So why follow up all these girls and families over such a long period of time?
The first survey (reported in “Are you my sister, Mummy?”) provided an important database of information regarding pregnant schoolgirls and their circumstances. This was a vital piece of work in terms of looking at the British scene since previously available information had dealt with American groups whose population was not comparable in any demographic or social sense. We needed information on our own population with a view to examining the factors, risks and social stresses of the environment pertinent to British - and particularly London - based teenagers.
This information base was important in terms of understanding factors which led to early pregnancy and childbearing - what motivated young people, what the family’s influence might be and how we might intervene to help at any stage. Most important - what were the problems? It is not sufficient to pose the question - how do we reduce teenage pregnancies? This presupposes that all teenage pregnancies are unwanted and problematic - clearly this is not the case and even in the early survey years it was quite obvious that even for the very young schoolgirl mothers there were reasons and needs for pregnancy not all of which were undesirable.
Most behaviour, including early childbearing is measured as problematic in terms of how it measures up to the norms and values of a particular society or group. For some girls pregnancy represented a solution to a sea of problems albeit the reasoning might be flawed and the solution a ‘false’ one. We do need to acknowledge however that for a great many young mothers pregnancy is desirable and very much the norm of their family culture.
Continuing this argument, there are also many cultures where early marriage and pregnancy is very much desired and one should separate the ‘problems’ raised by cultural expectations and lack of societal support from the personal and individual conflicts and stresses which might be caused by early pregnancy.
Hence the baseline data of the initial work gave us some facts which had previously been supplanted by myths and prejudices about pregnant teens. It gave us information upon which to base interventions, support and help for pregnant girls and young mothers and fathers.
Throughout the follow up period it has been essential to provide some ‘service’ and support to the young parents and no doubt many would question whether inclusion in the survey has in itself altered the outcome. I think not. Whatever help might have been given over the years has been very spread out by time and diluted by the number of cases. None of the girls had any way near as much help as they needed and deserved.
Certainly for some the knowledge that someone cared and that their lives were of interest to others was important. Many of the girls included in various television and radio programmes were justly proud of their contributions and we were proud of them.
It is important to acknowledge that whatever help we were able to give the young mothers, this was a reciprocal process and we are immensely grateful to all the girls and their families for the support they have given us over the years in terms of answering questionnaires, coming to interviews and allowing us into their homes. Without them, this piece of work would have been impossible.
This is a unique survey. Certainly in the United Kingdom a cohort of pregnant schoolgirls has never been followed up for this length of time (fifteen years) before. The size of the sample - 174 - is small by North American standards but respectable by European ones. In addition the cases are all very well known to us and have been very intensely followed up.
Personal in depth knowledge is worth so much more in terms of understanding the girls position than mere statistical analyses. It is due to the ‘personal’ approach and engagement with the girls and families that we have managed to keep up an excellent follow up rate - currently 89% overall - which again is a major achievement.
It began in a small way .. just talking to the girls who came for advice… visiting the families of teenagers who had for a number of reasons dropped out of the regular school system. I began to ask questions, to wonder why these girls? What differentiated the school girls who would get pregnant from those who did not? Could we predict teenage pregnancy or indeed teenage problems or disturbance in general? Was any kind of intervention appropriate or desirable and, if so, what should we be doing to intervene, support and help?
Gradually the idea evolved of providing a support service for teenage mothers and of somehow co-ordinating the input of the many professionals who might briefly impinge on the schoolgirl’s life.
Home visits were essential both as a means of providing support for a population group who were notoriously bad clinic attenders and who found it hard to remember appointments and stick to times. More importantly home visits gave a much better insight into the life stresses facing the young girl, allowed the family dynamic to be looked at and gave other family members the opportunity to also obtain some support. Sometimes the baby father could also be included in these visits.
When it came to seeing what basic resources and facilities were available for young parents, home visiting was essential. In the clinic the pregnant girl can be asked if she has her own bedroom, space for a cot and the bare minimum of information can be elicited. This is no substitute for actually standing in a cold flat, seeing the damp running down the walls, seeing the peeling ceiling flake off plaster onto the child’s bed or seeing the baby wedged in an open drawer because there is no room for a crib.
In the clinic you can be told how Dad is angry, upset and not talking to the expectant mother - but on personal visit you can see how depressed and helpless this man feels.
As the support service was taking form it became even more clear that a scientific survey of this group was required in order to both establish need and to better plan service provision. Hence contact was made with every school girl who became pregnant in a specific geographical area - which at the time was defined by the area covered by a London Health District (Camberwell / King’s) In two London Boroughs (Lambeth and Southwark).
All girls were of statutory school age at the time of conception. In the United Kingdom school leaving age was then 16 years. All girls falling pregnant and who by intent or by default continued their pregnancies within a time limit were included - new inclusions to the group began in 1980 and ceased in 1987.
The data and conclusions of this part of the survey are included in the book ‘Are you my sister, Mummy?’.
Further survey work included a self esteem measure performed in 1987 which tested and compared -
· part of the first group of the cohort, who at that time were young mothers with pre-school children with
· the last group of girls who were still pregnant.
This study is reported fully in ‘Inner Worlds’ and is also discussed at the end of ‘The Child That Rocks the Cradle’.
At the five year stage we experimented with some peer involvement in follow up. This was largely unsuccessful and alternative arrangements were eventually made to return to the standard format for visits.
The trial involved young mothers and some ‘ex patients’ of Youth Support who were given a territory near their homes and helped to visit some of their peers. Letters were sent in advance and the participants were also given letters of authority proving their bona fide.
The reasons for lack of success were several. Young people were unable to trace or follow address changes - transport was a problem - and families and neighbours did not take the youngsters seriously hence did not prove helpful or willing to disclose any information. It was hard for young people to go visiting in the evenings or after dark when many families were in - hence many ‘missed’ visits took place.
Generally speaking families did not read or respond to letters. That has been our experience throughout. A small group - the same individuals at all stages respond to letters - the majority discard written communication. Many because of a general attitude to letters - often bills , circulars and bad tidings .. a number due to literacy problems.
Interestingly, at fifteen years, many of the young mums have said that they would very much have welcomed some peer group involvement and would have found it an important support to have a girl in similar circumstances visit them. Groups have also been suggested. In practice however the barriers to peer support are difficult to surmount. I am glad we tried it - but it is not an exercise which I would care to repeat.
At the ten year follow up children were in their last year of primary school and hence it had been planned to perform some follow up in liaison with the schools - the school medical records could have proved interesting and communication with school doctors would have given useful insights to both parties. Unfortunately we were obstructed in this process by administrative ‘red tape’ The whole direction of the ten year follow up therefore had to be changed again and rather than communicating with the school health service - all follow up was done by means of home visits and individual communication directly with the families.
The fifteen year follow up was the most thorough of all the sweeps since the initial information gathering exercise in the early eighties. We endeavoured to trace as many girls and their families as possible - going back over the ‘failed’ follow ups of previous years and catching a number of girls who had been lost for some time. Information missing from previous survey data was thus filled in at this stage and a final follow up rate of 89 % was obtained.
All the information was elicited by virtue of home visits - often to the young mother’s home and also to the parental home (grandparent). Where there was more than one household - all households were visited to make sure that information on partners and the children was accurate.
One of our biggest problems was in tracking down families current addresses. At the two year follow up stage there had been considerable problems in keeping in touch.
London as a whole has a very mobile population and this factor is even higher in the inner city and poorer areas. Teenage mothers move very frequently - by the time her baby is two years old the average young mother has moved three times since the birth of her child - many moved as many as seven times.
Over the next ten to fifteen years the nomadic nature of the families lifestyles continued,constituting a problem for follow up and a barrier for provision of services and adequate health care. Moves were necessitated by temporary housing arrangements, living with relatives and friends, squatting, inadequate housing and council rehousing.
Follow up technique involved writing a letter to all the address combinations informing people that visits might follow and letting them know that we were trying to trace them. The response rate for letters was approximately 2% of girls - amounting to about 0.5% of addresses - but we did not really expect a response - most who got the letters just waited for the follow up visit - many letters went to ‘dead’ addresses - but ‘blanket’ postings had to be made in the hope of reaching even a few correct addresses.
The next stage was telephone contact with as many households as possible. We did have the numbers of about half the families - but many had been cut off or changed and were not in the telephone directory.
The third stage was the visit. This is the prime information gathering opportunity - if the visit is successful. Visiting can be depressing and draining. A day packed with approximately 20 visits may result in just one or two successes. … the process was slow and meticulous ..
We contacted - housing offices - social service departments - doctors surgeries - the health authorities - health visitors - local clinics - hospitals where mother or child may have received treatment - schools ...... etc. etc. etc.
.... Telephone companies and telephone directories - for several girls with unusual names we rang every one in London with that name to find a relative!
Libraries were scoured for the voters’ lists - often not registered partly because of the general avoidance of ‘paperwork’ - partly in an attempt sometimes to avoid the poll tax of recent years - and girls also change their names .... Sometimes many times. In fact the least ‘stable’ in their lifestyles are those most likely to change names most often as they move from one relationship and one household to another.
Churches where families might belong to the congregation ... Laundrettes and dry cleaners, the local newspaper shop, the corner shop where they might buy groceries!
“.. Listen, be observant, never rush or appear in a hurry .. this feels like a discount .. we need to show genuine interest in their lives and problems. Never prejudge or generalise and do not put words in their mouths .. let them take the lead in conversation .. there may be something they are really wanting to talk about and have not had the opportunity. Many are isolated and welcome a visitor ... particularly some of the ‘grandmothers’.”
We never use a questionnaire on home visits. The information required for the survey takes second place to providing a friendly ear and a support. Key questions are memorised and replies just jotted down on a piece of paper and copied out later - questionnaires push people into boxes and turn them into ‘case numbers’.
We do not carry files and usually visit alone rather than in pairs. People carrying bags and files look too much like social security officers, bailiffs or social service agents. It is important to make sure people identify us quickly as being from Youth Support and that we have nothing to do with ‘officialdom’ and that nothing they say to us will be passed on to anyone official.
This is very important .. having a medical base is also helpful. There have been many instances of being admitted to a household which was a ‘no-go’ area for other agencies. ...
Incidents occur which can be funny, poignant or frightening .. we have to be ready for anything and prepared to step in and help.
“On my first visit of the day I found myself calming a neighbour running around brandishing a knife .. he turned out not to be as disturbed as he looked .. and he did give me some useful information on our family living opposite who were driving him mad with the noise of seven children all screaming at once.
..... The second lady - a grandmother - had the carpet cleaners in and I made myself useful keeping the dog off the wet floor while she told me about her daughter.
... The third visit brought me up against a very drunk elderly woman who had been at the rum .. the conversation was interesting ... but about the wrong family!
The last case which I got to late in the early evening was at a flat where a young woman opened the door with a baby in her arms. She looked frightened and downtrodden - very vulnerable.
Before she could open her mouth a very hostile looking man appeared behind her. I reassured both of them that I had an invitation for the reunion and I had called in for a little chat to see if transport was needed.
... I was taken down a bare, very poor hallway to a room with a bed and cupboard and a cot. I sat on the end of the bed with the mother, we knew her partner was hovering outside the door, listening... I made small talk about the baby ... I could see fear in her eyes and I raised my eyebrows questioningly. She whispered ‘Please help me’.
.... I passed her the telephone number and made an excuse to leave so as not to raise his suspicions. Later she rang and told me her story when he was out of the house. We involved the domestic violence unit.
On 4th February 1996 we endeavoured to have a young families reunion. The purpose of this reunion was social, as a thank you, as a celebration and rewarding of young parents .. and to an extent as an information gathering process. This latter point was of lesser importance since all the families had previously been interviewed to obtain essential information. However the event provided the opportunity for inter family discussion, for sharing of information and for interviewing children and family members who may have been absent at the home visits.
The reunion was more successful than we could ever have dreamed ...
.... I am left wondering what the residents of a quiet London suburb thought when sixteen bus loads of young families converged on Youth Support House on a Sunday afternoon.
It was a very moving experience ... seeing all the girls again ... seeing some of the children who were growing up .. and most of all seeing how well girls had done bringing up their families. I really felt a great sense of pride in their accomplishments ... as if they were part of the ‘family’ -
Of course many of the stories were sad and we uncovered a tremendous depth of pain and need ... a need which in some ways we hope to fulfill if only we can find the resources to do so.
In fact the ‘Reunion’ turned out to be more than a ‘one off’ event. ,,, And hopefully this contact and support will continue ...