Monday 2 May 2011

decisions decisions...

My relationship with TV researchers is one of false hope followed by inevitable disappointment. Each time researchers have been putting together a new series of the Sex Education Show they have called me up. Like a fool my heart beats a little faster and my brain starts whirring and I believe, I really believe, that this time they actually want to get it right.

The first time abortion was mentioned on the Sex Education Show (an episode first aired in 2010) it was a description of an abortion method, accompanied by the presenter making eeuch faces and yeuch noises. I tweeted like a lunatic - Why the focus on the abortion procedure? Why the pulling of faces? Another missed opportunity to represent abortion and abortion education constructively.

This time when they rang asking for something I couldn't and wouldn't provide them with (probably a young woman who would talk about her abortion to the nation), I grabbed the bull by the horns. 'I'm afraid we can't help you with a real life case study, but what we can do is spend a bit of time helping you to consider useful ways in which to represent abortion and ways to address it within the Sex Education Show.' Silence at the other end of the phone.

'For example', I blathered on, 'I could send you the resources we use in schools. If you like you could come and observe one of our workshops to see what it is that young people really want to know about abortion and how you can usefully address the subject. I can send you a list of the questions they commonly ask and an explanation of how to answer them. Anything you'd like to know about this we'd be happy to explain, or to demonstrate '...SILENCE.

'It's just (I don't give up easily) it would be so much better if we could help the young people think about why abortion happens and how people come to that decision, rather than looking solely at the abortion process as you did last time. After all the abortion process is quick as a few minutes, and labour a few hours, but the decision to have a baby may be life changing.'

'Ok, well we'll get back to you, thanks' came the chirpy TV researcher voice on the other end of the phone.

So, did she get back to me?...No!
So, did the show focus on decision-making and avoid obsessing about the procedure itself?...No!
So, was I surprised?...No!

The show got some things right – abortion is a 'real' issue that YP aren’t given many opportunities to learn about. As one of the girl’s commented, the only stuff about abortion she knows comes from East Enders, hardly a reliable source of accurate information on the subject.  40,000 young women under 18 become pregnant in England and Wales each year many of whom face a real dilemma about what to do. As the show rightly stated, 18,000 abortions carried out for young women under the age of 18 every year in England and Wales, so it's a real shame so little good quality work is done around this topic within SRE. The young people interviewed were - as we find they always are - hungry for discussion of abortion.

Once again the opportunity to demonstrate good work was lost. Once again the abortion procedure took centre stage. As the presenter said 'we want to show teenagers the cold hard facts about abortion'.

At 40 minutes in to Episode 3 you can watch as a group of young people are led into the procedure room of a Marie Stopes abortion clinic. I've met the nurse who talked them through the procedure. She might even have participated in some of our training, and she was great - calm, clear and reassuring. But the constant camera fixation with the stirrups on the bed, and the cutting in of a photo of surgical instruments (which would only be used in a small proportion of the 9% of abortions that take place after 13 weeks) couldn't but make the whole procedure seem scary. One of the young women who had her hand over her mouth to denote 'I'm going to be sick' mode, before she even entered the room, became another point of repeated focus for the camera and editor.

Although both surgical and medical methods of abortion where mentioned, the information given was muddy and unclear, it implied that all abortions after 9 weeks are surgical which is not true - in fact the RCOG recommend medical procedures be used at all stages of gestation.

On the positive side it was instructive to see the small size of the cannula (a straw sized tube) which is inserted through the cervix and into the uterus to perform a 'surgical' or vacuum aspiration abortion. Many young people we talk to assume that it will be done using something the size of a hoover or, worse, that they have to actually cut you open. One of the young men in the programme said he had always assumed that this was how they performed abortion and it's not surprising since it's a common piece of misinformation deliberately disseminated by some anti-abortion organisations speaking to students in schools.)

As part of a comprehensive discussion of abortion it is natural that young people will ask about different abortion methods, but it really is only one part of the discussion and not, IMHO, the most important.

In Education For Choice workshops we explore the reasons women get pregnant when they don't intend to. That means looking at different contraceptive methods, different circumstances, positive and negative situations. We then get everyone to consider what that must feel like. What would the dilemma be like for the young woman and how would her partner be feeling. How easy would it be for them to talk to each other, what would they have to take into account in making a decision about pregnancy, who else could they talk to and would they get family support for whichever option they chose. We always ask them to consider adoption as well as parenthood and abortion and allow them to consider the pros and cons of all of these. We ask them to identify local services that can help with contraception, pregnancy testing and impartial pregnancy decision-making support. These lessons generate thoughtfulness and empathy as well as a lot of forthright views and interesting questions. Most young people leave the classroom with a much better understanding of what abortion is and why it is the right option for some people, but most importantly they are more motivated to avoid conception and to use contraception.

We always answer questions about abortion method clearly and simply, but just as I would if I had a pregnant young woman in front of me, we try to get them to prioritise thinking about the decision itself. However squeamish we are or fearful of pain and discomfort, the decision to bring a baby into the world and the lifelong commitment to caring for it must take priority over worrying about the relatively short abortion procedure or even the potentially long and painful labour.

I'm sad that I couldn't get this message through and that once again Channel 4 has prioritised 'shock and awe' over quality information giving. I wonder whether the next time the Sex Education Show ring me up to ask for help will I rebutt them?

Somehow I doubt it. Once again, my heart will beat faster, my brain will start to whirr and I will try again. Maybe I'm stupid, but this is just too important to get wrong.


  1. I agree that focussing only on the process of an abortion is a mistake, giving some of the 'gory details' might discourage the view I have heard from some young girls (and boys) that if they don't want to use contraception they can 'just get an abortion'.

    Obviously not all YP have that view, but it is out there. Knowledge of what an abortion actually involves might persuade them that an undesirable condom or pill is a better option.

  2. I agree discussion of method is a *part* of a holistic programme of discussion about abortion, and it's something we always address if young people raise it (many young people don't want the precise details of the abortion, but are interested in the referral process). However, in terms of promoting contraception and motivating people to use it we find that just getting young people to empathise with the dilemma, the decision and all the factors that inform that process is enough to get them reaching for the condoms, or committing to not having sex again. Gore and fear clouds arguments, empathy, communication, knowledge and thoughtfulness are much better weapons against unintended pregnancy.
    The reality of abortion in the UK is that it is accessible and free and people need to know that so that they don't delay seeking help because of ignorance or fear. This is not the same sa saying it's 'easy' and certainly not 'easier' than using contraception. The personal process of seeking abortion including the thinking and discussion that need to go into working out what's the right decision can be really hard - especially for a young woman who may not have supportive parents, supportive relationship etc. Many young people are ill-equipped to make decisions, having not reached an age they have had to take responsibility for themselves. I hope you're reassured to know that while our main focus of lessons is not how gruesome an abortion is, the main outcome of evaluations seems to be phrases like 'will never forget to use a condom now' 'hadn't thought about how hard the decision would be before' etc.