Antenatal clinics in schools 'would protect teenage mothers'

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Antenatal clinics should be set up in schools to reduce the risks to teenage mothers, an independent health watchdog says.

Young women under the age of 20 have a higher risk of suffering a stillbirth or death within the first six weeks, and women from deprived backgrounds are five times more likely to die in pregnancy or childbirth.

But pregnant teenagers are often reluctant to attend clinics dominated by older women and can feel excluded from mainstream antenatal care, according to the National Institute for Health and Clinical Excellence (Nice).

About 40,000 girls under 18 become pregnant each year, of whom half have an abortion.

The remainder are at higher risk of having a premature birth or a baby with a low birth weight than their older peers. In new guidance published today, Nice calls on antenatal services to target teenage mothers who need particular support throughout pregnancy.

It says midwives should be able to go into schools to offer advice to expectant young mothers and carry out health checks. The guidance is part of wider recommendations focused on other groups including victims of domestic abuse, recent immigrants who struggle to understand English and drug and alcohol abusers.

Pregnant women in these situations often miss antenatal appointments because traditional services are not flexible enough to meet their needs and run the risk of complications which can result in the death of mother or baby.

The guidance proposes "one-stop shop" antenatal care in areas with high teenage pregnancy rates, which could be located in schools or colleges, as well as GP surgeries to encourage peer group support.

The clinics should offer a range of services and include a named midwife for each pregnant woman, who should provide the majority of the woman's care as well as a telephone number where she can be contacted.

The information should be tailored for teenagers and efforts made to include the father in preparations for the birth, if the mother agrees, the guidance says.

"Young women aged under 20 may be reluctant to recognise their pregnancy or inhibited by embarrassment and fear of parental reaction. They may also have practical problems such as difficulty getting to and from antenatal appointments," Nice added.

Rhona Hughes, chair of the guideline development group, said that no British schools were currently providing antenatal classes but that it was a "common pattern of care" in the US.

She added: "It would not be appropriate for many teenagers, 18, 19, 20-year-olds, but we did find examples in the literature of good practice where clinics were held in schools and young women were more likely to access care."

She said teenagers can "feel embarrassed going to clinics where there are older women", and can feel like outsiders. Dr Gillian Leng, the deputy chief executive of Nice, said the services should be focused in schools where there was a teen pregnancy problem.

"They might feel scared, overwhelmed, judged, unable to communicate, or may be physically stopped from attending appointments. Although these women represent a small proportion of those having babies in the UK each year, they and their unborn children deserve the same level of care as anyone else," she said.

But the Royal College of Midwives said more staff and resources would be needed to implement the guidelines, which were unlikely to be available. Louise Silverton, the deputy general secretary, said: "These important recommendations will require significantly more, rather than less, one-to-one care and time from midwives."

In numbers...

41,325 The number of girls under the age of 18 who became pregnant in 2008

49 per cent The number of girls under the age of 18 who had an abortion in 2008

600 per cent The increased risk of dying in pregnancy or childbirth for a woman from a deprived area (compared with a woman from an affluent area)

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