Comment: Why are we giving our schoolchildren contraceptives?
By Peter SaundersFollow @drpetersaunders
School nurses have given implants or jabs to girls aged between 13 and 15 more than 900 times in the past two years, according to a survey last week by The Daily Telegraph. A further 7,400 girls aged 15 and under have been given contraceptive injections or implants at family planning clinics.
The implants, which prevent pregnancy for up to three years by releasing hormones into the blood, are inserted into girls' arms. The injections are effective for up to three months.
Under patient confidentiality rules, school nurses are banned from seeking the permission of parents beforehand, or even informing them afterwards, without the pupil's permission.
The implants and contraceptive injections are being offered in schools in Bristol, Northumbria, Peterborough, Co Durham, the West Midlands and Berkshire and their use may be far more widespread given that many trusts claimed they did not keep records or said releasing information would breach patient confidentiality.
Sex under 16 is illegal in Britain. Under section 3 of the Sexual Offences Act 2003, sex with someone under 16, whether consensual or not, is regarded as sexual assault and carries a prison sentence of two to five years. Underage sex is illegal because it can be profoundly damaging physically, emotionally and spiritually and its consequences can be expensive for society, both socially and financially. The duty of government is to uphold the law and to ensure that people are both protected from criminal acts and are also able to seek redress for damages.
So why is government money being used to help teenagers engage in criminal acts? Children under a certain age cannot drink, drive or vote as they are not considered sufficiently mature to do so but we don't see government-sponsored programmes facilitating or protecting any of these illegal activities. So why do we take a different attitude to sex? The law against sex under 16 is there for a reason. It is intended to protect vulnerable teenagers from potential harm.
Why, when parental consent is required before children can undertake a perfectly legal activity such as going on a school trip or receiving medicine, can nurses facilitate their involvement in an illegal activity behind the backs of their parents or guardians? When this story first came to light earlier this year there were understandably a lot of angry parents who felt that their responsibility for their own children had been undermined and that their children were being exposed to risk and encouraged to experiment. Parents should be informed and should be empowered to take responsibility and be fully involved in their children's decision making.
Some might argue that providing contraception to young teenagers is done specifically to protect them from harm. It is true that contraceptive implants and jabs will protect young girls to some degree against unplanned pregnancy but they offer no protection against sexually transmitted infections (STIs) or sexual exploitation. If a young teenage girl is in an abusive relationship or has pressure put on her to have sex then she can be very easily manipulated especially if she is emotionally involved with the boy or man who is trying to coerce her.
After a jab or implant she can also no longer offer the eager man the excuse that if she has sex she might become pregnant. He will have more confidence about his illicit activity not being detected and if there are STIs or allegations of coercion it will be her word against his. The dangers of authorities turning a blind eye to supposedly consensual sex involving children under 16 have already been dramatically illustrated in these last few weeks in the case of Jimmy Savile and others for whom contraceptives gave fresh opportunity in the 1960s. Long-acting contraceptives that give three years 'protection' to a vulnerable 13-year-old heighten that opportunity and make her an easier target for abuse.
We know also that the younger a girl starts to have sex, the more partners she will have and the less likely she is to be able to form long-lasting relationships in the future. Underage sex may later unwittingly contribute to the divorce rate with all its consequences for children. One in three young women later has regrets about the way they lost their virginity.
Are these school nurses explaining to these girls the facts about STIs and their risks including infertility? Are they really taking the time to explain the emotional and social consequences of underage sex and taking a detailed history of each girl to ensure that they are not being exploited, coerced or abused? I wonder.
Professor David Paton of Nottingham University showed last year that making the morning after pill available free over the counter without prescription in a given region leads to no change in pregnancy rates and a 12% increase in rates of STIs. Where is the hard evidence that a strategy involving making implants and jabs more widely available will lead to a decrease of pregnancies in this population? It doesn't actually exist. Why then is the government using public money to back what is effectively a social experiment that may well not work in its primary aim whilst leading to other adverse consequences?
It is a fact that young people who feel that they are secure and protected by contraception will take more risks sexually. The phenomenon whereby applying a prevention measure results in an increase in the very thing it is trying to prevent is known as 'risk compensation'. The term has been applied to the fact that the wearing of seatbelts does not decrease the level of some forms of road traffic injuries since drivers are thereby encouraged to drive more recklessly. In the same way it has been convincingly argued that making contraception readily available to vulnerable people can actually increase rather than decrease rates of pregnancy and sexually transmitted infections because teenagers are thereby encouraged to take more sexual risks in the false belief that they will not suffer harm.
This move to provide contraceptive implants and jabs to girls under 16 is the latest development in a government teenage sex strategy that is not working. Although teenage pregnancy rates in Britain have fallen to their lowest level since 1969, they remain around twice as high as those in France and Germany and five times the rate in the Netherlands. Meanwhile the number of STIs continues to rise.
Contraceptive provision alone will never address Britain's epidemic of promiscuity and its consequences. More needs to be done to dissuade young people from having sex and promoting abstinence as a good lifestyle choice. The government also needs to be ensuring that the existing law is upheld and doing more to curb easy access to pornography, which promulgates unrealistic ideas and expectations about sex, further fuels risk-taking behaviour and makes it more likely that young people will end up making decisions they later regret.
It is not difficult to see why many adolescents want to have sex in the light of the many pressures on them to do so. Never before have adolescents been exposed to such relentless media pressure to have sex as early as possible. The internet, cinema, television, pop music, novels and magazines all combine to project sex as a status symbol, and as the primary reason for living. Adults must take greater responsibility for the impact of media and cultural messaging.
There are communities in the UK – both ethnic and faith communities – which have very low levels of promiscuity and accordingly very low levels of unplanned pregnancy and sexually transmitted disease, divorce and broken relationships. These groups are getting something right and the government should be learning from them rather than basing their strategy on a non-evidence-based ideology involving more and more contraceptives to younger and younger people.
School nurses should be advising 13-to-15-year-olds that whoever has sex with them is committing a criminal offence and that sex is an activity that provides significant risks for their physical and emotional health. To tacitly facilitate such behaviour, especially behind parents' backs, is unprofessional, irresponsible and morally wrong.
Peter Saunders is chief executive of the Christian Medical Fellowship, a UK-based organisation with 4,000 UK doctors and 800 medical students as members. He was formerly a general surgeon.
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