|Professor David Paton|
Professor Paton said:
What is the best way to reduce teenage pregnancy, abortion and sexually transmitted infections (STIs)? What does the evidence reveal?
One approach to address these questions is to compare jurisdictions that differ in their strategies yet are otherwise similar. For example, compared with England, Northern Ireland has restrictive abortion laws, lower provision of family planning services, and a stated goal to decrease the rate of teenage sexual activity. The results? Teenage pregnancy in NI (abortion plus births for U16s) is less than a third of that in England, and STIs for the same age group are also about one third. Diagnoses for gonorrhea, considered the best marker of sexual health, are strikingly lower in NI where there have been 4 diagnoses among U16s in the past 10 years compared with 160-200 each year in England.
In the last decade or so, NI has started to go the way of England, introducing better access to family planning services, sex education, and emergency birth control (EBC, the ‘morning after pill’). But a careful analysis of the data reveals that none of these appears to have had any positive effect at all. Teenage birth rates remain unchanged, and rather than improve, rates of diagnoses of STIs have steadily increased throughout the 2000s. For NI, going the way of England is very unappealing.
Besides comparing population figures from different countries, other research more specifically targeted at the efficacy of various strategies is also throwing light on what works and what doesn’t. It has been argued that ensuring teenagers have confidential access to family planning services and abortion will have a positive impact on teenage pregnancy and abortion rates. However, instead it can be demonstrated that the consequent reduction in perceived risk leads to increased risky behaviour, and combined with contraceptive failure, the net pregnancy rate could increase. This may explain what has happened in England.
Studies from the US, where some states have mandated parental involvement in contraception and/or abortion for minors, reveal a subsequent decline in abortion rates, overall conception rates and STIs. This should not be surprising given parental protective instincts. One somewhat tangential finding linked to these laws has been a decline in suicide amongst female minors.
What about mandatory early sex and relationships education (SRE), or alternatively abstinence-based education, and their impact upon teenage pregnancy? The evidence is unclear and in some cases conflicting. However, what can be said is the evidence so far suggests SRE is no better than abstinence-based education. The Netherlands has sometimes been held up as an example of low teenage pregnancy rates which have resulted from early and explicit SRE. However, The Netherlands actually has later SRE than the UK, and since the content of SRE is not mandatory by Dutch statute, it varies widely from quite conservative at one end to quite explicit at the other.
The upshot of all this is that the evidence is beginning to confirm the idea that advancing contraception, EBC, and abortion, as well as keeping parents away from their children’s decisions in this area, is having a detrimental impact on the lives and health of teenagers.
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