Teenage pregnancy rates in the UK are stubbornly high compared with most of Europe, and sexually transmitted infections (STIs), particularly chlamydia, are on the increase. Recent figures for England and Wales showed a slight drop in pregnancies for 16-18 year olds and a slight rise for 14 and 15 year olds. This revived a perennial debate between protagonists on each side of the sex education argument.
On the right, it is taken as evidence that school sex education and young people’s sexual health services do not work, and perhaps even encourage sexual activity. On the left, it is taken as evidence of insufficient sex education and inaccessible sexual health services. While some social scientists have been enlisted on either side of this debate, most take the view that wider social factors are far more important than sex education or services in shaping rates of teenage pregnancy. It was notable that in the recent discussion, the Minister for Children and Families, Beverley Hughes, seemed inclined towards this third line, saying that government efforts had ‘reached a sticking point’ and greater involvement from parents would be necessary to change young people’s behaviour.
So what does research tell us about the role of school sex education in reducing teenage pregnancies? And more generally, what explains the high levels of pregnancies and STIs amongst young people in the UK?
How effective is sexual education?
First, it is important to point out how difficult it is to conduct rigorous evaluations of school sex education. The main problem is that one cannot deny all sex education to a comparison group, so studies can only demonstrate whether there is any extra value of a specific programme over conventional programmes.
Several international overviews of adolescent sexual health programmes conclude that sex education does not encourage earlier or more sexual activity. Some, for example by the National Campaign to Prevent Teenage Pregnancy in 2001, found that it can have beneficial effects on behaviour.
However, the more rigorously evaluations are carried out, as published in the Journal of Clinical Epidemiology in 2000, the less likely they are to find programmes effective. Furthermore, it is only certain kinds of programme, namely those that are narrowly focussed on behaviours, have a clear message about appropriate behaviour, and develop pupils’ negotiation skills, that are likely to be effective.
Public Health Reports suggested in 2001 that the school-based programme that probably has the best evidence of effectiveness is a multi-component American programme with school-wide events, parent education and 20 lessons over two years. Few schools in the UK would give sex education such priority.
In 1995, The BMJBMJ evaluated a programme that combines teacher, peer and school nurse educators and found that it delays age of first intercourse. However, the only two randomised controlled trials, regarded as the best test of effectiveness, had less positive results. In one study which appeared in the Lancet in 2004, peer education did not influence condom use but did delay first sex amongst girls (an unintended outcome), while another study, which appeared in the BMJ in 2002, found a specially designed teacher-delivered programme had no effect on behaviour. In both, programmes were compared against conventional sex education. The overall conclusion to take from these studies is that varying the form of school-based sex education seems to have little impact on behaviour.
Limits to further effectiveness of sex education
Why is it that even when sex education meets the recommendations from international research, and is delivered by highly trained teachers, it has no more effect on behaviour than conventional sex education? There are several possible answers.
- First, according to a report in the Lancet in 2001, it is important to note that four in five young people already report using contraception consistently, and at least 70% report using condoms at first sex. Existing sexual health promotion, in all its forms, is clearly working to some extent. This makes the further reduction of unsafe sex by a new programme much more challenging. Those who do not use condoms are probably the most resistant to doing so.
- Second, the minority who take the greatest sexual risks are those most likely to be persistently absent from school, and when they are there, least likely to be influenced by their teachers.
- Third, skills-based lessons might require high motivation to be successful. However, in British secondary schools, sex education generally comes within social education. This is widely seen by pupils as a skive, not requiring any serious effort. Furthermore, it is practically impossible to timetable sex education so that the skills taught are directly relevant to the majority of the class. At any one time, between 14 and 16, some pupils (mainly girls), will already be sexually experienced, others will have only had the occasional fondle, while others (mainly boys), will still regard intimate physical contact as scary. Consequently, the skills component of sex education often comes too late for the precocious minority and too early for the majority, some of whom disguise this through detachment or disruption of lessons.
- Fourth, even a prolonged sex education course, such as 10 periods a year (which many pupils say is too long), is probably insignificant compared with the long-term, pervasive influences in young people’s lives. There is clear research evidence that socio-economic factors, parents and peers are each far more influential than schools, in shaping sexual behaviour. It is likely that the mass media is also extremely important, but little research has been done in this area.
Wider social influences
Teenage pregnancy is strongly associated with social deprivation and low educational aspirations. Though rarely planned, becoming pregnant is not a disaster for young women with bleak economic prospects. Rather, it provides a respected status within the local community and greater fulfilment than a minimum waged, unskilled job. It is striking that during the 1970s, UK teenage pregnancy figures fell dramatically, along with those in the rest of Europe, but the fall stopped with the mass unemployment of the 1980s. According to a 2005 Teenage Pregnancy Strategy report, in much of Europe it continued to decline, to level off at one third of ours. Some attribute this to better sex education in other European countries, but there is little evidence for this.
Both the composition of families and, more importantly, the way parents bring up their children, strongly influence their sexual behaviour. Development Review carried a report in 2001 suggesting there is good evidence that the more parents spend time with their children, are supportive of them, or keep a check on what they are doing, the less likely their children are to take sexual risks. However the evidence on parental communication about sexual issues is far less clear, said the Journal of Adolescence. It might be that it is not the amount of communication that matters, but its content.
Peers and local culture are also important. Those young people who think that others like them are already having sex, or do not use condoms, are far more likely to behave in that way themselves. Rates of sexual activity, conceptions and abortions vary considerably by local neighbourhood, suggesting that local culture, and particularly views about child-bearing, are influential.
An influence that might sometimes conflict with local culture is that of the mass media, which almost certainly shapes young people’s expectations of what others are doing. Young people’s television and magazines are full of sexual themes. They often glamorize sex, suggest that most people have had sex by the age of 16, and rarely address the physical consequences of sexual relationships. However, there has been little research on how young people interpret what they watch or read. We should not assume that they accept it uncritically, but rather, they interpret it in the light of their own, and their friends’, experiences. Nevertheless, American research in Paediatrics, in 1999 found strong associations between greater television exposure and higher sexual activity.
Sexually transmitted infections
If high teenage pregnancy rates are primarily a symptom of social exclusion, sexually transmitted infections are clearly a sexual health issue. Although the rise in recorded chlamydia is partly due to greater awareness of the disease, it is also linked to greater exposure. This comes about because the average age of first sex has fallen from 18 to 16, over the last thirty years, and people have more sexual partners before establishing long-term relationships, according to a report in the Lancet in 2001. Sexual values have changed radically over a generation, particularly for young women. It is now far more common for two people to consider themselves ‘a couple’ because they have started having sex, rather than going out together for a long period before having full intercourse. Condoms are, of course, an effective barrier to STIs, but most people (including women), dislike them. Once a couple see themselves as ‘going steady’, they tend to trust each other not to be infected, nor to be having other sexual partners, and so drop condoms in favour of the pill. It takes considerable resolve and negotiating skills to maintain routine condom use.
The way forward
Recent research in the UK suggests that it will be very difficult to improve the impact that school sex education is already having on sexual behaviour. Teenage pregnancy rates are more likely to be influenced by long-term social policies that reduce social exclusion, change educational aspirations and modify local views towards child- bearing according to the National Campaign to Prevent Teenage Pregnancyin 2001. School sex education has an important part to play in promoting sexual health and should be delivered comprehensively. However, it needs to be complemented with initiatives to encourage different styles of parenting and to modify the sexual values broadcast through the media.