Katherine Austin-Evelyn, IWHC’s Program Officer for Learning, Monitoring, and Evaluation, spoke with Alison Hadley, Director, Teenage Pregnancy Knowledge Exchange, Faculty of Health and Social Sciences, University of Bedfordshire, who led implementation of the UK Government’s 10-year strategy on teenage pregnancy prevention. The strategy is credited for halving the under-18 pregnancy rate in England and is being used as a model for other countries that want to emulate its success. A major element of the strategy was comprehensive sexuality education (CSE). Since NGOs and civil society organizations in low-resource countries advocating for CSE are often unable to conduct research at a scale that would allow for meaningful results, these results are significant. The results contribute to the evidence base that advocates can use to make the case to governments that investing in CSE works.
At IWHC, we are interested in using evidence for advocacy at the national, regional and global level. How might organizations advocating for CSE and sexual and reproductive health and rights more broadly use lessons from your study to assist them in advocating for CSE in their own countries?
England was a country with persistently high rates of teenage pregnancy which was out of line with comparable Western European countries. Before the strategy many people thought high rates were impossible to change, but the results proved the opposite. So, highlighting a case study that seemed so hopeless but yet achieved success with a concerted, dedicated strategy with CSE as a central component and a commitment to giving young people choices, can effect real change can be useful for advocates.
The window of opportunity is also crucial. This window of opportunity is different for every country. For us in England it was the election of the Labour government, who had a mandate to tackle inequalities and social exclusion. So adapting your “pitch” to whatever the priorities of the government are at the time is key. For us it was that teenage pregnancy is a cause and consequence of inequalities so reducing rates combined with the critical importance of CSE will contribute to a number of other outcomes – like increasing school attendance and educational attainment or reducing maternal and infant mortality. The skill is identifying what is really bothering governments at the moment and then explaining how improvements in CSE and access to sexual and reproductive health services will help address their priorities.
Do you have any suggestions for lessons and/or research that NGOs and smaller organizations can take up to make the case to their governments that CSE works?
There is strong international evidence of the benefits of CSE and we should be confident in explaining that to governments. But critically important is making sure decision makers and the public understand what good CSE looks like! Misleading and provocative headlines suggesting sex lessons for 5 year olds scare politicians and parents. Support for CSE increases when the content of CSE at different ages is explained and put in the context of keeping children and young people safe and healthy. Smaller organisations can play an important role in providing accurate information to local decision makers and parents.
But I think the most powerful influencers of decision makers can be young people themselves. During the strategy there was a big survey conducted by a group called the UK Youth Parliament on student’s perceptions of the CSE they were receiving in schools. Over 40 percent of those who participated said their CSE was very poor or inadequate. The strategy advisory group and NGOs had consistently highlighted the inadequacy of CSE and recommended statutory status. But it was the voice of young peoples that got ministers to listen and unlock the door to further conversations on CSE.
In your recent Journal of Adolescent Health article, you and your co-authors suggest that the England model could be used as a blueprint in countries that want to emulate its success, particularly in low and middle-income countries. What are the top three lessons for low and middle-income countries from this study?
The first lesson is government recognition that reducing teenage pregnancy is a complex issue requiring a comprehensive, multi-pronged strategy, with each agency understanding its contribution. The England strategy, developed from international evidence, included high quality comprehensive sexuality education in schools, but also better access to effective contraception in youth friendly clinics, a widespread communications campaign, and more intensive support targeting the most at-risk groups.
Second, is the importance of regularly reviewing progress of a strategy and tailoring actions to respond to the findings. A key milestone for us was the mid-course review where a comparison of high and poor performing areas confirmed that if all the strategy actions were implemented, rates would come down, even in deprived areas. The vital ingredient in the successful areas was having a local senior champion, committed to change.
The third lesson is the emphasis on investment and leadership for the full length of the long-term strategy. Our strategy was a 10-year program of work, with a 10-year goal. At the halfway mark, the progress was slow and the reduction in pregnancy rates were behind the target. We were bombarded by media reports at the time saying the strategy had failed and it was a waste of money but the government stuck to the evidence and carried on, and in fact redoubled their efforts! We did eventually reach the goal of halving the rate, but the cumulative actions of the strategy only started to show significant impact in the later stages after the mid-course review. Sustained commitment and funding over a long period is a really important lesson for governments and for advocacy organizations: progress in tackling complex issues takes time.