A couple of years ago Peter Saunders wrote that current government sexual health strategies for tackling teenage pregnancies are primarily based on three false presuppositions: that contraception is safe, that youngsters will actually use it and that abstinence is impossible.
I recently blogged that the cost of pursuing current sexual health strategies has been more than £250 million over the past forty or so years. The outcome has not been a drop in conceptions to teenagers but instead a burgeoning epidemic of sexually transmitted disease, unplanned pregnancy and abortion amongst young people.
Concerns about these high rates of abortion and teenage pregnancy have prompted yet another Parliamentary Inquiry into ways to reduce the high rates of unwanted pregnancies. CMF submitted evidence to this ‘Unwanted Pregnancy Inquiry’, with the aim of countering some of the typical presuppositions and to suggest alternative approaches.
Here are three counters to the three presuppositions on teenage pregnancy cited above:
1. Contraception is safe. In fact, contraception has a high failure rate among teenagers (see here too). US Research suggests that 16% of under 20 year olds will become pregnant in the first 12 months of contraceptive use.
Moreover, the increased availability of contraception has not led to a significant reduction in pregnancy rates but has led to increased STI rates. Between 1999-2001 conception rates amongst teens fell by 3.5% but rates of STIs rose by nearly 16%. Paton found that where there was an emergency birth control scheme operating, STI rates for under 16s increased by 12%. Young people aged 16-24 are the most affected group, accounting for 50-65% of all newly-diagnosed STIs in the UK in 2007.
2. Youngsters will use it. Yes, many will use it (57% of 16-19 year olds in 2008-9) but because easier access to family planning reduces the effective cost of sexual activity, by doing so it actually makes it more likely (at least for some teenagers) that they will engage in underage sexual activity.
This is known as ‘risk compensation’, a phenomenon where applying a prevention measure results in an increase in the very thing it is trying to prevent. Some teenagers will take risks they would not otherwise take, because contraception and abortion are promoted as risk reduction measures. So if a girl is on the pill then her sexual behavior will seem to her to be less risky or costly and so she will continue with it or even increase it, in the false belief that she will not suffer harm.
The effectiveness of the strategy should instead be evidence-based and judged by outcomes. Paton says that the evaluation of the government Teenage Pregnancy Strategy in 1996 was unable to find a correlation between local authorities judged to have the best SRE provision and those with the biggest decreases in teenage pregnancy rates. In other words, the impact of sex education (read, easily available contraception) on pregnancy rates is weak.
3. Abstinence education is a waste of time and money. Even the mention of abstinence education is generally met with a derogatory response.
In fact the evidence is more mixed than usually admitted. Some studies have found that abstinence-focused education does have beneficial impacts and youngsters who have experienced the ‘abstinence only’ approach had significantly later sexual initiation than those in the other programmes. This editorial by Trevor Stammers in the Postgraduate Medical Journal states that: ‘66% of the decrease in teenage pregnancies among unmarried girls from 1991 to 1995 [in the US] is attributed to an increase in abstinence, and 53% of the decline in overall teenage pregnancies between 1991 to 2001 is attributed to changes in sexual behaviour including, but not limited to, abstinence. As yet, the UK government continues to turn a blind eye to such striking evidence.’
Rather than dismissing all approaches based on, or including, abstinence, it would be better to try to find out which programmes are actually more effective.
Add to this evidence from a number of research studies which have shown that teenagers often regret the age when they started having intercourse, and that over 40% of teenagers in the UK give peer pressure as the reason for first intercourse.
It does then seem ironic that an approach based on encouraging young people to exercise self-control attracts so little support, and indeed sometimes outright opposition, from official sources.
The main problem with current strategies is that they are underpinned by the assumption that there is no right or wrong in teenage sexual activity – just choice. This assumption has led to the development of a values-free framework.
The other concerning outcome of current sexual health strategies and their values-free framework is the permissive attitude within society towards abortion as the primary solution to unwanted pregnancies. This has led to an unprecedented loss of human life as well as carrying a significant risk of harming the women involved.
Many women request abortion out of a sense of panic, or obligation, or because they feel that there are no other real options open to them. It is not always a fully informed, rationally made decision and some women can later regret their decision. Women need information, time and space to think and talk through the alternative options open to them. Many countries offer counselling as standard for women with an unwanted pregnancy. And several countries require mandatory counselling to be provided for women, including Australia, France, Netherlands, Belgium, Croatia, Cuba, Czech republic, Germany, Guyana, Hungary, Poland and Singapore.
So here are three alternative approaches that we’ve suggested:
1.Reduce the level of underage sexual activity (not just the ‘risk’) by including assurance that virginity is good and that saying ‘No’ is OK.
2. Involve parents in their children’s decision-making. There is research evidence that including teenagers’ parents in information and prevention programmes is effective in reducing teen pregnancies.
3. Challenge and change wider cultural messages. Young people live in a highly sexualised culture, putting them under enormous pressure to conform. Adults must take greater responsibility for the impact of media and cultural messaging.
In the end of course, unpalatable as it is for those who do not hold to Christian truths, nothing will work as effectively as the biblical model for sex: save it for marriage.