Friday 30 July 2010

Are you talkin' to me?

This week Scarleteen, the US young people's sexual health information and support website, is asking young people want they want from sex and relationships education (SRE). Check out some of their great ideas: "Only unbiased teachers" "Factual information, please!" It was a great reminder of how young people's voices can sometimes get lost in the hubub about their own SRE.

How can we keep the dialogue up on our side of the pond?
  • If you're a professional, ask young people what they want to know about sex and relationships and how they want to hear it. The Sex Ed Forum even publishes a handy toolkit on involving young people in assessing and planning SRE curricula
  • If you're a young person, speak up! Sure, it's awkward, but most professionals will be happy for the help
  • If you're a parent, do you know what your young person's school is providing in SRE? Feel free to use our abortion education survey to find out

The above poster hangs above my desk at the EFC office, reminding us every day of what young people want and why we do what we do. Thanks to Shine Aloud, Newham's young people's sexual health steering committee, and the Newham Young Parents Group for their awesome work (on this and on so many other things!).

Monday 26 July 2010

Myth-Busting Monday: Do abortions routinely take place right up until 24 weeks?

Every Monday EFC busts myths and take names, cutting through the misinformation, disinformation, and straight up nonsense to bring you the facts.

Abortions rarely take place later in pregnancy.  In fact, less than 2% of abortions take place after 20 weeks. Although abortion is a safe procedure overall, risks do increase with gestation, so it’s preferable for women to have abortions as early in pregnancy as possible. 90% of abortions now take place within the first 12 weeks. Early access also helps ensure women are able to access services closer to home. Women seeking abortion even after 12 weeks are often forced to travel out of their local areas to a small number of clinics around the country that offer later abortions.

Friday 23 July 2010

Being 18

In addition to news today that sex ed is not up to snuff in many parts of the country, the completely fascinating (though not-very-catchily-named) Youth Cohort Study and Longitudinal Survey of Young People in England was published today. It's full of detailed information about the behaviour of 18-year-olds across England, including, for the first time, sexual behaviour.

What did we learn? For one thing, despite not always receiving much support from schools and families, most 18-year-olds are doing their best to stay sexually healthy: over half of young people NEVER have sex without "precautions or contraception", while only 2% have unprotected sex all the time. Furthermore, 97% of 18-year-olds who knew they had an STI accessed treatment for it. We didn't really learn anything new about the fact that young people sometimes face unintended pregnancy, and that some of these young people choose to continue their pregnancies, while others opt for abortion.

What did the media learn? I'll give you a hint: it starts with "N" and ends with "
othing". Okay, I'm being harsh. But I couldn't help but be disappointed. Despite all this interesting news, the ever-reliable Metro went with "1 in 8 teenagers girls gets pregnant" for a headline. (Apparently no boys were involved, girls just "get" pregnant. Do you think it's airborne? Dust off your swine flu masks, everyone.) Yes, this is a very interesting statistic, and it's worth talking about. But just once, couldn't we start with a pat on the back for young people? While newspapers are busy shouting themselves blue about the "teenage pregnancy epidemic" (see below), young people have been quietly getting on with being really sensible. As the astute Dr. Petra pointed out, couldn't we have a headline about getting these young people better support and better education instead?

Lest I fall into my same old "dang media" ramble, let me add that
Metro at least made the link between unintended teenage pregnancy (which, of course, not all teenage conceptions are) and the lack of sex education. That's actually a great start. But until the media catches up with us, let us simply note that in at least one way (and depending on how you feel about eye liner, in so many ways) Alice Cooper was wrong: 18-year-olds do sometimes know what they want. (And they don't have babies' brains- that's a really weird line anyway). Despite not always having someone to talk to or learn from about sexual health, they're trying to take care of themselves, and props to them.

Wednesday 21 July 2010

Outbreak! The teen pregnancy "epidemic"?

The brilliant Choice USA just tweeted (not sure what I mean? Check out our Twitter account!) a Huffington Post article about the myth of the teenage pregnancy epidemic by its director, Kierra Johnson. The article itself is worth a read, not least because of brilliant bits like this:
“Teenage pregnancy isn't the epidemic. The lack of information and support for people to make healthy decisions about their lives is the true epidemic. The culture of shame and scapegoating around sex is the real problem. And this epidemic crosses generations, with young people feeling the brunt of it.”

In the parlance of our times, word.

Although the author refers to many uniquely American phenomena (the abstinence-promoting billboard, for example. A favourite in my home state of Wisconsin informs the driver that true love waits, mother is heart of the family, and you should choose life – 3 messages for the price of one!), the article makes several points that apply to the UK, too. The most interesting and important point the author makes – what is the “problem” with teens having sex? – I couldn’t articulate better.

I think there are several reasons why the idea of the teenage pregnancy “epidemic” is a pretty useless concept. As Johnson points out, it’s not sex or pregnancy that are inherently the problem, it’s a lack of informed choice and support. A more prosaic but nonetheless important reason this “epidemic” is nonsense is the myth about the rates of teenage pregnancy. At a training on Monday, I was reminded of this issue when some participants referred to the “rising teenage pregnancy rate”. Whether or not you think teenage pregnancy is a “problem”, the teenage conception rate in the UK has not risen over the last ten years. In fact, it's fallen. Unfortunately, though, constant media panic about teenage pregnancy and perennial “Teens have sex!” headlines lead even sexual health professionals (I was guilty of this too, trainees, until I started at EFC- I’m not picking on you!) to believe the rates are higher than ever. In fact, teens today are far less likely to become pregnant than they were in Britain in the 1950s. So whenever anyone gets nostalgic for the alleged golden era of “family values” I suggest s/he a) watch
Mad Men and think about what it was like to be gay, female, black, or anyone other than Don Draper and b) consider that “kids these days” are just like “kids those days”.

Monday 19 July 2010

Myth-Busting Monday: If it's my first time/I do it standing up/I'm on my period, can I get pregnant?

Every Monday EFC busts myths and take names, cutting through the misinformation, disinformation, and straight up nonsense to bring you the facts.

Although women are most at risk of pregnancy around the time they ovulate, women can get pregnant at all times of the month, in any position, at any time in their reproductive lives!  Many women use contraception inconsistently or not at all and may not get pregnant immediately, but this should not be taken to mean that they are not fertile. Even if they have been lucky a few times, they may not be the next time, so women who don’t want to be pregnant should assume that every sexual encounter puts them at risk of pregnancy and should use contraception.

Thursday 15 July 2010

Working Links for NICE consultation

The links in the blogpost on NICE (below) aren't working. To save you copying and pasting them fromt he article here are the working links

A link to the guidance is here and simple word document comments form to submit is here

The consultation closes at 5pm this afternoon.

Wednesday 14 July 2010

EFC response to NICE consultation

Tomorrow is the deadline for responding to the National Institute for Health and Clinical Excellence (NICE) draft guidance on sex and relationships (SRE) and alcohol education. NICE was set up to make recommendations for practitioners and policy makers in public health. NICE looks at the efficacy and cost-effectiveness of different treatments and approaches.

Most of this guidance is extremely common sense stuff taken from years of research into what works in SRE ( in a nutshell, talking about everything accurately) and what doesn’t (in a nutshell abstinence only education and lying to children).

There are also several points in the guidance where it recommends working with people from faith communities to deliver SRE and alcohol education. This despite a dearth of evidence that people with a religious position on sexual behaviour are the best people to educate young people on sexual health and behaviour. Soon I will publish a blog post on a presentation I have delivered to various conferences on Ethics AND Evidence, in which I argue that both must be addressed within SRE. I am as happy as the next guy to think about the range of views and values which inform our sexual identities and behaviours. However, I believe strongly that SRE should remain a neutral space in which evidence-based information from reliable sources is provided to young people and in which they are encouraged to distinguish between facts and values.

Therefore I have written to NICE asking that they remove the recommendations to work with the faith community on delivery of SRE. If you want to respond to this consultation the deadline is 5PM tomorrow. A link to the guidance is here and simple word document comments form to submit is here

My response to NICE is here

Tuesday 13 July 2010

Caught in the net?

A recent report published by youth charity Get Connected found that 86% of under 25 year olds questioned had used the internet to search for help with a personal problem. Worryingly, more than half of these young people (53%) said that the information they found actually made them more anxious about their problem than they were before.

If you Google abortion you can see why this might be the case for a young woman looking for information about an unplanned pregnancy. As well as reliable information from sexual health agencies such as Brook, bpas, and Marie Stopes, there is an awful lot of misinformation out there. We often hear young people in our Talk About Choice sessions tell us about something they’ve read or watched online which feeds into the kind of myths we feature on this blog. Just searching using the term abortion I’ve found plenty of websites which proffer false information and graphic images related to abortion. Others present a seemingly non-judgmental, open environment for discussion of pregnancy options which, upon closer inspection, is unraveled to reveal an anti-abortion agenda, but perhaps too late for a vulnerable young woman genuinely unsure about her pregnancy.

Here at EFC we believe in presenting young people with the facts about abortion, in an unbiased manner. Only 18% of the young people questioned by Get Connected said that they would double check any information they found online with another source like a friend or parent. I worry that without proper access to genuine unbiased information about all their pregnancy options young people are at risk of reading things on the internet which simply aren’t true, or are shaped by a particular anti-abortion agenda. This isn’t to say that young people can’t be critical about what they read, but it means that we as educators, parents and professionals need to make sure we do know where to signpost for good, reliable information on abortion.

Monday 12 July 2010

Myth-Busting Monday: If everyone used contraception, would there still be a need for abortion?

Every Monday EFC busts myths and take names, cutting through the misinformation, disinformation, and straight up nonsense to bring you the facts.

There are many methods of contraception, and most of them are reliant on the woman or her partner to use them consistently and correctly. Long Acting Reversible Contraceptive (LARC) methods can be fitted for the woman by a doctor or nurse and do not rely on perfect usage.  These methods have an extremely high success rate in preventing pregnancy. Even so, all contraceptive methods occasionally fail (LARC fails less than others; see James Trussell’s presentation on why contraception fails). In fact, if every single contraception user worldwide used their chosen contraceptive methods perfectly, there would still be hundreds of thousands of unintended pregnancies each year around the world.

Despite the existence of effective methods of contraception, some women do not always find it easy to seek contraceptive care or advice or may find it hard to reach their local family planning clinic; others may find it hard to get support from their partners to use contraception; others may have the intention of using condoms or other barrier methods each time they have sex, but find it hard to remember to do so.  Sexual assault continues to be a massive problem in the UK and internationally, and can lead to unintended pregnancy. For many reasons the existence of contraception per se does not remove the need for the safety net of abortion for those women who haven’t successfully protected themselves against unwanted pregnancy.

Monday 5 July 2010

Myth-Busting Monday: Do only teenagers have abortions?

Every Monday EFC busts myths and take names, cutting through the misinformation, disinformation, and straight up nonsense to bring you the facts.

Teenagers have about 40,000 abortions a year out of the 195,000 that are carried out in England and Wales each year.  About half of teenage pregnancies end in abortion (for women of all ages it’s 22%). However, while women in the 20-35 age bracket end a smaller proportion of their pregnancies in abortion, they have a lot more pregnancies altogether, and therefore a lot more abortions. In fact, there are more abortions performed on over-40s than there are for under-16s each year.

Thursday 1 July 2010

It's true - truth is stranger than fiction

On Friday I was asked to respond to the publication of a report on fetal  awareness produced by the Royal College of Obstetricians and Gynaecologists. I welcome the conclusions that scientific evidence does not support any revision of the time limit on abortion. In almost every Parliament the current 24 week time limit is challenged. Legislative challenge is normally spearheaded by those who would see abortion outlawed altogether - some of whom would even want to see contraception restricted - but have given up all pretence they can ever get it banned. This tactic of attacking the outer margins of abortion (only 1.6% of all abortion takes place after 20 weeks) is aimed at creating generalised anxiety about abortion amongst ordinary people who are, largely, supportive of safe legal abortion provision.

So where does this anxiety come from? Most of the arguments about abortion time limits have focused on the issue of viability and the question ‘at what point in pregnancy could this fetus survive outside of the womb?’. This may seem like a neat formulation for deciding on abortion time limits, but it is imperfect. Viability is not a fixed concept because survival rates of extremely premature neo-nates will vary widely around the world (even around the country) depending on the skills, resources, equipment and experience of those providing them with care. I don’t think anyone would say that a fetus in Timbuktu  is morally less worthy, than one in Birmingham, and yet the chances of survival outside of the womb for babies born in one city are totally different to the other. 

Assuming we could pinpoint viability with any certainty what would it look like? Many extremely premature neonates survive birth but may never leave the hospital alive despite intensive and expert care. Some who leave the hospital may have a poor chance of long time survival or may suffer mild to serious developmental problems. This is not – as I’m sure some anti-abortion advocates will imply – a comment on the relative value of children with or without disabilities, it is merely an observation that viability is not a fixed measurable concept, but one that is open to interpretation and therefore not the gold standard criterion for deciding on abortion time limits some may wish it were. 

Even assuming it was, there is currently no scientific evidence for reducing the time limit on abortion. Despite the best efforts of paediatricians to support infant survival at earlier and earlier points in pregnancy, they seem to have hit a wall at around 24 weeks. At this point in pregnancy increasing numbers of premature babies are being kept alive successfully, but before this although rates of survival for hours or days are growing (reflecting vast investment of resources and expertise) even this level of intervention often ends in infant death.

This week, with the publication of the RCOG guidance, the argument on viability has been superceded by one about fetal pain and awareness. When asked to comment on the conclusion that new evidence about fetal awareness shows that the current time limit is appropriate, I was baffled. Fetal pain has often been used as an argument against abortion. Yet in all other areas of medicine, mismanagement of pain rather than the potential for pain per se would be considered the problem. A consultant wouldn’t refuse appropriate surgery to a patient on the basis that surgery hurts. They would ensure their patient was cared for properly, including – where appropriate – anaesthesia or pain medication.  Without wanting to be flippant, the human race would have rapidly diminished had we outlawed labour on the basis that it is painful. I am satisfied with the RCOG’s conclusions, and happy especially if it is reassuring to women who will go on to experience later abortion, but I am concerned that this is a red herring. Abortion does result in ending the life of a fetus and there is a legitimate argument to be had about whether that is ok or not. Moving from arguments about viability to arguments about fetal awareness or pain seem to me simply another disingenuous and desperate way to attack safe legal abortion 

This week, commenting on the RCOG guidance, a spokesperson for the Society for the Protection of the Unborn Child (SPUC) said he too felt that all this discussion of abortion time limits is a red herring because abortion is just wrong whenever it takes place. How refreshingly honest. Never mind the conclusions of the RCOG report, now SPUC and I are singing from the same hymn sheet (truth is stranger than fiction), and agreeing that the time limit is a red herring, maybe it’s time to call a halt to the incessant attacks on our current abortion law.