Thursday, 26 April 2012

Normalising sexual promiscuity in the young

The BBC news website today carries a story about plans to widen over-the-counter access to the contraceptive pill.  A study by NHS South East concludes that the provision of the Pill by pharmacists, with no GP prescription necessary, should be widened from the five pharmacies currently offering the service.  These pharmacies are in Southwark and Lambeth, two boroughs which apparently have the highest teenage conception rates in London and some of the highest in the whole of Europe.  It seems that there has been a significant drop in emergency contraception in these areas since over-the-counter contraceptive pills have been made available.

This of course does not mean that women's behaviour with regard to casual sex has changed, simply that they are preparing better for it in advance, which as far as modern sex education goes seems to be the end and only goal.  Even that does not seem to be happening as effectively as it could.  In fact, the BBC reports, "While one pharmacy saw a significant drop in the use of emergency contraception after the pilot was launched, the report also found that a large proportion of women did not return for a subsequent pill supply - having gone back to emergency contraception. Many said this was because they did not have a regular partner."

This is enough of a shame when we are talking about adult or near-adult women, but becomes positively sinister when we read that the same NHS report suggests widening the over-the-counter service to include girls as young as 13 - which, of course, is already happening in the Isle of Wight and Manchester.  Just how quick, convenient and "normal" can we make it for under-age girls to have sex?  As one user of the South London service told the BBC, "It is a quick way to get contraception, and it is very private, unlike a clinic where everyone will know what you are going there for."  Talk as much as you like about guidelines for pharmacists and the questions they will be expected to ask before giving out the Pill, the fact is that this scheme intends to make it substantially easier to obtain the contraceptive pill and that is what will happen.

So here we go again. As ever, the answer to teenage pregnancy rates is... encouraging teenagers to ask for contraception.  Contraception that is not only easier and easier to obtain at an ever younger age, but is also easier and easier to obtain without parental knowledge. The net effect is that we are progressively normalising casual sexual behaviour for girls and boys who are effectively still children.

A Department of Health spokesperson has said, "Young people should think carefully before they have sex". And yet no-one thinks to point out to them that there are alternatives to "contraception and sexually transmitted infections".  We could try that much-mocked word, ABSTINENCE, for a start.  The comeback to that one, of course, is always, "But they're going to do it anyway so we have to make sure they do it safely".  Well of course they're going to do it when we're making so much effort to show them it's normal and easy... in fact, it's the done thing and anyone who doesn't do it is, well, a bit odd.

There is no solid evidence that this approach works, anyway.  The BBC reports that "Currently it is not known if the service has helped reduce teenage pregnancies as conception data for the last three years is not available" and quotes Dr Peter Saunders as saying, "There is no clear evidence from this study that it will reduce unplanned pregnancy and abortion and there is a real risk that, by encouraging more risk-taking behaviour, it could fuel the epidemic of sexually transmitted disease. Without comprehensive research on real outcomes this strategy could well be like pouring petrol on flames. We should instead be focusing on evidence-based strategies aimed at bringing about real behaviour change" (my emphases).

After I had read the BBC report, an article in the latest Pro Life Times caught my eye. Its topic is a SPUC conference earlier this year where Professor David Paton gave Northern Ireland politicans "a stark warning not to copy England's strategy to reduce teenage pregnancies".  Northern Ireland, as we are well aware, has had much more restrictive abortion laws to England, a lower provision of family planning services and "a stated goal to decrease the rate of teenage sexual activity" (hurrah!).  Despite this, said Professor Paton, rates of both teenage pregnancy (abortion plus births for under 16s) and sexually transmitted infections in Northern Ireland are less than a third of those in England.  Unfortunately this could change, as Northern Ireland has started to emulate England in the past decade with regard to easier access to birth control for teenagers and in its sex education.  The result of its new strategies?  From the available data, none of them appear to have had a positive result, says Prof Paton.  "In fact, the under-17 birth rate... was higher in 2010 than when the [new] policy started in 2002."

Isn't it time, at long last, to stop flogging a dead horse and try a new approach to sex education and reproductive health?  As responsible adults who care about the health and welfare of our upcoming generations, I would suggest that it is our positive duty to do so. Instead of applying plasters to the wounds created by our current behaviours, we should - we must - suggest modifying those behaviours themselves.  It can be done.

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