Monday, 5 November 2012

Contraception in the News

The Daily Mail Article - the voice of "moral" Britain, is fuming about contraception. Under a headline entitled "Today, children, we're teaching underage sex and debauchery", Peter Hitchens says:

If we are all so disgusted by the Savile affair, which is over, why are we not much more revolted by the schools and clinics which, during next week, will be giving contraceptive jabs and implants to underage girls, so they can have underage sex? The almighty authorities of this country, backed by Parliament, and ultimately by the force of fines, police and prisons, are now forcing their  tawdry sexual standards on an entire generation. They involve the deliberate violation of innocence, the undermining of family life, and the subversion of parental authority. Schoolgirls as young as 13 are being given contraceptive injections and implants without their parents' knowledge, hundreds of them actually in schools, thousands more in 'clinics'.

Notice the highly emotive language - "debauchery", "tawdry" - in Hitchens rant, and the implication that this is being forced on schoolgirls. In fact, as the Telegraph notes " implants were being offered to their children".

The key word here is of course, "offer" rather than "force". Of course, the problem with the offer is that there can be considerable pressure put on the child, especially as this is not involving parental consent of any form.

For example - whether or not the MMR causes autism, the "fear factor" used either against it by critics, or promoting it by governments, shows how fraught the area of vaccination is when it comes to informed consent. That's used against parents, not against children who have less resistance to emotive language conjuring up frightening scenarios.

The discourse of facts is often suborned by the discourse of emotive appeals, often involving frightening people into submission. In that respect, the position has not moved a million miles from the Mediaeval correlate, where the fear of hell could bludgeon people into obedience.

But the fear factor may go both ways. Doctors may warn young schoolchildren against the risk of an unwanted pregnancy, but religious groups - mostly Christians - oppose contraception, and may even lead to the risk within the Catholic church of "mortal sin" - and as the teaching has it - "those who die in a state of mortal sin risk eternal damnation." (3)

Islam is more nuanced, but becoming less so. Eight of the nine classic schools of Islamic law permit contraception, but more conservative Islamic leaders have openly campaigned against the use of condoms or other birth control methods. However, in the teachings of Islam, sex before or outside of marriage is forbidden.

Hitchens is clearly concerned that the message is sent out to school girls that promiscuity is fine. This is also the opinion of Norman Wells:

Norman Wells, director of the Family Education Trust, said: "Schemes like this are giving girls as young as 13 a licence to engage in illegal sexual activity and denying them the protection that the law on the age of consent is intended to give. (3)

But the doctors themselves see it as a preventative measure. In 2010, the Institute for Public Policy Research was talking about teaching school children about the importance of contraception. Its report showed that British teenagers were the most sexual active in Europe and the third least likely to use a condom during underage sex. It noted that:

Britain has the highest rate of births to teenagers in Europe, with an average of 26 live births per 1,000 women aged 15 to 19 - nearly a fifth higher than Latvia, the country with the next highest rate, and more than four times the rate of Cyprus, Slovenia, Sweden and Denmark. Despite a concerted efforts from Government and a target to halve teenage pregnancy rates between 1999 and 2010, progress remains frustratingly slow: there were 41.4 conceptions per thousand women under the age of 18 in 2005 - just 2.9 per thousand lower than in 1991. (4)

The report showed that almost one in three 15 year olds didn't use a condom during their last sexual intercourse. It showed that British teenagers' sexual health is considerably poorer than it was a decade ago. In the last ten years:

Levels of genital chlamydia rose by 508 for male and 238 percent for female teenagers.
Levels of genital herpes rose by 52 for male and 38 percent for female teenagers.
Levels of syphilis increased nearly 16 fold for males and 14 fold for female teenagers.

The figures looking back at statistics gathered during 2001/2 showed that:

The proportion of 15 year olds who had sexual intercourse in the period 2001/2 was: 38 percent in the United Kingdom.
Proportion of 15 year olds who used a condom during their last sexual intercourse, 2001/2: 70 percent in the United Kingdom,

The question is - how best to tackle this problem. Moral advice clearly is still being given by the churches, but it is obviously falling on deaf ears.

The pragmatic solution is to offer means of contraception, but unless we know what advice is being given, and how it is being given, we don't know whether it might give young girls an incentive to experiment sexually at an earlier age. That's hidden within the black box of doctor-patient confidentiality, and can only be broken by the girls themselves.

There's also a worrying trend with the pragmatism.

The number of implants and injections administered is likely to be higher as many health trusts said they did not keep records or that releasing the information would breach patient confidentiality. (5)

Now I've seen the lack of adequate record keeping before. Two of the three vaccine brands for MMR that were introduced in 1988 had to be withdrawn for safety reasons:

A rogue strain of the measles, mumps and rubella vaccine caused deafness in children, the Government has admitted. Katie Stephen, 21, who lost the use of her left ear days after being inoculated, is the first known victim to prove her case to the Vaccine Damage Payments Unit. Miss Stephen's medical records prove that she was deafened by an MMR jab using the rogue Urabe strain of mumps, which was given to 5.4 million British children between 1988 and 1992. The stock was withdrawn because it caused meningitis.(6)

When records around that time were checked, there was a shocking lack of proper documentation, and even in Jersey, no notes were being kept of batch numbers etc. The impetus to treat the child was the main concern, and any side effects could often not be linked back to the batches of vaccine used because of the poor administrative records. 

The haste with which this recent development seems to be taking shape does give me the same kinds of concern, especially as these implants may give a false sense of security, and records are not kept. In 2011, Channel 4 had a documentary which:

"revealed a number of NHS trusts have paid £200,000 in clinical negligence compensation to women who've become pregnant or experienced injury when using the contraceptive implant." (7)

The lack of records does not inspire confidence if matters go wrong.

Moreover it is not clear how a focus on contraception alone, as appears to be the case, will solve the problems of sexually transmitted diseases, which are on the increase. Insofar as it may give a school girl the assurance that she will not get pregnant, alone that would be a mistaken assurance, as it does not mean she cannot be infected with a sexually transmitted disease.

In this respect a 2009 South African study gets the balance better when it notes that "it makes little sense to empower women about their sexuality without concomitant efforts to empower young men about equitable gender relations".

I don't see any easy answers, but the trite reactions of the Daily Mail with its moralising tone do not help create an informed debate. Clearly there are questions to answer, and ethic and legal matters which require discussion. The sensationalist reporting can't help with that; rather than Peter Hitchens, it would have been more helpful to have the philosopher Michael Sandel to pen an article.

Above all clarity is needed, and I'm not convinced it is coming either from the rather bland medical establishment's press releases, which only seem concentrate on the end result - which is important, but not the only matter to consider - or the fulminations of the newspapers making lurid headlines out of the matter, who seem to think that teenage pregnancy will go away with suitable moral teaching. There seems little change of rapprochement between the two sides, as both seem in principle to believe that they are right, and are not prepared to budge.

(8) Teenage Pregnancy in South Africa with Special Emphasis on School Leavers, 2009

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