One of the key ways in which the National Institute for Health and Care Excellence (NICE) sets out to fulfil its remit to improve health outcomes is by means of producing evidence-based guidance.
However, when it comes to offering advice on reducing teenage pregnancy rates and improving the sexual health of young people its approach is distinctly ideological.
Take yesterday’s recommendations on the morning-after pill. NICE states that emergency birth control should be made widely available to girls under the age of 16 free of charge and without the knowledge or consent of their parents, and asserts that advance provision will ‘fulfil an unmet need for some young people’.’
The guidance states that health managers, doctors, nurses (including school nurses) and pharmacists. should all have a role to play in ensuring that girls and young women are able to access the morning-after pill.
Even school receptionists are not exempt from doing their bit to promote emergency birth control.
It emphasises confidentiality, even to the point that: ‘Even if it is decided that a young person is not mature enough to consent to contraceptive advice and treatment, the discussion should remain confidential.’
True, the guidance does tell health workers to explain to young people that ‘sharing information with another professional may be necessary if there are concerns’.
However, this is prefaced by the instruction to: ‘Reassure young people that they will not be discussed with others without their explicit consent.’ And notice that if any information is to be shared it will be ‘with another professional’ – not, of course, with the child’s parent.
NICE asserts that, ‘Improving contraceptive services will help ensure young people get the support they need and reduce unwanted pregnancies.’
Yet as far as the morning-after pill is concerned, studies from around the world have consistently demonstrated that it has failed to reduce rates of abortion and unintended pregnancy across a population level.
Even where the drug has been supplied in advance of ‘need’ and used more frequently, it has still had no measurable effect on pregnancy or abortion rates.
If NICE’s advocacy of the morning-after pill merely rested on a non-existent evidence base, that in itself would be bad enough. But the unintended consequences of the institute’s ill-advised advice are even more alarming.
The first is contempt for the law:
To read the NICE guidance, you would never know that there is such a thing as an age of consent to sexual intercourse enshrined in statute.
The only type of consent that the guidance is interested in is the consent of the young person to receiving contraceptive advice and treatment – even if the young person concerned is below the age at which she can consent to intercourse.
This is already par for the course for health clinic messages to young people. One notice my wife spotted read:
Although strictly speaking, it’s illegal for someone to have sex with a girl under 16, we know that maturity does not suddenly arrive on the 16th birthday, and that many young people are mature enough to make their own decisions about their lives.
The message to young people is that they are free to decide for themselves whether or not they keep the law. They are above the law and are free, if they wish, to treat it with contempt.
The second is parents taking less responsibility for their children
Politicians frequently insist that parents have a key part to play in reducing teenage pregnancy rates. Yet while successive governments have trumpeted the importance of parents, they have pursued policies that undermine them.
And this fundamental lack of respect is nowhere more clearly seen than in the way confidentiality policies are keeping parents in the dark about the illegal activities of their children.
The more they are undermined the less responsibility parents will be inclined to take for their children. Authority and responsibility go hand in hand.
The government can’t have it both ways: it can’t disempower parents and at the same time blame them for society’s ills.
The third is increased risk of sexually transmitted infections
According to Professor David Paton from the Nottingham University Business School, there is evidence that some measures aimed at reducing teenage pregnancy rates are proving counter-productive and having a negative impact on sexual health.
It is not difficult to see how the ready availability of the morning-after pill reduces the perceived risk of pregnancy and so removes one of the major restraints to underage sexual activity.
In this way it becomes part of a mix that encourages a more casual attitude to sex and exposes young people to increased risk of sexually transmitted infections.
The fourth is emotional harm
Governments and health experts have been so preoccupied with the risks of unplanned pregnancy and sexually transmitted infection they have ignored the third risk of emotional and psychological harm associated with early sexual activity.
The fact remains that sexually active teenagers are more likely to suffer from depression and more likely to have attempted suicide than those who abstain.
There is evidence that when the ‘sex/bonding/breaking-up’ cycle is repeated a few or many times, young people find it more difficult to develop significant and meaningful relationships in the future.
The fifth is heightened risk of abuse and exploitation
Health professionals in Rochdale failed to protect teenage girls from severe and prolonged sexual abuse because their preoccupation with reducing teenage pregnancy rates had encouraged a culture in which underage sexual activity was allowed to go unchallenged.
Two serious case reviews found that professional agencies had become complacent about underage sex and had assumed that the girls concerned were making a ‘lifestyle choice’.
The fact is the more that underage sexual activity is viewed as a legitimate option, the more that accessing contraception and the morning-after pill is regarded as a mark of maturity and responsibility, the greater the risk that cases of abuse and exploitation will be missed.
Anne Weyman, formerly chief executive of the Family Planning Association, who chaired the committee that developed the NICE guidance argues that ‘modest investment’ in contraceptive services could have health benefits for young people and potentially result in reduced financial cost in the longer term.
However, the unintended consequences of the NICE recommendations threaten to add considerable costs – not only financial, but also personal and social.