This annual report - Taranaki District Health Board

post intervention. Engagement in education appears to be important in reducing repeatteenage pregnancy: continuous connection to the education system after the birth of a firstchild has been linked to a reduction in the risk of a second teenage pregnancy [163].In New Zealand, school age pregnant women and parents are eligible to attend one of theTeen Parent Units (TPUs) located around the country. However, only a small proportion(estimated 5%) of teenage parents currently attends a TPU [246]. TPUs aim to provideeducational support for young parents, for example through providing individualisededucation plans, a suitable environment for feeding and changing babies, help withtransport and peer support. Each unit is linked to an Early Childhood Education provider toensure accessible child care. The 2011 Education Review Office evaluation of TPUs foundthat units could offer individualised programmes and supportive environment, althoughattendance was problematic at most units [246]. Most of the students valued their time attheir unit and felt they were progressing towards their goals. Many were motivated by adesire to make their children proud of them and most students achieved NCEA creditswhile at the TPU.A 2006 survey of 220 teenage parents (overall response rate 49%), attending 19 of the 21TPUs in New Zealand, found that most teenage parents attending the units were wellconnected to their families and felt supported within the unit. However, a number of areasof concern were also identified, including sexual health issues, nutrition and physicalactivity, and mental health. A more recent Families Commission report found that youngparents who had access to TPUs value them highly and have aspirations and goals thatthey otherwise might not have [163]. The report highlighted supporting pathways intofurther education, training and employment as a priority area to help support teenageparents and prevent repeat pregnancies [163]. It identified that teenage parents need easyaccess to a range of differing educational opportunities that link to post-secondary schoolcourses, employment or apprenticeships and affordable and accessible childcare.Systematic Reviews and Guidelines Addressing Services forPregnant Women Experiencing AdversityAs the previous sections have shown, New Zealand women and their families/whānau maybe exposed to a range of adversities during pregnancy. Services currently exist locally toassist women and their babies during this critical period. However, recent local reviewshighlight the need for the health sector to continue to identify barriers to care and effectiveinterventions to address these barriers, as well as to prioritise antenatal care for “highneeds” and vulnerable women [138,240]. In this context, there is a wealth of information inthe international literature on interventions and services aimed at improving outcomes forwomen and their babies exposed to adversity, which is of relevance to New Zealand.However, when reviewing the information presented, the reader must remember thatmodels of maternity care vary between countries, and thus that the utility of the findingspresented should be viewed in the context of New Zealand’s LMC based model of primarymaternity care.The review of the international literature which follows is primarily based on the findings ofsystematic reviews and guidelines and was undertaken using the methodology outlined inAppendix 1. As a result of the structure of the underlying literature, it considers antenatalinterventions from a number of different perspectives: with some reviews focusing onspecific types of intervention, some focusing on specific population groups and somefocusing on specific outcomes. The section thus begins by reviewing interventions aimedat socioeconomically disadvantaged and vulnerable women in general, before consideringinterventions which aim to meet the needs of the specific groups of pregnant womenidentified in the previous section, namely: women who use alcohol and other drugs,teenage parents, women exposed to family violence, and women experiencing mentalillness in pregnancy. When reading these sections, it is important to remember thatvulnerable women often have multiple needs and may experience a number of adversities,necessitating an approach that crosses population groups and requires intervention from arange of services and agencies [139].In-Depth Topic: Adversity in Pregnancy - 292