Improving the sexual health of young people in the United Kingdom must remain a priority for whoever becomes the next Labour leader. Sexual health has deteriorated over the last 12 years, and poor sexual health can be both a cause and a consequence of poverty and social exclusion.
Diagnoses of sexually transmitted infections have increased year on year since 1995, with young people under 25 particularly likely to be affected by infections such as chlamydia. One in eight sexually active teenage women are now thought to have the infection. Teenage conception rates have declined but remain well above those of our western European neighbours. And achieving the government’s stated target of a 50 per cent reduction in conceptions by under 18s by 2010 will require a major effort. Meanwhile, survey after survey reminds us that many young people feel ill equipped with the skills or knowledge they need to negotiate safe and fulfilling relationships. They continue to be dissatisfied with the sex and relationships education they receive in schools and often don’t know where to go for advice.
There is general agreement about the direction in which services need to develop to improve young people’s sexual health. Yet there is significant evidence that many services, far from being modernised, are being reduced or even closed, despite the commitment of substantial additional funding contained in the Choosing Health white paper. With the NHS set to receive smaller increases in funding than it has been used to, an emphasis on reducing NHS deficits, and devolution of decision making, there will be a greater challenge to ensure that sexual health receives the priority at local level that the government intends.
Poor sexual health is inextricably linked to poverty and social exclusion. Teenage pregnancy is more common among young people living in areas of high deprivation or who have poor expectations of education and the job market. Higher levels of deprivation are also associated with less consistent use of contraception and some groups, such as young people leaving care and young people from some ethnic minority communities, find it harder to access services. Interventions aimed at individuals or groups judged to be most at risk will help, but while income inequality remains high by historical standards we will continue to experience poor sexual health in this country.
Societal attitudes also have an impact on young people’s wellbeing and their ability to protect their sexual health. We frequently exhibit very negative attitudes to young people (reflected in the UK’s poor ranking in the recent UNICEF report on children’s wellbeing) and find it especially difficult to accept their development as sexual beings. The tabloid media in particular demonises teenage parents whilst being critical of services which are trying to help young people make informed choices and protect their sexual health. In contrast, countries like the Netherlands and Sweden, which are more positive about young people’s sexual development, have lower teenage pregnancy rates, high rates of contraceptive use, and young people are much more likely to discuss sex and contraception with their parents and partners compared to teenagers in Britain. The long term challenge for all of us, not just the government, is to create a climate where young people are valued and respected, where there is open acceptance of their sexuality and of their rights to access information, advice and services in confidence.
In the short term the new Labour leader can make a start by strengthening the powers of the Children’s Commissioner as the first step towards full implementation of the UN Convention on the Rights of the Child. Second, the government should reintroduce ring fencing of funding for sexual health services to ensure that money is spent on what it was intended for.
And third, Sex and Relationships Education must be made compulsory in schools by making Personal Social and Health Education (the subject within which SRE is delivered) a statutory part of the national curriculum. Only then can we guarantee that children and young people will learn more than just the biology of reproduction and STIs, and are helped instead to develop the ability to recognise and resist pressure so that they can delay intercourse until they are ready for it; to develop healthy relationships; to negotiate and practise safer sex and enjoy their sexuality without harm.