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Published: 06/02/2003, Volume II3, No. 5841 Page 27

Expectant mothers aged 12 and teenagers too embarrassed to buy condoms... But where can the government turn for guidance on how to improve the nation's sexual health - how about the young people themselves? Eleanor Turpin reports

The government may think it understands the scale of the work ahead to tackle Britain's appalling track record on teenage pregnancy and sexually transmitted infections.

But even so, ministers might be shocked to hear of young people sneaking out of chemists with pockets stuffed full of stolen condoms, claiming they cannot afford to pay for them.

And those who do have the money still fear embarrassment, preferring to procure their supplies from vending machines in pubs and clubs rather than face glares over the chemist's counter.

As for getting them from sexual health or family planning clinics - well, they simply do not want to be spotted in those sorts of places.

And that is if they can find a clinic open outside school hours.

An exaggeration of the current state of sexual health and behaviour among teenagers today? Not if the accounts of 15-21-year-olds at the penultimate meeting of the Commons health select inquiry into sexual health are to be believed.

'A lot of people just want the condoms. . . not the lecture, ' 18-yearold Scott said candidly to MPs.

That said, the young people who appeared before the committee had clear ideas about what sort of sex education they do want. They also had strong opinions on why their peers are not accessing sexual health services.

Unanimously, they do not want sex education from their geography or English teacher: 'We have English teachers to teach English, but no sex education teachers to teach sex education - and surely that has more of an impact on lives.' In truth, most of them say they would rather do away with adult instruction altogether and teach themselves.

Peer-led sex education is springing up across the country. One hundred schools have enrolled in A PAUSE (added power and understanding in sex education), a sex education programme run by Exeter University's department of child health and funded by health and education authorities.Teachers still teach the 'technical' aspects, but 16-18 year olds are brought in to lead discussions on peer pressure and reasons to have sex, in an attempt to create new social norms.

There is also the critical issue of when sex education should start.

Witnesses at the inquiry insisted it cannot be left until secondary school, when girls as young as 12 have become pregnant.

Rachael, a representative from Wigan borough-wide youth council, called for the 'basics' to be taught at primary school followed by more in-depth discussion at the age of 13.

Two 17-year-old mothers from Swindon praised the use of their school's£300 electronic babies that wail and scream day and night, giving a grim warning of the downside of life as a young parent. But for Natalie, aged 17, the lesson came too late: 'I got mine when I was pregnant.'

There were a few surprises about the use of technology for providing sexual health advice. Text services were given the thumbs up: 'If I can get texts on how my football team is doing, then why not sex advice?'

But sniggers went round at the mention of sex advice lines, seen as the sort of service to phone up for a joke. And it seems that the internet is not a good means of getting sexual health messages across to young people: school computers will not access sites containing the word 'sex' and at home there is the chance that parents will read the e-mails.

It takes courage for teenagers to overcome the embarrassment of walking into a sexual health clinic.The youngsters proposed a simple solution that was met with nods of approval from the health committee: sex clinics in sports centres.

Committee chair David Hinchliffe told HSJ he believes this is a good idea, but feels they 'would be missing a large number of people, especially young females' if this suggestion was adopted. He says clinics in sports centres 'may be more relevant to young men'. The suggestion of separate youth centres is also being considered by the committee, an idea that has been put into practice in other countries which, Mr Hinchliffe says, 'have a much more constructive sexual health strategy'.

Four members of the Wakefield peer-group research project gave evidence to the inquiry. The group has been trying to improve its current sexual health services, reacting to criticisms voiced in its survey of young people - much of which concerned confidentiality.

In an attempt to make clinics more youth-friendly, they have trained staff at their local sexual health clinics, reminding doctors, nurses and receptionists what helps and hinders them in accessing the service.

While some parents fear that sex education in schools risks encouraging young people to have sex, young people have other ideas about what prompts them to become sexually active. And a report from the Wakefield peergroup research project puts alcohol top of the list.

Mr Hinchliffe is particularly concerned about the generational differences in drinking habits. While in the past it was mainly young men who were likely to drink to excess, 'now it is very common to see women in that state. . . we need wider education on alcohol and binge drinking'.

The relationship between drinking and sex is clearly key to any attempt to change sexual behaviour among young people.

The select committee was keen to hear the thoughts of the teenagers present on what action should be taken to address issues around alcohol-fuelled sex.

For once, the articulate, opinionated young people were stumped. Asked what could be done, they simply laughed.