Feature

A doctor writes

Jane Harvey gives the view from the family planning clinic

In family planning clinics we see a lot of teenagers (about 20% in South Manchester) and quite a few are under 16 years old (about 4%). They come to us in crises — for pregnancy tests and post-coital contraception, but also for routine birth control, condoms, advice and information.

But we only see those who are lucky enough to know about the clinic and then brave enough to come. The large number who present needing crisis management shows that young people need good sex education before they need family planning.

The current public debate over sex education is ruled by the misconception that to provide education and access to contraception encourages sex. There is good evidence to the contrary. In the Netherlands they have tackled irresponsible sex with intensive education at all ages, easy access to contraception and national campaigns to encourage safe sex in adults and teenagers. In the last 13 years teenage pregnancies in the Netherlands have declined from 14 per 1,000 to less than 10 per 1,000, whereas in the UK they have increased from 45 to 69 per 1,000 over the same period.

The changes have been even more dramatic in the under-16 age group, where in the UK we now have 10 times more pregnancies than the Netherlands per 1,000 teenagers. Yet in the Netherlands the age of consent is 12. The lesson is that criminalising under-16s who have sex does not seem to prevent them from getting pregnant.

Luckily, the duty of a doctor faced with a 15-year-old requesting contraception was carefully clarified by the House of Lords in the Gillick case of 1985. As doctors we can extend our complete confidentiality to under-16s if they are ‘Gillick competent’, that is, if a girl is at risk of pregnancy and is likely to continue to be, is mature enough to understand the situation and the benefits of telling the parents have been discussed.

Many teenagers have parents they can confide in but some feel unable to talk to their parents about sexual matters. Teachers are in an excellent position to help teenagers who have no-one else to turn to and although it may be inappropriate to discuss medical details, advice about contraception, condoms and clinics is vital.

We accept daily sexual titillation in the tabloids, on television and in magazines, yet have little understanding of what children make of this information. The hypocrisy that exists in adults’ open fascination with sex coupled with their moral outrage about it creates a confusion which leaves teenagers and teachers as scapegoats.

Teenagers are portrayed as wicked and promiscuous — even criminals. The result of this discouraging attitude to sex education is teenagers who are underinformed and not confident to seek help.