In this issue:
Annual Conference
Dutch Utopia
Children’s Commissioner for England?
Children’s sexual ‘rights’
The ‘proof’ that sex education works
Review: Sex, condoms and STDs
Annual Conference
Saturday 28 June 2003
The Royal Air Force Club
128 Piccadilly, London W1
10.30am-5.00pm
This year’s annual general meeting and annual conference will be held, as usual, at the RAF Club in Piccadilly on Saturday 28 June.
We are looking forward to welcoming to the conference for the first time Patrick Fagan from the Heritage Foundation in Washington DC. Mr Fagan worked as a family therapist, sociologist, and clinical psychologist prior to becoming involved in public policy issues and serving as a Deputy Assistant Secretary of Health and Human Services during the administration of George Bush Snr. He is currently the William H G Fitzgerald Research Fellow in Family and Cultural Issues at the Heritage Foundation, a public policy research organisation. Mr Fagan will be addressing the conference on: ‘Facing the facts of family breakdown’.
Following the publication of his groundbreaking report, Deconstructing the Dutch Utopia, earlier in the year, we are also delighted to announce that Dr Joost van Loon from Nottingham Trent University will be speaking on ‘Teenage Sexual Activity: Its consequences and how to prevent them’. Dr van Loon will be sharing his session with Dr David Paton from Nottingham University Business School, whose influential article on ‘The economics of family planning and underage conceptions’ was published in the Journal of Health Economics in the spring of 2002. Dr Paton’s research called into question the long-standing official view that the problem of teenage pregnancy can be solved by making contraception more easily available to young teens, without their parents’ knowledge or consent (see Family Bulletin 107).
We warmly encourage members within reach of London to join us for what promises to be a full and stimulating programme.
Dutch Utopia
Following the publication of our report, Deconstructing the Dutch Utopia, Kerry Pollard MP (Lab, St Albans) sponsored an Early Day Motion (809) noting its findings and calling on the government ‘to honour its pledge to promote sexual abstinence among the young and do more to strengthen the role of the family’. To date the EDM has attracted an additional 13 signatures: Harold Best, Joe Benton, Jim Dobbin, David Drew, John Horam, Kevin McNamara, Andrew Rosindell, Andrew Selous, Martin Smyth, Bob Spink, David Taylor, Ann Widdecombe, and Ann Winterton.
The EDM notes that sex education in the Netherlands is not more explicit than in the UK and highlights the fact that family links in the Netherlands are stronger, with British children five times more likely to live in households headed by lone parents. It further notes that teenage extra-marital sex and pregnancy are socially frowned upon in the Netherlands and that welfare benefits for teenage mothers are low.
Supporters are encouraged to write to their MP and ask him/her to sign Early Day Motion 809, ‘Sex education in the Netherlands’. You will find the name of your Member of Parliament in your local telephone directory or on the UK Parliament website at: www.parliament.uk
The address to write to is: House of Commons, London SW1A 0AA.
A Children’s Commissioner for England?
The parliamentary Joint Committee on Human Rights (JCHR) is currently considering arguments in favour of appointing a children’s commissioner for England in the context of its inquiry on the case for a human rights commission. Since the Welsh Assembly appointed a children’s commissioner in 2001, the Scottish Parliament has recently passed a bill to create a similar post in Scotland, and the Northern Ireland Executive has recently advertised a £75,000 pa position for the province, the children’s rights lobby is now insisting that ‘England’s 11.3 million children are at risk of being left behind and let down’.
During March, Family Education Trust made a submission to the JCHR in which we expressed a number of concerns about the establishment of an office of commissioner for children. The following paragraphs contain extracts from our submission. The full text can be downloaded from our website: familyeducationtrust.org.uk/JCHRsubmission.pdf
We believe there are a number of reasons why the establishment of a children’s commissioner would not serve the best interests of children:
(a) It would undermine parents. In the vast majority of cases, children have parents who are well able to represent their interests, and we find it disturbing that the assumption is being made that a Commissioner would fulfil this advocacy role more adequately than parents. Most parents do far more to promote and protect the rights and interests of their children than any statutory office will ever do. Parents are far better placed and equipped to represent the interests of their children than any impersonal mechanism or bureaucratic machine.
(b) It would threaten the autonomy of the family unit. We are concerned at the lack of attention devoted to the family unit in discussions about a children’s commissioner. The emphasis on children as citizens of the state is so great that there is a danger of forgetting that children are first and foremost members of a family. It is not the role of the state, but rather the responsibility of parents to enable children to enjoy a happy, safe and secure childhood. Family relationships are very personal and individual matters, and each family is shaped and influenced by certain social, cultural, religious and philosophical factors which are not common to every other family. We should therefore be very wary of any approach which could lead to an official body intervening in the family and siding with the child against his or her parents in the name of ‘children’s rights’.
(c) It would threaten the unique character of childhood. While no one denies that ‘children are people too’, they are not fully-grown and fully-developed and mature. They are dependent on their parents, not only for the provision of their physical needs, but also for their moral training and development. It is precisely because children are vulnerable to manipulation, ill-treatment or abuse by those more powerful than themselves that they need the protection of their parents.
We are concerned that the appointment of a children’s commissioner would exacerbate the tendency to promote the ‘sexual rights’ of the child to the detriment of parental authority. Where adults gain access to children without the knowledge and consent of their parents, there is considerable risk of exploitation.
(d) There are grounds to fear that the office would be used as a vehicle to advance a carefully-defined ‘children’s rights’ agenda. There is no doubt that many of the individuals and groups who support the appointment of a children’s commissioner see it as a vehicle to pursue a radical agenda which would see a transference of authority and responsibility for children’s upbringing away from parents to the state. It is a matter of some concern that an agenda of this sort has been pursued in other countries which have appointed a children’s commissioner or ombudsman.
(e) The remit and powers of a children’s commissioner are likely to grow increasingly intrusive. Even before the first postholder took up his position, the remit of the Welsh children’s commissioner was extended beyond the care system to embrace ‘any matter affecting the rights or welfare of children in Wales’. Many children’s rights activists would like to see those powers extended still further. For example, Peter Newell, chairman of the Children’s Rights Alliance for England, in his oral evidence before the JCHR, made it clear that he was in favour of granting the commissioner a right of access to the family home, though he felt that to advocate such powers at the present stage ‘would probably delay us having a children’s commissioner for many more years’.
Norman Wells
Children’s sexual ‘rights’ and the age of consent
In the course of giving oral evidence before the Joint Committee on Human Rights, the President of the Royal College of Pediatrics and Child Health, Professor David Hall, was asked about the provision of contraception to a 12-year-old girl involved in a sexual relationship with a 22-year-old man. The questioner explained:
‘The parents are livid and want the full force of the law brought to bear on that situation. The child herself appears to be consenting and maintaining the position that she is capable of making her own decisions and the law of course says that that relationship, if it is taking place, is statutory rape which has a sentence of life imprisonment as a maximum. If the child in that situation wants contraceptive advice and contraception, how do you we deal with that terribly difficult situation?’
Professor Hall responded:
‘The advice that GPs receive…would be that as far as the young person herself is concerned you would have to make a judgment as her doctor about the right course of action. If your judgment was that she was making a mature and considered decision in coming to consult you and was asking for contraceptive advice, I think most doctors would provide that advice and treat that in confidence. If their judgment was that this girl was being manipulated and used then the terms used include ‘some secrets are too big to keep’. That might be the sort of language you would use to someone you treat as a child. In the case you describe I suspect most people would feel that as far as their behaviour as a doctor was concerned, they would probably give her the advice that she was requesting because they would consider her very competent by the very act of having come to seek advice on contraception and they would consider that was how she was behaving. They would probably then ring their Medical Defence Union and say, ‘Help, have I done the right thing?’ I think that is probably what most of them would do.’
If Professor Hall is correct in his assessment of current GP practice, it is to be feared we have lost sight of the protective provisions of the legal age of consent to sexual intercourse and the protective instincts of the child’s parents. We have also moved a long way from the judgment of the law lords in Gillick v West Norfolk and Wisbech Area Health Authority, when Lord Fraser ruled:
‘Nobody doubts, certainly I do not doubt, that in the overwhelming majority of cases the best judges of a child’s welfare are his or her parents. Nor do I doubt that any important medical treatment of a child under 16 would normally only be carried out with the parents’ approval. That is why it would and should be most unusual for a doctor to advise a child without the knowledge and consent of parents on contraceptive matters.’
The ‘proof’ that sex education works
Sex education has been a controversial part of the school curriculum for the last thirty years. As we pointed out in our 1995 publication Tried But Untested, one of the peculiarities of sex education was the absence of any research into its effectiveness. In every other subject area there is constant testing to see if children are benefiting from particular pedagogical approaches. Sex education alone has been allowed to continue unmonitored, with no evidence that it was actually succeeding in what most people would have considered its main function – the prevention of teenage pregnancy and sexually transmitted infections.
This lack of research could be explained in only one way: the people promoting sex education did not want to expose their efforts to the sort of scrutiny which is routinely applied to other areas of the curriculum.
Since the publication of Tried But Untested, there has been some attempt to discover if sex education programmes are effective in delaying first intercourse and encouraging responsible behaviour, but the results have been a disappointment from the sex educators’ point of view (see Family Bulletin 108). However, within the last few years we have seen the rapid spread of abstinence education in the USA, and calls for its introduction here.
Suddenly, the sex educators are interested in research! They oppose any attempt to introduce abstinence education on the grounds that it can’t be ‘proved’ to be effective. Strictly speaking, of course, this is true. The best research is that which can follow large samples of people over a long period of time and monitor outcomes, but as abstinence education is so new, there hasn’t been time for that. It is true that the widespread movement for abstinence education in the USA has co-incided with a dramatic drop in teenage pregnancy – by 20% during the last decade of the twentieth century – but we cannot, at this stage, ‘prove’ that one thing caused the other. However, you would think that the authors of our government’s teenage pregnancy strategy would at least consider the possibility.
Unfortunately, this is an area where prejudice rules, and the Teenage Pregnancy Unit is so hostile to the very idea that it has a link from its website to a feeble piece of ‘research’ produced by the Sex Education Forum called Just Say No – To Abstinence Education (see Family Bulletin 106). Time and time again, those associated with the teenage pregnancy strategy have gone out of their way to attack abstinence education, including Sir Liam Donaldson, the Chief Medical Officer, who in his January 2003 Update claimed that ‘Evidence does not exist to suggest that abstinence approaches are effective’ in sex education. www.doh.gov.uk/cmo/cmo_35.html#10.
Our trustee Dr Trevor Stammers, Hon Senior Tutor in General Practice at St. George’s Hospital Medical School, wrote to him to query this assertion:
Dear Sir Liam
I was very concerned to read the item on ‘Evidence to support teenage pregnancy strategy’ in your January Update. At best, most of it is contentious, much is tenuous and at least one line is in my view mendacious.
It states categorically that: ‘Evidence does not exist to suggest that abstinence approaches are effective’. This is simply untrue. You may be unaware of the extent of such evidence so I append a brief list of references to just some of the data available on Medline. There are many more.
This research needs to be seriously considered by the Department of Health, rather than its very existence falsely being denied and I would request that you amend the website text of the Update to take account of this research.
I would also challenge the statement that there is ‘strong evidence for the effectiveness of sex and relationships education, when linked to contraceptive services’. The evidence is in fact quite weak, (1-3) which is why the cover of the BMJ featuring the latter two papers on this subject could suggest sex education ‘has little effect on behaviour and outcomes’. There is also recent peer-reviewed evidence that merely increasing contraceptive provision may be counter-productive (4).
Overall, the January 2003 Update gives a highly misleading impression about the strength of evidence to support the current teenage pregnancy strategy and shows more political bias than evidence base. I urge you to rectify this in a future Update as encouraging young people to delay having intercourse is every bit as important as contraceptive provision in maintaining sexual health.
References
1. Card J Teen pregnancy: do any programs work? Annu Rev Public Health 1999 20 257-85
2. Wright D Raab GM Henderson M et al Limits of teacher delivered sex education: interim behavioural outcomes from randomised trial BMJ 2002 324 1430-3
3. Censo A Guyatt G Willan A Griffith L Interventions to reduce unintended pregnancies among adolescents; systematic trials review of randomised control BMJ 2002 324 1426-9
4. Paton D The economics of family planning and underage conceptions J Health Econ 2002 21 207-225
Dr Stammers has now drawn together the research into abstinence education, and turned it into an article for the Postgraduate Medical Journal.
Review: Sex, condoms and STDs
Published by The Medical Institute for Sexual Health, PO Box 162306, Austin, Texas 78716 Order online at www.medinstitute.org
Within its mere 32 pages, this excellent monograph from the USA’s Medical Institute for Sexual Health, in a highly readable and meticulously referenced format, presents all the latest research findings on whether or not condoms prevent STDs.
It summarises the findings of the July 2000 conference on this subject by the US National Institutes of Health and adds important data from more recent research.
It answers in detail such important questions as: Do condoms give substantial protection against HIV? (Yes). Are condoms usually used consistently and correctly? (No). Do condoms offer substantial protection against the majority of non-HIV STDs? (No). Does leakage of infectious particles through pores in latex condoms constitute a significant risk of STD transmission? (No).
Anyone looking for an authoritative, concise and, to my mind, irrefutable case for ‘safer sex’ being not nearly safe enough will find it here.
Trevor Stammers
Senior Tutor in General Practice,
St. George’s Hospital Medical School