This report presents the findings from a systematic review of the research evidence relating to teenage pregnancy, parenting and social exclusion. It contributes a new focus to the wealth of existing research on teenage pregnancy by locating it within the context of social disadvantage and exclusion. The review systematically examines research relating to policy initiatives aimed at tackling the social exclusion associated with unintended teenage pregnancy and young parenthood. It concludes that there are strong grounds for investing in early childhood and youth development programmes as strategies for reducing unintended teenage pregnancy rates. Happiness, enjoyment of school and ambition can all help to delay early parenthood. The available research evidence also points both to daycare and to education and career development programmes as promising ways of supporting young parents. Holistic support programmes appear to be appropriate but have not yet been shown to be effective. However, studies of young people’s views suggest many important research gaps. These include the development and evaluation of policies to promote young people’s involvement in schooling, further education and training, and to support families experiencing problems linked with social disadvantage and poverty.
The background to the review is the widespread policy concern with high rates of unintended teenage pregnancy in the UK, the highest in western Europe. While rates are falling in many European countries, recent statistics show that the UK Government target of halving teenage conceptions by 2010 is unlikely to be met. Social disadvantage and teenage pregnancy are strongly related. Young people are more strongly motivated to defer parenthood in countries where they have a reasonable expectation of inclusion in the opportunities and advantages of living in an economically advanced society. There are also more resources and support available in these countries to young people who do become parents.
Teenage parenthood is not in itself a social problem, and some young people make positive choices to become parents early. The problem, and the focus of this review, is the social disadvantage and exclusion that in some societies, especially the UK, are linked to young parenthood both as consequences and as contributing factors.
This review seeks to answer two questions:
- What research has been undertaken that is relevant to informing policy and practice in the area of young people, pregnancy, parenting and social exclusion?
- What is known about effective, appropriate and promising interventions that target the social exclusion associated with teenage pregnancy and parenting, which might therefore have a role to play in lowering rates of unintended teenage pregnancy and supporting teenage parents?
The review was conducted in three parts. First, we searched for and mapped the existing research literature. Secondly, and thirdly, we conducted two separate reviews of the evidence relating to the prevention of unintended teenage pregnancy and support for young parents. The focus of these reviews was on the following areas: housing, childcare, education and training, employment and careers, and financial circumstances. These in-depth reviews included statistical meta-analyses of the effects of different approaches on pregnancy rates, young people’s participation in education, training or employment, and mothers’ emotional wellbeing.
An important feature of the review is that it includes different types of research. Its conclusions are drawn both from international evaluations of policy and practice interventions, and from the findings of recent ‘qualitative’ research conducted in the UK examining the views and experiences of young people themselves.
We did not include in the review studies of sex education alone, since these have already been the subject of several systematic reviews and they do not include a focus on social exclusion.
Mapping the research
Altogether our literature searches produced 34,615 records. These were narrowed down to 669 studies which were included in the first, mapping stage of the review. Three quarters of the studies included in the map related to social exclusion and teenage parenthood, and a quarter to teenage pregnancy. Most of the intervention research was conducted in the USA. We found only seven studies of UK-based interventions.
Most of the intervention studies reported multi-component interventions. In the area of teenage pregnancy, the most common intervention was some type of educational support. The most popular approach for teenage parenthood was parent training. The qualitative research focused on personal and family issues rather than structural factors.
Like all systematic reviews although comprehensive methods were used to search for studies it is possible that some relevant research has been missed. We invite readers to contact us if they know of relevant published or unpublished studies that have not been included in the review.
The research in-depth
A smaller number of studies were looked at in more detail for the two in-depth reviews. The teenage pregnancy review included 15 studies: 10 evaluations of interventions, and 5 studies of young people’s views. All the interventions were multi-component and based in the USA. Six of the intervention studies provided sound evidence of the value of two particular approaches to targeting the social exclusion associated with unintended teenage pregnancy: early childhood interventions consisting of preschool education, parenting support, and social skills development; and youth development programmes combining community service and student learning, or providing a programme of academic and social development. A statistical meta-analysis (random effects model) revealed that these approaches reduced by 39% the number of young women reporting teenage pregnancy (Relative Risk = 0.61, 95% CI 0.48, 0.77), and also had positive effects on employment and economic status. The qualitative research revealed three recurrent themes in the experiences of young people: dislike of school; poor material circumstances and unhappy childhoods; and low expectations for the future.
A total of 38 studies, 18 of interventions and 20 of young people’s views, were included in the in-depth review of parenting support. Ten of the intervention studies provided sound evidence for the value of particular approaches. Two of these looked at welfare sanctions or bonuses, four reported on the effects of educational and career development programmes, three examined holistic, multi-agency support, and one focused on the effects of daycare. A statistical meta-analysis (random effects model) suggested that educational and career development interventions increased by 213% the number of young parents in education or training in the short-term (Relative Risk = 3.13, 95% CI 1.49, 6.56). Daycare and welfare sanction/bonuses programmes also had positive short-term effects. None of these types of interventions showed any long-term effects. The most promising approach for reducing repeat pregnancy appears to be the provision of daycare. The qualitative research included in the in-depth review of parenting support highlights the diversity of needs and preferences within this group; struggles against negative stereotypes of teenage parenthood; heavy reliance on family support; the continuation of problems existing before parenthood; and the wider costs and benefits of education and employment.
The contribution of this review
By focusing on social exclusion as the major context within which many young people embark on parenthood, the review described in this report identifies important pointers to successful strategies for lowering the incidence of unintended teenage pregnancy and for supporting parents. These conclusions need to be set against the findings of sex education research. Although sex education is an important part of young people’s preparation for adulthood, the evidence is that it is not, on its own, an effective strategy for encouraging teenagers to defer parenthood. Our review also highlights significant research gaps, particularly the lack of evidence from the UK relating to the value of social-structural interventions, and the neglect of the messages arising from qualitative research with young people themselves.
This report should be cited as: Harden A, Brunton G, Fletcher A, Oakley A, Burchett H, Backhans M (2006) 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.