Wednesday 29 February 2012

Mid-week Metro myth bust 'Teenage Abortion Rates are Rising'

A headline in the Metro today claimed that while teenage conception rates have fallen, teenage abortion rates have risen. 

It's worth reminding ourselves that two days ago when the new Under-18 teenage pregnancy statistics were announced lots of sceptics on Twitter were asking just how the papers might spin this to make it look bad and controversial and scary instead of recognising that actually teenage pregnancy rates are falling. They are the lowest they have been since 1969 which is what everybody seems to want whatever end of the political spectrum they inhabit.

Hooray, then? Teenage pregnancy rates are falling....but, in today’s Metro we were asked to temper our happiness with the sad news that actually teenage abortion rates have risen. So, is this true?

The statistics for under-18s in England and Wales (see table 6) break down the figures in several ways:

  1. Conception numbers (the actual number of under-18 pregnancies)
  2. The conception rate ( number of women out of 1,000 under-18 yrs who got pregnant)
  3. The maternity rate (number of women out of 1,000 under-18 yrs who continued their pregnancy)
  4. The abortion rate (number of women out of 1,000 under-18 yrs who ended their pregnancy)
  5. The percentage of pregnancies to women under-18 yrs that ended in abortion (sometimes also known as the abortion proportion)

So what actually has happened to under-18 conception and abortion rates in England and Wales?

  • Under 18 Conception numbers decreased from 41,361 (2009) to 38,259 (2010)
  • The conception rate, maternity rate AND abortion rate ALL fell between 2009 and 2010 that means that fewer under 18s got pregnant, had babies or had abortions.
  • The percentage of conceptions that ended in abortion (the abortion proportion) rose slightly from 48.8 to 49.9.
Clearly the Metro is mixing up its abortion 'rate' with its abortion 'proportion'.

What do the statistics tell us?

These statistics demonstrate a trend towards a decrease in teenage pregnancy overall with the rate of women continuing pregnancy to maternity falling faster than the rate of women choosing to end pregnancy in abortion. This is represented in the statistics by a small year on year increase in the abortion proportion.

For people who generally oppose abortion, an increase in the abortion proportion is obviously a cause for concern especially if it represents the growing acceptability and accessibility of abortion. However, the fact that the actual number of abortions fell should be cause for celebration.

For people who generally support the right to choose abortion an increasing abortion proportion may be seen as something that has some positives if it represents the increasing awareness of abortion as an option, and improved accessibility of services. However, pro-choice people would also celebrate the fall in the number of actual abortions because ideally everyone would prefer someone not to become pregnant in the first place if they don’t want to be, rather than have to make this decision.

What the statistics tell us about the teenage pregnancy strategy which ended in 2010 is that it succeeded in bringing about reductions in the rates, but not in achieving its huge ambition of halving the teenage pregnancy rate. It took an enormous amount of investment to make even  modest reductions. With the end of the strategy and cutbacks and reorganisation across health promotion and teenage pregnancy services it remains to be seen whether this downward trend will continue.

Thursday 23 February 2012

Sex-selective abortion the new 'revelation'

Until relatively recently when we talked about sex-selective abortion it was largely something that happened in far away lands and was almost always something carried out by women carrying female fetuses. It’s something that the Indian government and others have been trying to address for many years. The practice is both the result of, and reinforces, social, sexual, economic and political inequality. It also leads to numerical imbalance in the population which you can see in countries where abortion of female fetuses is routine.

Sex-selective abortion in this context presents a huge challenge. In addition to embedded historical valuing of boys over girls, there are compelling material reasons for families to dread the birth of a baby girl. The dowry system can impoverish a family, the loss of a daughter to the in-laws family after marriage can leave parents with no support in old age; this in addition to all the incidental inequality and discrimination that can blight, and prematurely end, the lives of women and girls. Women carrying female fetuses may also be subject to violence if they have been unable to ‘produce’ a boy child. All this contributes to a context in which it’s possible for mobile ultra sound units to travel through rural areas making a fortune out of extremely poor families who want to know the sex of their fetus and will often resort to unsafe illegal abortion to end their pregnancies if they get the ‘wrong’ news.

Criminalising this practice has not ended it, and those who dread the birth of a female child but cannot access ultrasound or abortion sometimes resort to infanticide of female infants. For girls who survive their early years, a life time of poorer access to education, health care, and food means that for many life is harsh, brutal and short. Those working in this field recognise that until girls and women are seen and treated as equals; until families and communities reject traditions that socially and financially disadvantage women; until marriage traditions that impoverish the families of brides are ended and women are no longer seen as a burden, until universal good quality health care and education is a realised right, and the burden of poverty is lifted no amount of legislation will bring sex-selective abortion to an end.

Today the Telegraph runs a story about abortion clinics in the UK providing abortion for women and their partners who want to choose the sex of their child. While some people desiring this may come from communities where boys are traditionally seen as more desirable than girls, there may be other motivations for people in the UK to want to choose the sex of their children. Although I have not seen a research evidence to support this, there is anecdotal evidence (reported on the Radio 4 Today programme this morning) of couples who want to have ‘one of each’ or as the Telegraph article calls it ‘family balancing’. I’ve also heard of couples who, ironically, want to have girls only (as girls in UK mainstream culture are seen as less trouble or less of a burden than boys). If it is true, it is hard to know where to start with it. People in the economically developed world may look down their noses at the global South, and the appalling gender discrimination that leads to specific abortion of girl fetuses, but what notions of gender could be behind such decision-making in the global North? Only yesterday a Daily Mail journalist showed how far we have to go, characterising ‘tom boys’ as an irritation  who, thankfully, grow out of it when they start getting interested in boys and start dressing and behaving like proper women - alongside a whole load of other prejudice and ignorance... *despair*. This is such a big discussion, I’m going to leave it for another day...

Meanwhile, I’m sure the anti-abortion lobby are going to have a field day with the Telegraph’s report. It is, of course, no coincidence that the article has come out just before the Department of Health is about to publish a consultation document on pre-abortion counselling which is premised on the un-evidenced claim that there is a current problem with the abortion counselling provided by the two big independent abortion providers MSI and bpas. It is part of whipping up anxiety about the current state of practice in order to support changing the system, despite the House of Commons wholeheartedly rejecting an attempt to do so through Nadine Dorries MP’s amendment to the Health and Social Care bill in September last year. 

The current system means that all women seeking abortion from MSI and bpas which provide 62% of NHS funded abortions and a large proportion of privately funded abortions to women from N.Ireland and the Republic of Ireland, go through a process heavily regulated by the Department of Health. Education For Choice has worked tirelessly to promote good practice in supporting pregnancy decision-making for years and to root out poor practice, and have found no evidence of poor practice, and no record of formal complaints to regulators about the practice of organisations currently registered as Pregnancy Advice Bureaux

If clinics are providing abortion without offering good standards of care  then of course this should be addressed as a matter of urgency. As well as meeting legal requirements, women attending properly regulated Bureaux are always checked for signs of coercion or pressure from partners and family members, and a check on how confident she is in her decision. Every piece of research I have read about the outcomes of abortion suggest that feeling ambivalent about the abortion or being coerced into having one are significant risk factors in negative psychological outcomes. So clinics should ensure that this check on the decision-making process is part of the referral procedure.

If there is any evidence of poor practice, it should be addressed. However, we should be wary about using this as the basis for a wide ranging change in law and regulation of all clinics which would disadvantage all women seeking abortion in the long term.  Suggestions of new commissioning regulations for abortion counselling are likely to divert women away from professional, well-regulated and well-evaluated abortion services towards a hotch potch of unskilled, unregulated independent counsellors some of whose agenda might be to prevent women accessing abortion and who will, in any case add delays into the process of accessing abortion, adding to the waiting times, risks and costs for women and the NHS.

Most importantly, these ‘revelations’ should not be seen as grounds for rexamining the basis of our abortion law in this country as is clearly the intention behind this article. A minority of people in the UK would like to see abortion completely criminalised here and aim to get there by stealth, chipping away at, and reducing women’s access to abortion incrementally through changes to regulation, law and practice. This strategy has been extremely successful in the United States, making abortion extremely hard to access in many parts of the country, though failing to bring down the abortion rate overall. 

The anti-abortion movement in the UK is learning its lessons from the US well. The rest of us – who all want abortion to remain a safe, legal and well-regulated option for women – need to be alert and learn them too.  Be prepared for more ‘revelations’ more ‘shocking truth’ about abortion, more undermining of current law and provision. Coming to a newspaper near you soon. Watch this space...

Post Script - Some couples sex-select because they want to prevent the risk of passing on genetic disesases. I have not addressed this in this blog, but it is addressed in this report on the issue from the Human Fertilisation and Embryology Authority

Wednesday 22 February 2012

"I didn’t know there was such a thing as an implant": Sixth Formers tell us about their sex education lessons

I recently visited a school in Essex to deliver EFC’s Talk About Choice presentation to the Sixth Form there. I was lucky enough to be able to speak to a few of the students afterwards to get their thoughts on the presentation and what they’d learnt.

I was surprised when the students told me that a lot of the information on contraceptive methods had been new for them:

‘The contraception methods I didn’t know about’

‘I didn’t know there was such a thing as an implant’

 ‘I didn’t know you could get injections’

‘We know the usual stuff like pills and condoms but we didn’t know the sort of more unconventional stuff’

As years 12 and 13 I had expected them to have covered basic sexual health topics such as STIs and contraception in earlier years but it seems that had been limited and worryingly, for most of them, had taken place in R.E lessons as a purely abstract discussion of religious views:

 ‘They did talk about some types of contraception but it was more about what religions thought’

‘It was sort of like, if you were Christian what would you think about abortion’

Sex education outside of R.E lessons had only been experienced by some of the students:

 ‘A good 60 people a year group don’t have that lesson so all they have is the RE side’

‘If you did triple science you don’t do it’

These students were articulate about what was missing from their sex and relationships education. Sadly, their clear need and desire for sexual health education was not being met thanks to patchy delivery. With little knowledge of their own rights and responsibilities, or practical information about local services the students recognised that they were less able to practice safer sex. As two pupils remarked on their lack of condom education:  ‘if you don’t use it properly then you’re gonna be at a higher risk’ and ‘if you don’t know how to do it then obviously you’re gonna worry when you do it and also then you might be more embarrassed and then you don’t use it’.

The students also gave an extremely mature and thoughtful take on what abortion education should look like. They appreciated having a talk about contraception and abortion which was not attempting to push a moral agenda but rather gave factual information:

‘(you)made it less daunting, like saying, don’t be scared to talk to who you need to talk to rather than saying like, I dunno, you’ll be punished and shamed’

 ‘I think when approaching the subject of can’t be biased, like ‘abortion is completely wrong’ or ‘abortion is fun, it’s really good’ you have to be neutral, it’s neutral territory when it comes to approaching teenagers I think’

‘It’s good when you’re not really presented with ‘a viewpoint’, because a lot of the time you already have some form of viewpoint and if you just give the statistics, ...then it’s more like making up your own mind’

They were also concerned about the effect a strongly anti-abortion speaker might have on a young audience. When I asked how they would feel if a speaker used images in their talk, one young man said:

Doesn’t matter as long as they’re not being biased, like if they’re using it to influence...then it’s a bit unfair. Cos if there was a girl in that room for example who was pregnant she might look at that and feel awful’

It was refreshing and heartening to hear them speak so enthusiastically and sensibly about the need for a non-biased approach to abortion education, but it’s disappointing that a school which clearly had good intentions had so clearly failed to provide the students with what they needed. I’d like to think this is a blip, but all the evidence from surveys, questionnaires and anecdotes suggests it’s pretty typical.

Brook survey shows almost half of secondary school students felt that their SRE was unsatisfactory

Monday 13 February 2012

Contraceptive implants for 13 year olds a Four for One mythbust

As the groundwork is laid for an attack on young people’s access to contraceptive advice, we offer this myth-busting Monday special - busting four of the many myths that have been asserted following publication of this article last week.

13 year olds are all running around having contraceptive implants

In fact most younger teenagers are not having sex at all. When Dorries raised the issue of 13 year old girls being given secret implants she chose an eye catching, but relatively rare example to get press attention – it worked!

The under 16 conception rate for England is 7.5 per thousand (7,100 13-15 year olds got pregnant in 2009). Of these, the vast majority are conceptions to 15 year olds and relatively few to younger girls. This statistic has fallen over the 10 years of the teenage pregnancy strategy which means either that the strategy and its emphasis on good Sex and Relationships Education (SRE) which encourages thoughtful decision-making about sexual activity (including delaying sex) has paid off and resulted in less sex OR that young teenagers are having as much sex as the media sometimes claims, but being pretty successful in using contraception to prevent pregnancy, or maybe both. Either way the fact that this rate has fallen (not by enough, but still fallen) should not be ignored. Analysing the statistics more carefully you can see that some of the more dramatic reductions have taken place in the areas that originally had the highest teenage pregnancy rates. This is significant because these are often the areas that invested the most in SRE and tailor-made sexual health services for young people. 

Parents are always the best people to make decisions about their children’s health choices

We would love to think that parents are all able to have supportive, constructive conversations with their teenagers about all aspects of health and lifestyle, but we know that parenting and adolescence don’t always work this way. Some of the most loving, caring and competent parents struggle to communicate with their teenagers effectively, but there are also the parents who don’t attempt to communicate with, care for, or nurture their children. Then there are young people in the care system where the local authority has taken over parental responsibility because there parents simply can't or won't keep them safe.

Parents are not a homogenous group of caring, loving, competent, infallible, sexual health experts. At their best they provide love, nurture and a values framework that they hope their children will follow, but often they cannot provide objectivity or expertise, something that young people need and value when making important decisions about their health and lifestyle. 

Providing contraception encourages/increases under-age sexual activity

This assertion does not reflect sexual health practice at all. Although sexual health providers would probably prefer under-16s not to have sex at all, the fact is that many of them are choosing to. A conversation about contraception with young teenagers is an opportunity health workers use to find out more about their lifestyle, sexual behaviour and relationships; to check for coercion, pressure or abuse within their relationships; to explore sexual decision-making with them; to signpost them to services that will help address additional needs young people often present with; and to establish whether they are currently having, or imminently going to have, sex. While many people - parents and professionals - may feel conflicted about providing contraception to a young teenager, what we know is that NOT providing contraception will NOT prevent young people having sex, because the presence of one or more of adolescent sexual desire, love, adrenalin, alcohol, and culture are often irresistible even in the face of the law, and the risk of pregnancy and STIs.

The law says that 16 is the age of consent so surely giving contraception to under-16s is breaking the law. 

The law is intended to protect young people and is implemented in this spirit. It is unlikely that similarly-aged adolescents who have both consented to sex would be prosecuted even if one is underage, but a sexual relationship entailing a large age gap or a very young person would be subject to safeguarding procedures and further investigation.
Alongside the age of consent, The Fraser Guidelines which govern sexual health advice for under-16s  allow nurses and doctors to have a confidential consultation with a young person of any age and to provide them with contraception or abortion. In this situation their legal duty is:

to decide whether there are any safeguarding issues and whether information about this young person must be shared with other professionals in order to protect him/her/other young people;
to assess the competency (or ability) of a young person to understand the risks and benefits of any treatment they ask for; 
to assess on balance of risk whether providing contraception will be beneficial (for example what is the likelihood of the young person becoming sexually active whether or not they are provided with contraception); 
to encourage the young person to consider talking to a parent or carer and to help them assess the risks and benefits of doing so.

More on this:

Wednesday 8 February 2012

EFC Youth Advisory Group – Round Two!

After the success of last year’s Youth Advisory Group project we’re happy to announce that the 2012 iteration has begun! A group of seven young people form EFC’s new youth group and are currently working on producing a short film looking at pregnancy testing. We’ll be keeping you updated via Twitter and hopefully a few guest posts here from the Youth Advisors themselves!

For now, here are a few words from some of the group on why they joined the YAG and what they hope to get out of it:

''I joined YAG because I'm currently a student nurse and think it'd be good to learn a lot more about sexual health and abortion to help with my future career. I also thought it would be a good way to share my views on how sex education is taught in schools'' Hannah

“As someone coming from a background of no sex education, I joined YAG because I think that everyone should have the right kind of information to make the right choices in their lives” Namratha

“I have an interest in sexual health and teaching in general. I feel that young people have the right to accurate information on their sexual health”