds. ac. uk