With new figures confirming Scotland's high rates of teenage pregnancy, Barbara Millar reports on initiatives to address the issue and provide sex education earlier

It is rare for the Scots not to revel in a march stolen on the English, but it is a dubious honour to have fought England and won the distinction of having the highest teenage pregnancy rates in Europe.

Data published in the annual Health in Scotland 1997 report last week shows that while the rate of first births among teenagers fell by a fifth in the 20 years to 1995, the fall occurred entirely among those aged 17 to 19.

Furthermore, admits Fraser Patrick, chief neighbourhood resources officer with Dundee city council, Dundee has the worst rates among Scottish cities. Among every 1,000 girls aged 13 to 19, there are 51.2 pregnancies.

The figures have prompted the council to set up a taskforce, including its own education and social services, Tayside health board and local trusts, to find ways to cut the rate in half.

The Dundee taskforce will report later this month, but Mr Patrick says a strategy has to be devised which will raise public awareness.

'Education and information services on sexual health matters for young people are much worse in Scotland than in Europe,' he says.

'European youngsters approach matters with more maturity. We believe if we start sex education for young people earlier - at eight or nine years of age - it may encourage them to delay initial sexual activity.'

Changing the often 'negative, fearful and hypocritical stance' of many adults will not be easy, he acknowledges. 'But we hope we can find creative ways of engaging the local population in the debate about sexual health.'

Tayside health board's department of health promotion is running day courses to train primary school teachers in sex education.

So far, three courses have run, but this is only scratching the surface, says senior health promotion officer Julie Redman.

But the health board is funding supply cover for teachers who attend the course, which has helped to address why it is difficult for teachers to attend training outside school, she adds.

'It is important that children leave primary school with information about how their bodies work, about relationships and feelings,' says Ms Redman. 'But we also have to address society's attitude and the double standards that prevail.'

On the one hand, young people are given the message that sex is dirty and not to be spoken about, while, on the other, they are told that sex is everything, she says.

'This creates bewilderment in young people. I would like to see us move more towards the way things are in the Netherlands where people are much more open and honest about sex and where adults have come to terms with young people's sexuality.'

Grampian health board and the health promotion and family planning services sections of Grampian Healthcare trust recently launched a new website on contraception and sexual health.

'Teenage pregnancies are a priority issue,' explains Gillian Flett, a consultant in family planning and reproductive health.

In Edinburgh and Lothian, the rate of teenage pregnancies is around the Scottish average of 43 per 1,000.

The board's health promotion department is working with agencies in areas of deprivation to develop more accessible services, says senior health promotion officer Elspeth Murray.

A steering group has been formed by Midlothian community education department to establish a sexual health clinic as an integral part of a new youth enquiry and advisory service.

According to the most recent report on the health behaviours of Scottish school children, more than one-third of Scotland's 15-year-olds have had sex. Between 1990 and 1994 their numbers rose from 26 per cent to 37 per cent.

But the study, commissioned by the Health Education Board for Scotland, also revealed that schools were providing teenagers with key information about safer sex, says Martin Raymond, head of public affairs for HEBS.

HEBS launched its 'Think about it' campaign last year. The campaign has tackled drinking and smoking so far and is soon to focus on sexual health issues.

'We are targeting the 13 to 15-year-olds because they are at the critical period when the opportunities to drink, smoke, take drugs and get involved in sexual relationships are often presented to them for the first time,' says Mr Raymond.

'Through the campaign we hope to put sexual health matters firmly on teenagers' agendas.'

Health in Scotland 1997. www.scotland.gov.uk/library/ docs-health/his97- 00.htm

Grampian's Essential Safer Sex. www.es-sensualsafersex.co.uk

Message in a travel pack

Greater Glasgow health board has forged links with travel agents across the city to promote the safe sex message among teenagers going abroad on holiday.

Researchers who observed the behaviour of 160 young clubbers on a Spanish holiday discovered that, of those who had sex abroad, only 27 per cent used condoms, compared with 40 per cent who used them when they were back home in Scotland.

Now any teenager who books a foreign trip through one of the participating travel agents can pick up a free travel pack which includes information on safe sex and a condom.