Whatever our feelings and beliefs, the fact is that universally sexual activity is starting at an earlier age. According to a report published in 1992, first intercourse had occurred in 50% of sixteen-year-olds in the United Kingdom. The media of the twentieth century have flaunted sex, no doubt to increase ratings. Whilst sex should not be regarded as a taboo subject and sex education is to be welcomed, few young adolescents are mentally or emotionally ready for sexual experience. There is little evidence that contraceptive-based sex education programmes have resulted in reduced sexual activity or diminished teenage-pregnancy rates. Increased self-esteem and sense of responsibility are associated with greater caution. Those with inadequate family support are those most at risk of sexually transmitted disease and unplanned pregnancy. Pregnant teenagers are more likely to have a mother who had a teen pregnancy and they are less likely to seek pregnancy termination.
Informal youth clinics are often well received by adolescents. One of the more common reasons for first visits to this clinic is the fear of unplanned pregnancy; pregnancy testing and emergency contraception need to be readily available. A partnership between patient and health care providers is essential if long-term support is to be continued. These clinics should provide the full range of contraceptive services within a friendly atmosphere and there should be no suggestion that the staff are being judgemental.
For those with the foresight to seek protection against unwanted pregnancy and sexually transmitted diseases, there are an ever increasing number of adolescent clinics catering for these special needs. Where confidential, readily available and friendly contraceptive services are available, contraceptive usage increases and teen pregnancy rates are reduced. Dutch teenagers apparently have a great deal of trust in their medical services, which encourages them to seek early contraceptive advice. The teen pregnancy rate in the United Kingdom is three times higher than in Holland and in the United states it is seven times higher. Health professionals must be aware of the rights of adolescents to confidentiality.
In the UK, sexual intercourse before the age of consent (16 years of age) is against the law. Prosecutions are, however, rare if both partners are of similar age. A working party of the Royal College of Obstetricians andGynaecologistshas provided invaluable advice: 'It is for the doctor to decide whether to provide contraceptive advice and treatment, and the Department of Health has advised that if he (or she) does so for a girl under the age of 16 years he is not acting unlawfully provided he acts in good faith in protecting the girl against potentially harmful effects of intercourse' The Gillick judgement of 1985 upheld the view that doctors can lawfully prescribe contraceptives for under-16 year olds without parental consent in certain circumstances:
- that the young person could understand the doctor's advice and had sufficient maturity to understand what was involved in terms of the moral social and emotional implications;
- that the doctor could neither persuade the young person to inform the parents, nor to allow him to inform them, that contraceptive advice was being sought;
- that the young person would be very likely to begin, or to continue having, sexual intercourse with or without contraceptive treatment;
- that, without contraceptive advice or treatment, the young person's physical or mental health, or both, would be likely to suffer;
- that the young person's best interests required the doctor to give
contraceptive advice, treatment, or both, without parental consent;
We consider that young people under 16 who are sexually active require confidential professional counselling in relation to contraception. They need to be assured that the health professional they consult will respect their confidentiality in spite of their youth. The health professional has a responsibility to help the young person to understand the implications of sexual activity and the value of confiding in her parents. However, it is important to appreciate that the developing sexuality of young people creates a barrier between them and their parents that is part of the process of growing-up. A trained responsible outsider, such as a general practitioner or a family planning doctor or a family planning nurse, may be a more effective source of counselling than the parents.
