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ss nucleus - autumn 2006,  Morning after: the truth comes out

Morning after: the truth comes out

Mark Houghton analyses a recent public policy failure

Gripping my hand, the female patient asked, 'Doctor, can I ever be forgiven?' She was talking about an abortion done decades before. Lovemaking without cost is the elusive Holy Grail of the sexual revolution.

A policy that isn't working

The morning after pill, one form of emergency contraception, was hailed as the government's answer to ever rising rates of teenage pregnancies and abortions. But new research published in the British Medical Journal (BMJ) shows the failure of this policy. Despite the clear increase in the use of emergency contraception, abortion rates have not fallen in the UK.[1] Figures for England and Wales now top the 200,000 per year mark, up 12% in ten years.[2]

Since 2002 the UK government has spent £138 million on its Teenage Pregnancy Strategy. In early September, just before the news broke, Prime Minister Tony Blair promoted a major thrust at schools with, 'an expanded media campaign and better access to contraceptives.' Thousands more school nurses are being recruited and parents need not be told if their daughters under 16 years old are given contraceptives or sent for an abortion.[3] This was established in the courts this year when parent Sue Axon, whose daughter had a secret abortion while under 16, fought unsuccessfully for the parent's right to know what doctors were saying to underage girls.

Sexual health expert Professor Anna Glasier, director of family planning at Lothian primary care NHS trust in Edinburgh, writing in the BMJ[4] mentioned three studies that measured subsequent pregnancy rates when women were given an advanced supply of emergency contraception at home. These showed that use of the pills was increased but this had no measurable effect on rate of pregnancy or abortion.

'Despite the clear increase in the use of emergency contraception, abortion rates have not fallen in the UK,' said Professor Glasier. She summarised that the pill, 'will prevent pregnancy in some women some of the time', but that, 'if you are looking for an intervention that will reduce abortion rates, emergency contraception may not be the solution'.

One might ask who is advising Mr Blair on policy, since the price tag for failure is high. Does the government really care, or do they just want the votes? In a comparison of adolescents and adults undergoing abortion it was found that teenagers are more than twice as likely as adult women to attempt suicide after abortion (29% v 13%).[5]

CMF member, Dr Trevor Stammers, a London GP and spokesman for the Family Education Trust, said he had written to the BMJ almost five years ago, predicting the likely failure of the policy. Speaking during September he said, 'It has fuelled the increase in sexually transmitted infections (STIs).' Rates of STIs are up 60% since 1995. New diagnoses will soon top one million per year.

In political terms the morning after pill was seen to be attractive because the risk was displaced away from the tricky issue of teenage pregnancy. In fact it has not helped that nor STIs and perhaps made them worse.

All this is sad news for the teenagers involved and we should not gloat over a massive public policy failure. No pill can protect against the emotional heartbreak of a broken relationship; and what can doctors say to a teenager made infertile by chlamydia?

Is there another way?

So what can we do? 'They'll do it anyway so we must limit the damage', is the sad refrain from most of the sexual health lobby. Many teenagers that do have sex wish they had waited[6] and most want the age of consent raised and clearer boundaries from parents.[7]

The Bible, with its wisdom on human nature, has some excellent advice on happy relationships and disease avoidance: 'The prostitute reduces you to a loaf of bread'[8] or, 'Fear the Lord and shun evil. This will bring health to your body.'[9] But since most of today's movers and shakers, with their entrenched ideological stance on personal autonomy, dump anything biblical we must use the powerful evidence now available from clinical studies.

Recently I asked a Ugandan doctor, Bernard Opar, how they reduced the HIV rate from 35% to 6% in his country. 'Firstly everyone said, “Abstinence till married”', he replied. 'Later we added, “Be faithful to your spouse”.' These results are impressive in a society torn by war and with many migrant sex workers. An important new study in the American Journal of Obstetrics and Gynecology,[10] confirms this abstinence only approach in delaying sexual activity. This was based on over 25,000 middle school students and demonstrated increased knowledge and a shift in attitude towards delaying sexual activity.

Other studies highlight parental influence as one of the few factors known to influence teenage sexual behaviour. The presence of a father at home and having sex education from parents helps delay age of first intercourse.[11] In July 2006 the Joseph Rowntree Foundation[12] published a devastating critique of the government's obsession with sex education and contraception as the cure all for teenage pregnancy. They found many teenage mothers were actively planning to become pregnant: as a means of escape from an unhappy childhood; a means of proving their fertility and a means of demonstrating they could have control over something. They were all aware of the purpose of contraception!

Not surprisingly the World Health Organisation, faced with the worldwide scourge of AIDS, has recommended for years, 'one partner for life'.

So as doctors we must actively promote evidence based support for the family, for marriage and for sexual abstinence outside marriage. This is personally costly and, in the UK, will evoke surprise and at times strong and emotional opposition. But it's worth it when you see the light dawning on the face of a youngster who realises they need not have sex yet.

Abstinence-based education

New educational programmes, often using student doctors as teachers, are now promoting the concept of 'saved' sex – saved for one person, because 'safe sex' in the real world has failed as an idea (see box for websites).

'Impossible!' is the cry from the 'more condoms' lobby, when anyone advocates sexual self-control. But it may be that the population as a whole are longing for something better. 71% of the UK population still call themselves Christian.[13] They may not all be in church on Sunday, but this does say something about their beliefs. Why should a liberal intellectual and political elite lead the cream of our nation towards disease and death? When one looks at how appalling social conditions were transformed by Christians in Britain in the 19th century or in Uganda in the 1990s, then 'impossible' should not be in our vocabulary. As Jesus said, 'with God all things are possible'.[14]

UK-based abstinence education programmes

  1. Glasier A. BMJ 2006;333:560,561
  2. Daily Mail 2006; 6 September
  3. Ibid.
  4. Glasier A. Op cit.
  5. Campbell N et al. Adolesence 1988;23:813-23
  6. Dickson N et al. BMJ 1998;316:29-33. Wight D et al. BMJ 2000;320:1243,1244
  7. Hill C. Sex under 16? Twickenham: Family Education Trust, 2000
  8. Pr 6:26
  9. Pr 3:7,8
  10. Sulak P et al. AJOG 2006;195(1):78-84
  11. Kay L. Postgraduate Medicine 1995;97:121-34
  13. UK Census, 2002
  14. Mt 19:26
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