How do the rates of teenage pregnancy in Croydon compare to other London Boroughs?

Background
Research studies have suggested that teenage pregnancy is a major global issue and it needs to be addressed accurately due to the health, social and economic risks associated with this issue (Baker, 2007; Roth et al., 2009; Kamberg, 2012). Decline in the number of teenage pregnancies have been reported as a result of the strategies undertaken by governing bodies across Europe to reduce the number of unplanned teenage conceptions. However, England still has the highest rate of teenage pregnancies which are mostly unplanned (Teenage Pregnancy Associates, 2011). Teenage pregnancies are a major cause of poor health conditions in teen mothers and their babies, it has an adverse economic impact and play a crucial role in increasing child poverty (WHO, 2012).
2. Individual Factors

Research studies have suggested that individual factors play an important role in teenage conceptions (Imamura et al., 2007). Children of teenage lone mothers are more vulnerable to become teenage parents (Botting et al. 1998). Members of some certain ethnic groups such as Caribbean and Asian are more likely to become teenage parents in comparison to white teenagers (Botting et al., 1998; Berthoud, 2001). Underperforming children at school who show little or no interest in learning and eventually drops out at early ages are also at a risk of becoming teenage parents (Kiernan, 1995). Research evidences have suggested that increased number of teenage pregnancies have also been observed in young children living in care or those who leave care (Imamura et al., 2007). According to Haldre et al. (2009) alcohol abuse in the family and lower levels of sexual knowledge also lead to higher number of teenage pregnancies.
3. Socio- Economic Factors
According to Baker (2007), socio-economic disadvantages are one of the major causes of teenage pregnancies. Teenagers who are detached or detach themselves from the society as a result of discrimination or lack of support from the society are highly vulnerable to early pregnancies. Social disadvantages as identified by England’s Social Exclusion Unit includes unemployment, poor quality of health, living in deprived areas, having lower levels of skills, poor housing facilities, family fall outs and low income (SEU, 2001). Gruber (2009) argued that individuals become socially disadvantaged when they are denied their basic rights and the opportunities to become an active part of the society which leas to involvements in crimes and other illegal activities. Research studies have suggested that children of socially disadvantaged young parents live in poverty (Baker, 2007). However, not many evidences are present in the literature about the contribution of poverty to teenage pregnancies and this area needs more exploration. According to a research study by Arai (2009), poverty is common in households where the head of the household is a teenager. MacPhail and Campbell (2001) identified that poverty pose an influential impact on the decisions of teenagers to buy contraceptives leading to unintended teenage pregnancies which further leads to lack of finance and support. Trapani (1999) found out that in most cases of teenage pregnancies boyfriends of teenage pregnant girls hesitate from taking the responsibility of the child due to its impact on their educational and employment opportunities. This rejection from partners can cause depression in teenage mothers and their children could significantly suffer in many ways as a result of this depression.
It is clear from the preliminary literature review that individual, social and economic factors play an important role in increased number of teenage conceptions. Recent reports published by NHS (Wilpers,2011) suggest that government has taken a number of steps to reduce teenage pregnancies; however, despite of these measures the success rate is low. This leads to the formulation of the research question for this study which is to understand why is teenage pregnancy increasing and what more factors are contributing to this problem in addition to the ones identified by previous research studies.
4. Rationale for the study
According to a recent press release, London Borough of Croydon recorded 50% increase in the teenage conceptions; and the borough is still amongst the regions with highest teenage pregnancy rate (Croydon, 2012). In order to further reduce the rate of teenage pregnancies in Borough of Croydon it is crucial to identify the factors causing the increase in teenage conceptions. Therefore, the aim of this research study is to effectively recognize the factors causing the higher rates in teenage pregnancies in the London Borough of Croydon, and the chosen organisation is Croydon Health Services NHS Trust.
Research question identify the factors causing higher rates in teenage pregnancies through a systematic literature review
Aims of the study
To identify the factors causing higher rates in teenage pregnancies in the London Borough of Croydon.
To identify the strategies that could be adopted by the governing bodies in London Borough of Croydon to address the issues of higher rates in teenage pregnancies.
Study population
The target population for this research study are the pregnant teenagers attending antenatal clinics in Croydon and the sample size would be 15. Initially contact over the phone was established with a supervisor of midwives to arrange a meeting in order to explain the benefits of this research study. It was decided in the meeting that the invitation for participating in the research study will be given to the pregnant teenagers by the midwives attending antenatal clinics in local medical practices. Pregnant teenagers willing to participate will be given a date and time for the interviews after consulting the researcher and all the interviews will take place in a room within the medical practices so that an assuring environment could be provided to the participants.
Study design – justification of methodology
An exploratory case study research strategy has been undertaken for the accomplishment of the aim of this research study because of its effectiveness in exploring the problem understudy and because of its proficiency in unveiling new issues (Walsh and Wigens, 2003). This research strategy is extremely time consuming and provides no control over the information provided by the participants; however, according to Kumar (2008) the researcher can effectively overcome these problems through his/her competent research skills.
A qualitative approach has been adopted for this research study. Qualitative research which is robust in its detail and empiricism will facilitate the collection of quality data, having high validity in a natural setting (Belk, 2008). Research approach can be inductive or deductive depending upon the type of the research study and for this qualitative research study inductive research approach has been adopted. The advantages of inductive research approach include its flexibility and its ability to inform insights from the study as it develops, so we can recognise the relationship and connection between insights.
Methods
Primary as well as secondary data will be collected for this research study. Secondary data will be collected from the reports published by NHS, books, journals and news articles. Both the primary and secondary sources of information will be explored. The advantages of these include time effectiveness, cost effectiveness and the ease of access to the information. Invalid or incomplete pieces of information and possible confusion due to the availability of huge amount of information are few limitations of this data collection method (Kumar, 2011). Primary data will be collected by conducting individual semi- structured interviews because of its efficacy in establishing an informal two way conversation between the researcher and the participant (Carter and Thomas, 1997). A qualitative approach is suitable for this project, as qualitative research has numerous advantages that will be suitable for a subject that requires significant levels of nuance and detail in order to fully understand it. Crucially, qualitative research is able to focus on how a subject is affected by specific phenomena and social forces and can help to produce detailed experiences and information that can produce robust insights. It seeks to explore the “why’s”, “what’s” and “how’s” at play in situations and how people think, act and behave in the manner they do, “Qualitative research involves the studied use and collection of a variety of empirical materials- case study, personal experience, introspective, life story, interview, observational, historical, interactional and visual texts that describe routine and problematic matters and moments in the lives of individuals” (Denizen and Lincoln in Gordon, 1999:21). Individual interviews are especially effective at achieving this as they are often used to explore step by step processes that inform decision making and how situations unravel. (Gordon, 1999). Due to the highly sensitive nature of the subject matter semi-structured face to face interviews will serve as the most appropriate means of collecting information. Semi-structured interviews have the advantage of being able to combine predetermined questions in an order that can change and be adapted to information that the participant (Robson, 2000), discuss details relating to their experiences candidly, and without any fear of being judged by others. This will also be achieved by the researcher doing their utmost to make the participant feel relaxed, valued and comfortable. In order to do this, it will be necessary to find a location in which participants feel comfortable, and therefore participants should be consulted for their preferences in which interviews should be conducted ( Gage in Hammersley, 1999).
Although the interview will be semi structured, the subjects for discussion will be informed by the literature review, and a topic/ discussion guide will be drafted beforehand to ensure that the interviews run smoothly. In order to create a topic guide that addresses all the relevant topics and subjects, it will be useful to conduct a pilot interview, which can also help to ensure that the topic guide is clear and unambiguous. As a means of collecting the detailed information that is necessary for a project of this nature, the duration of interviews should last for at-least 60 minutes, and participants must be advised of this beforehand. However whilst the researcher will aim to engage the participants in lively and frank discussion there may be situations in which the participant is unable to express themselves articulately, or does not have the communications skills to do so. This can be overcome by the use of projective and enabling techniques, and the use of them can sometimes allow participants to open up. This is achieved by asking questions in a manner in which the participant is able to project themselves to someone or something else that is disengaged from the research process, “Projective techniques consist of a situation or stimulus that encourages a person to project part of themselves or an idea system on to an external object, or to bring it into the interview itself”. ( Gordon, 1999:165). An effective means of achieving by this is with the use of completion exercises such as sentence completions, for example, the interviewer may ask something along the lines of, “ People think organic food today is good because…..” which can enable participants to reveal opinions in an alternative guise. (Gordon, 1999). Once projective and enabling techniques have been conducted, it is always extremely worth-while questioning them on their responses in order to provide additional insights (Silverman, 2011).
Sampling
The target population for this research study are the pregnant teenagers attending antenatal clinics in Croydon and the sample size would be 15.
Ethical Considerations
Participation will be voluntary, anonymity will be maintained by attributing data to fictional names during the final report, information about the study will be provided to the participants and written consents will be taken prior to the interviews. Information collected will only be used by the researcher, and we will ensure that participants who are under 16 have formal consent from their parents, in order to take part in the project. All participants under the age of will also have a chaperone or legal guardian onsite.
Data management and protection
All the data will be kept confidential and utilised only for research purposes. The data will be safeguarded by the researcher and securely archived once the project has been completed.
Data analysis
Data will be analysed in a step wise manner (Maykut and Morehouse, 1994). Firstly all the responses will be carefully examined followed by the unitization and categorisation of different pieces of information and subject to a rigorous qualitative content analysis. Finally the responses will be interpreted. Prior to undertaking analysis, it is important to draft an analytical template, so that findings can be systematically ordered in a manner that enables the researcher to identify patterns, similarities, differences, key themes, narratives and other relevant details of interest. The template should be informed both by primary and secondary research and is often influenced by the order of topics included in the discussion guide used during the interview stage (Silverman, 2011). It is necessary to do this as the researcher can often feel overwhelmed by data and detail once they have completed the interviews on a research project, and drafting an analytical template can help the researcher to feel organised and stay focused. In order to do this the template can be coded so the responses from different participants are immediately recognized, structured based on a series of phrases, terminology, sequences and themes – so that dominant themes can emerge and that a “big picture” can start to come into focus. Once the main themes have been identified, it can be useful to add direct quotations, specific experiences and anecdotal information in order to bring the findings to life ( Miles and Huberman, 1994).
Research Timetable

Limitations
Generalisations are the potential limitation of the research study as the results might not completely reflect the condition in other Boroughs of England. Also when embarking on research that is informed by a qualitative approach, it is important to recognise that objective reality truth does not exist, and that all insights will on some level be shaped by a range of factors including, “ a personal history, biography, gender, social class and race and ethnicity” (Gordon, 1999:21).
Researcher bias
To maintain the reliability and validity of the data all the measures will be taken to avoid the chances of errors during face-to-face interviews and when analysing the data.
Presentation of findings
The observations of the research will be presented in form of interview transcripts. Analysis and thoughts over the research will be in the form of detailed report in style of journal.
Dissemination of results
Regular updates on the progress of the work will be informed to the supervisor. Any suggestions over the improvements will be sought after disseminating results to the supervisor. The research will be done entirely by me with the suggestions of supervisor and the intellectual rights will belong to me and the university.
Project management
It will be ensured that the progress of the study coincides with the research time table. If in case of any delay or unexpected observations, permission of the supervisor and the awarding body will be sought for extension and help as /when needed.
Reflection
In conclusion, despite of the limitation this research study will effectively contribute towards the information present in the literature about the factors causing the increase in the number of teenage conceptions.
REFERENCES
Arai, L. 2009. Teenage Pregnancy: The Making and Unmaking of a Problem. Bristol : The Policy Press.
Baker, P. 2007. Teen Pregnancy and Reproductive Health. Dorchester: The Dorchester Press.
Belk, R.W. 2008. Handbook of Qualitative Research Methods . Cheltenham: Edward Elgar Publishing Limited.
Berthoud, R. 2001. Teenage births to ethnic minority women. Population Trends summer, 104, pp. 12-7.
Botting, B., Rosato, M. and Wood, R. 1998. Teenage mothers and the health of their children. ONS Population Trends, 93, pp. 19-28.
Croydon, 2012. Croydon Teenage Pregnancy Rate Halves. [Online]. Available at: http://www.croydon.gov.uk/news/pressreleases/press-2012archive/croydon-teenage-pregnancy-rates-halve [Accessed 23 Feb 2013].
Gordon,W. 1999. Good Thinking. London: Admap.
Gruber, J. 2009. The Problems of Disadvantaged Youth. Chicago : The University of Chicago Press.
Haldre, K., Rahu, K., Rahu, M. and Karro, H. 2009. Individual and familial factors associated with teenage pregnancy: an interview study. Eur J Public Health, 19 (3), pp. 266-270.
Hammersley, M.1999. Social Research. London: Sage.
Imamura, M., Tucker, J., Hannaford, P. et al. 2007. Factors associated with teenage pregnancy in the European Union countries: a systematic review. Eur J Public Health, 17 (6), pp. 630-636.
Kamberg, M. 2012. Teen Pregnancy and Motherhood. NY: The Rosen Publishing Group.
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Kumar, 2011. Research Methodology. New Delhi: APH Publishing Group.
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MacPhail, C. and Campbell, C. 2001. I think condoms are good but I hate those things: condom use among adolescents and young people in a South African township. Social Science and Medicine, 52(6), pp. 1613-1627.
Monsen, E.R. and Horn, L.V. 2007. Research Successful Approaches. USA: ADA.
Robson,C. 2002. Real World Research. London: Blackwell.
Roth, J., Hendrickson, J., Schilling, M. and Stowell, D. W. 1998. The Risk of Teen Mothers Having Low Birth Weight Babies: Implications of Recent Medical Research for School Health Personnel. Journal of School Health, 68: pp. 271–275.
Social Exclusion Unit. 2001. Teenage Pregnancy: Report by the Social Exclusion Unit. London: Stationery Office.
Teenage Pregnancy Associates, 2012. Teenage Pregnancy: The Evidence. [Online]. Available at : http://teenagepregnancyassociates.co.uk/tpa-evidence.pdf [Accessed 23 Feb 2012].
Trapani, M. 1999. Reality Check : Teenage Fathers Speak Out. NY: The Rosen Publishing Group.
Carter, Y. And Thomas, C. 1997. Research Methods in Primary Care. Oxon: Radcliffe Medical Press Ltd.
Walsh, M. and Wigens, L. 2003. Introduction to Research. Cheltenham: Nelson Thornes Limited.
WHO, 2012. World Health Organisation. [Online]. Available at : www.who.int [Accessed 22 Feb 2013].
APPENDIX-1: Questionnaire to be used in the study:
Who do you live with
Was this pregnancy planned
Are you attending school
How do you intend to support your baby financiallyAre you or your partner working
Do you know what choices of contraceptives are to you and how important is it to use contraceptives
Are you and your partner mentally ready to take the responsibility of the baby