Sexual health, contraception, and teenage pregnancy
BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7491.590 (Published 10 March 2005) Cite this as: BMJ 2005;330:590
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In their contribution to the ABC of Adolosecence series (1) Tripp and Viner say that "increasing numbers of people believe" that campaigns and programmes to promote abstinence more strongly than the current British programmes do....."might result in greater health benefits". They go on to say that ABC programmes (Abstinence,Be faithful, if not use a condom) have been "remarkably successful" in some African countries
If it is true that increasing numbers of people believe these things then I suspect that these new believers are all coming from the religeous right wing, which is indeed growing - or at least becoming more vocal, and very dangerous this is too. They believe these things in the face of all the evidence, which unequivocally shows that abstinence programmes do not work despite all the millions of dollars that the Bush administration has poured into them.(2) Neither is the ABC programme (promoted by similar groups) responsible for the reduction in HIV prevalence seen in some african countries. Rather it is increased condom use and death that has led to some modest reduction.(3)
The authors have been careful in their use of words (knowing I am sure that the evidence was against them) but in a series such as the ABC series where readers may not be familiar with the literature I consider this paragraph to be misleading. Reducing the very high rates of teenage pregnancy in both Britain and the USA will only be achieved by providing easily accessible and effective contraceptive services to young people. A hidden moralising agenda is a great barrier to success, and may well be the reason for the much slower fall in teenage conceptions in these two countries as compared to most of Western Europe.
(1)Tripp J, Viner R. Sexual health, contraception and teenage pregnancy. ABC of adolescence. BMJ 330:590; 12 March 05
(2) Janice Hopkins Tanne. Abstinence only programmes do not change sexual behaviour. BMJ 2005. 330:326 12 Feb
(3)Roehr B. Abstinence programmes do not reduce HIV prevalence in Uganda. BMJ 2005 330: 496 March
Competing interests: None declared
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Editor,
In their Clinical Review in BMJ of 12 March 2005 the authors refer to the incidence of Sexually Transmitted Infections. I note that no mention is made of Human Papilloma Virus in this context and its relationship with cervical carcinoma. Indeed I have yet to read any explicit mention of this connection in any written piece of health education literature and I see this as a dangerous omission.
Competing interests: None declared
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Yes abstinence-only based programmes have their limitations, especially when they present only information without time for reflection and subsequent suggestions for behavioural change. Also when there is little or no family ,peer group nor community involvement and encouragement. Young people are like ships in a storm (of pressure to be sexually involved) they need all the help and the encouragement that they can get to see the way ahead and to keep going. In this way they are assured of find ing a truly safe haven.All medical personnel throughout the whole world cannot deny that, in principal, this IS true. On the other hand we know that the condom is not 100% safe (maybe 98.5% max.or 85% over one year). Also that adolescents are more vulnerable to STI's (Anatomically, Immunologically,multiple sexual partners and less adept at using the condom). It is most unprofessional of us to be attacking each other for our different points of view. Let us be honest with each other and the world that we both sides have problems and leave each other to find our way forward to the true benefit of young people everywhere.
Sincerely, Andrew Mitchell. aannndrew@hotmail.com
Competing interests: I am teaching an abstinence-only based programme
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It is surely time for Health Educationalists to differentiate between the two, common,physical risks of sexual intercourse."Safe Sex" is the current term covering both but if the girl is protected with a chemical contraception then sex is deemed safe and the infection risk ignored. The term "Clean Sex" should be introduced in advice regarding prevention of infection. Historically,and before Sexually Transmitted Diseases were so common in teenagers, "Safe Sex" meant "no pregnancy" but the term is now also used to cover the prevention of infection and I feel that this causes confusion.
Competing interests: None declared
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Schools are failing!
The continual rise in teenage pregnancies and occurrence of STIs clearly indicates that sex education at schools is failing miserably. Determining the cause of failure is difficult as schools vary tremendously in their characteristics. However a common fear of "the truth" seems to exist among most schools, where children are deemed “too innocent” for exposure to the world. The main focus of such schools is the compliance with government policy and not tackling the real issue at hand which is the mental and physical health of adolescents and its impact on the NHS.
As a young adult who has worked with children in a secondary school, I strongly believe that children should be prepared for the "real world" at a young age so they can cope better within society. I think that this is particularly important for those from disadvantaged backgrounds or ethnic minority groups; as they suffer the repercussions most. It goes without saying that all children deserve the chance of a bright future, however this is not always feasible due to lack of educated and impartial members of family, lack of funds to allow the collection of skills essential to life today, and lack of social integration as a whole.
Schools may have the duty of providing such education but they are prevented from doing so due to shortage of time, teachers, funds and resources, as well as issues such as the multicultural and multi-ability nature of their students. For this reason I think that it is essential to solve the problem at government level. I think that the incorporation of Social Studies as one of the main subjects in the national curriculum will be very beneficial. This is because it will give teachers greater time and incentive to delivery sex and relationship related education, as well as integrate their school with the local community. Studies have shown that school children prefer to learn from visitors that are similar in age to them; this could be used to the governments' advantage as schemes connecting university students to particular schools can be set up. This is to allow the delivery of specific and up to date information from the university students and it will result in providing community role models.
Overall social integration and the new delivery scheme will create a greater understanding of one another, increase tolerance and therefore reduce bullying and social exclusion. It will also give the students a bigger pool of knowledge to seek advice from. I think that schools play a central role in determining the future, so I don’t understand why it is not obvious to health care professionals to take advantage of this.
Competing interests: None declared
Competing interests: No competing interests