This article appears in the August 1999 edition of the Catholic Medical Quarterly
The recent announcement by the Prime Minister that 60 million pounds is to be provided to halve the rate of teenage pregnancies in Britain prompts reflections both on the causation and current attempts to reduce this problem. New guidelines are to be given to health professionals on prescribing contraceptives to children under 16 without telling their parents. School nurses will be seen as 'gateways' through which young children can get advice and help and will be able to arrange for girls under 16 to be given the Pill without parents being told. It is therefore worthwhile to examine the causes which I believe lie behind the UK's intractable teenage pregnancy rate. I propose to do it by examining certain myths which have been widely propagated.
'Under-age sex has always been commonplace. The only difference today is that young people have a healthier and more open and responsible attitude towards sex, and are more able to protect themselves from unwanted pregnancies'.
The reality is that fifty years ago, in the days before statutory sex education, when the Pill was only a twinkle in an Austrian chemist's eye and legal abortion not even a shadow on the horizon, pregnancies among under-age girls were a rarity.
Although most adolescents in the 1950s were fairly innocent of the finer details of sex and reproduction, they were far from ignorant of the uglier side of life, having spent their early childhood during the six unsettling years of the war.
Thousands of children have grown up as 'latch-key kids' with their mothers out at work all day and their fathers - if they still had one - away at the war. Poverty was no stranger to children in those post war years of food rationing and urban deprivation. Yet despite the social dislocation and family difficulties, young girls were better protected from sexual exploitation in the decade after the war, than at any time during the forty years that followed. Between 1948 and 1958 the annual number of live births among the million or so girls in England and Wales aged 11-14 averaged just 45.(1)
The first big change was felt in 1960, when the number of schoolgirl mothers suddenly increased to 111. It was partly due to the influence of older girls, more of whom were becoming mothers, but was largely the result of a mini-explosion in the population of adolescent girls, fourteen years after the post-war Baby Boom of 1946/47.
Throughout the affluent and permissive Sixties, the teenage population continued to rise and their moral standards gradually to decline, so that by 1967 the number of births to girls under 15 had doubled yet again to 222.
With the passing of the 1967 Abortion Act many of the babies that would have been born to 15 year old girls were now being aborted around six months earlier when the girls were still 14. Thus in 1969 the total of births and abortions to 11-14 year olds was 576.
During the three decades that followed, live births to girls under 15 only once rose above 300 a year. Abortions, on the other hand, rose inexorably for the greater part of that time, and by 1996 the combined total of births and abortions had reached 1,391. That year also laid shameful claim to the first recorded case of a pregnant 9 year-old. The baby was aborted, needless to say.
An equally clear indicator that younger and younger girls have been drawn into the sexual vortex can be seen in the increasing number of under-15s seeking contraception. While no records are kept of the thousands who are prescribed contraceptives and/ or the morning after Pill by their GPs. and it is not known how many purchase condoms from chemists and vending machines, the Department of Health recently began collecting data on the number of under- 16s attending NHS and Brook Advisory clinics who were aged 15 and how many were below that age.
The statistics show that between 1994-97 the number of girls aged 14 and under going to these clinics rose from 17,000 to 24,000, an increase of 4l%. (2) (As a percentage of the population of girls aged 14 these figures represent a rise from 6% to 8%.)
Everyone is rightly concerned at this worsening situation, not least because the younger the girl, the more likely she is to be pressurised into sex, or even raped, by more experienced older boys. In the USA, research by the Alan Guttmacher Institute (an off shoot of IPPF) reported in 1994 that six out of ten girls who had sex before the age of 15 were forced to do so by males on average six years their senior. There is every reason to believe that sexual predators are also targeting children in Britain.
Girls who start having sex under 16 tend not only to have several partners over a short period of time, but their early sexual debut sets a pattern of promiscuous behaviour that is likely to continue throughout their teenage years, bringing them a whole raft of personal and social problems difficult to overcome and incurring huge public expense to mitigate. These include single motherhood, abortion, chronic sexual ill-health, infertility, emotional instability and depression. Where teenagers are already disadvantaged by low educational achievements or a broken or dysfunctional family, these personal problems increase the likelihood of rootlessness, isolation, drug addiction, crime and poverty. It is a miserable scenario that has been visited on an-ever growing proportion of our young people in the years that have followed the so-called 'safe sex' revolution.
'A positive view of teenager sex is essential. Sex is a natural, recreational part of relationships which the young will wish to experience. We should therefore enable all young people to make Informed choices about their sexual relation ships so that they can enjoy their sexuality without harm.'
This is a blatantly permissive manifesto taken from recent comments and policy statements by the Brook Advisory Centres. (3) From the very beginning the Brook Centres have had the ear of government Ministers and have received every kind of official support and sanction for their aims and development. In the late 1950s, when Helen Brook was still working for the Family Planning Association, she went to the DHSS, the Colonial Office and the West Indian High Commission, to express her concern over the high birth rate among the newly arrived West Indian immigrants who had been recruited by London Transport. She was then given approval to offer contraceptive advice to the newcomers, and eventually set up a clinic in 1964 to deal specifically with West Indian mothers and young unmarried whites.(4) Perhaps it was significant that the first Brook Centre was established in a house given by the Eugenics Society. Today all the London Centres, and most of the others, are in areas where there are high numbers of ethnic minorities and poor whites. The Brook Centres have always championed permissive causes. In the 1960s they fully endorsed pre-marital sex, the legalisation of abortion and reform of the divorce and homosexuality laws. In the following decade their aim was '..... to challenge our established attitudes that sexual activity in young people is dangerous' and they claimed that '...there are still too many workers in birth control clinics who believe, consciously or subconsciously, that sex before sixteen is sinful'.(5)
Three vulnerable groups in particular were targeted 'The girls who looked much brighter than they are, but who are emotionally and sometimes socially deprived; the disadvantaged black girls who have been let down by society; and the 'invisible' (emotionally neglected) children of parents who live under acute marital stress'. (6) These poor inner-city waifs, whom the Brook described as being 'very often withdrawn and inarticulate' were a far cry from the sales pitch image of liberated youth that they presented to the gullible and conniving media in the 1970s: '....It's all happening younger these days; not only sex but mature attitudes come earlier. Parents see it only in the context of their generation, which is inappropriate'.(7)
In the wake of the 1973 National Health (Family Planning) Reorganisation Act, which required the taxpayer to fund everyone's birth control requirements, the Brook Centres were invited by the DHSS to advise on how the provisions of the Act should be applied to under-age girls. It resulted in the notorious 'Section G' of the DHSS Memorandum of Guidance in 1974 which advised doctors they could prescribe to girls of 'whatever age' without parental knowledge or consent. Three years later the DHSS issued the same advice to the medical profession regarding under-age abortions.
The Rubican had been crossed, the territory of parenthood had been officially invaded and the duties and responsibilities of parents effectively usurped, not by do-gooders who thought they could do better than parents in protecting children from moral harm, but by an already confused medical profession and a growing army of proselytising birth control agencies, backed by an international pharmaceutical industry.
But the Memorandum went further than excluding parents from decisions over their children's sexuality. It drafted the Health Education Council to mount a national campaign to inform everyone (including youth groups, community homes for adolescents, borstals and detention centres) about the new State-funded and State-managed birth control service. More importantly, it introduced the first national sex education programme for secondary schools and colleges, to be managed by family planning and health education staff in conjunction with local authorities. In short, an experiment in social engineering of massive bureaucratic proportions was being established.
Was it simply a coincidence that 1974 had been designated by WHO as 'World Population Year'?
A Golden Age for the Brook Centres had arisen. Funding by the Department of Health began in 1977 with a modest grant of �5,250, and was quickly followed by the Scottish Home and Health Board giving annual grants to Brook's Edinburgh clinic and 'All Scotland Work'. The number of Centres proliferated, and the contraceptive evangelisation of the young intensified.
In 1981 when the schoolgirl contraception rate at NHS and Brook clinics was 1.9%; under-age pregnancy rates 11 per 1,000; and abortion rates 6.2 per 1,000, the Centres received �875,858. In 1997, when contraception levels had topped 10% with pregnancy and abortion rates respectively 14 and 7.2 per 1,000, their annual funding from national and local government sources was an incredible �3,544,974.(8)
Between 1977-1997 the total amount of taxpayers' money received by this self-serving organisation was in excess of 30 million. Over that same 20-year period more than 185,000 schoolgirls in England, Scotland and Wales had become pregnant with over half of them having abortions.(9)
'The provision of contraceptives does not encourage under-age sex or promiscuity, since girls are usually already sexually active when they come for advice. Contraception is merely a realistic way of protecting them from pregnancy, abortion and disease.'
It is generally acknowledged that the advent of oral contraceptives was a pivotal moment in the history of women's sexual emancipation. Journalists have written endlessly on the theme of the Pill Revolution'; even its inventor Prof Carl Djerassi said "the pill liberated women. It gave them decision-making power and enormous independence".(10) As it allows unmarried women to have sex whenever they fancy, why should it be different for teenagers? Helen Brook herself regarded under-age contraception as "one little bit of a woman's fight for freedom". The Edinburgh Brook Centre made it abundantly clear that contraceptive services targeted at the young encouraged early sex, when it reported that between 1975 and 1980 the number of teenage clients who were 'not yet sexually active' had doubled from 11% to 22%, This was seen by Brooks as an 'encouraging trend'.(12)
The strongest evidence, that more contraception equals more under-age sex, came in the year following the Court of Appeal ruling in December 1984 (the Gillick Case) when for 10 months it was unlawful for doctors to provide contraceptives to girls under 16 without parental knowledge and consent. The Brook clinics reported a 50% drop in their under-age clients during 1985, and a detailed investigation by Sheffield Health authority found there had been a 30% fall in clinic and GP attendance in the region, and that 'a full year of continuing publicity and debate about the dangers of under-age sex, and the withdrawal of doctors' ability to prescribe contraception without parental consent, had no noticeable effect on the number of under-age girls who get pregnant' and concluded that this was '.... presumably because those girls either used some non-prescriptive method of contraception or abstained'(13)
National statistics show that the numbers attending family planning clinics in England during 19751984 had risen from 8,000 to 18,000 (rates: 1.1%-2.5%) and had fallen to 12,000 (1.7%) after the Court of Appeal ruling . Furthermore the predicted explosion in pregnancy levels had not occurred: the rates for the under-sixteens remained unchanged during that year, while the actual number of pregnancies declined from 9,096 to 8,829.
The Department of Health appealed against the Gillick ruling; and in October 1985, by a split vote of 3-2, the Law Lords reinstated the government's policy on under-age conceptions, but insisted that secrecy from parents should be 'most unusual' and that doctors should only withhold information from parents 'in the most exceptional cases' (14) such as emergency, parental neglect, abandonment of the child, or where the parent could not be found. The girl also had to have sufficient maturity and under standing of what was involved in the contraceptive or (abortion) treatment, and their long term emotional, physical, and social consequences, in order for her consent to be valid in law. This landmark judgement by the House of Lords should have prohibited secret contraception for the great majority of 11-15 year olds. But six months later in early 1986 the judgement was effectively set aside when the Department of Health launched its nation-wide 'Safe Sex 'condom campaign against the spread of HIV/AIDS. Schools, the media and teenage magazines were recruited in a combined and sustained attempt to promote the condom and the pill to teenagers, irrespective of age or whether their parents approved or not. The overt style and broad brush approach of this campaign had an immediate and lasting effect on the behaviour of the young. By 1990 almost every 12-19 year old had been exposed to sexual information which was novel, explicit and non-directional. It initiated children into the world of sexual lifestyles... (both hetero- and homosexual) and then invited them to choose one for themselves as and when they wanted.
Between 1986 and 1997 attendance at NHS and Brook clinics by the under-16 rose more than four fold from 15,000 to 66,000, while pregnancy rates increased from 12.8 to around 14 per 1,000 (they had been as high as 14.7 per 1,000 in 1990).
Claims by the Brook Centres and the BMA et al.(15) that very few girls went to their GPs for contraception because of fears over lack of confidentiality, were shown to be false when government "Health of the Nation" statistics revealed that several thousand girls were in fact going to their doctors each year - over 15,000 in 1993 rising to 26,500 by 1996.(16)
By now we had reached a point at which over 90,000 girls aged 14-15 (around 1 in 6) were going to clinics and GPs for some kind of birth control treatment, and yet the pregnancy and abortion rates were higher than at any time in the previous twenty years. Moreover, an ever increasing proportion were resorting to 'emergency' post-coital birth control. The numbers seeking the morning- after Pill at the clinics rose from 2,200 in 1989 to 22,700 by 1997. Among 16-19 year olds the numbers rose from around 12,00 to almost 83,000, and it is estimated that an even greater number seek treatment from their GPs.
An explosion in casual sex and promiscuity, together with an inability to take the Pill consistently, or use a condom properly, are the acknowledged reasons for most teenage pregnancies and abortions. They are also the cause of the increasing requests for post-coital treatment and the rising tide of sexually transmitted diseases.
The proportion of adolescent girls advised by clinic doctors to use condoms as their primary method of birth control has risen from a third to a half since 1992.
The shift to condoms may reflect a growing realisation in medical circles that the Pill is generally an unsuitable drug to give to immature females, since it has now been confirmed that women who begin taking it under the age of 20, have a 50% increased risk of developing breast cancer in their middle years.(17) How many countless thousands of 30-50 year olds must now be facing this risk? Or it may be that both girls and their doctors are better educated today about other risks associated with these sex steroids such as thrombosis and strokes.
Condoms, however, have a very high failure rate even among adults. A survey of regular condom users attending a large family planning clinic in Manchester found that 52% had experienced a condom 'accident' in the previous three months.(18)
Research in 1991 found that 7 out of 10 women who had unplanned pregnancies were using some form of contraceptives at the time.(19)
Two studies of pregnant teenagers attending hospitals in 1989 and 1995, for either a delivery or termination, show how an ever-increasing proportion are becoming pregnant despite contraceptive use: up from 54% to 71%. And in both studies the condom was the chief culprit.(20) The latter study also found that, among the majority of under-18s who had started having sex before they were 16, over half had more than one partner, while a third had three or more.(21)
So not only does the propaganda for 'Safe Sex' encourage more sex, at younger ages, it creates more peer pressure to have sex more frequently and with more partners. It also succeeds in putting vastly more girls into the highest risk category for unplanned 'child-motherhood', or abortion. And if contraception cannot protect the promiscuous young from pregnancy, then what chance has it of defending them from the present plague of opportunistic bacteria and viruses?
- OPCS Live births. England & Wales. Parents' Age Series FM! (HV) No. 1.
- Dept. of Health: Statistical Bulletin. NHS Contraceptive Services, England 1994/95 to 1997/98.
- Brook Advisory Centres (BAC): Annual Reports 1992/3 1997/8.
- Dickson R., 'Still beating those old taboos on sex'. General Practice, 4. May 1984.
- BAC 'Safe Sex forTeenagers' Dilys Cossey 1978
- 'They came in hand-in-hand' Roundabout. (Page 8), 9. Jan. 1974.
- BAC Annual reports 1981-1997.
- Office of National Statistics. Conceptions. Series FMI 1977-97.
- Rocco F., 'Creative chemist who prescribed the Pill'. Daily Telegraph 1. March. 1998.
- Virgo R., 'Ten years of Brook', Family Planning News, page 8. July 1974.
- BAC Annual Report 1982/3.
- Kirkman RJE, Meads A. "Was Mrs. Gillick right?" British Journal of Family Planning. 1987. 12; 137.
- House of Lords Oct 1985: Gillick v. Wisbech & W. Norfolk Health Authority and DHSS.
- 'Confidentiality and people under 16': Nov. 1993. Guidance by BMA, GMSC, HEA, FPA, RCGP, and BAC.
- Dept. of Health Common Information Core. Health of the Nation. 1993-1996.
- Breast cancer and hormonal contraception: collaborative re-analysis of individual data on 53,297 women with breast cancer, The Lancet, 1996, 347: 1713.
- Kirkman, RJE. Morris J, Webb MG, User experience: Mates versus Nuform. British Journal of Family Planning. 1990, 15: 107-111.
- Fleissig A., Unintended pregnancies and the use of contraception: changes from 1984 to 1989. BMJ,1991; 302:147.
- Curtis H., Teenage relationships and pregnancy, Schering Health Care. Novum No. 43, March 1989.
- Pearson VAH., et al., Family planning services in Devon: Awareness, experience and attitudes of pregnant teenagers. British Journal of Family Planning. 1995, 21:45-49.
Victoria Gillick is author, broadcaster, pro-life campaigner and pregnancy councillor. She is shortly to receive the award Pro Ecclesia et Pontifice.