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.

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