Heart-to-heart surgery;Sex education

26th February 1999 at 00:00
The media had a field day when the all-girls' Hayesfield School admitted its sex education programme included 'morning-after' contraceptive advice. But, as Wendy Wallace reports, school nurse Viv Crouch's drop-in clinic is only part of a wide-ranging course aimed at cutting Britain's soaring teenage pregnancy rate. So when should sex education start? It's never too early, says agony aunt Tricia Kreitman.

Hayesfield Upper School is part of a 1,000-pupil comprehensive set in the leafy outskirts of Bath, housed in a fine sandstone villa with the stained glass windows and tessellated floors beloved of the Victorians.

But the hordes of girls in dark trousers and heavy shoes making their way up and down the stairs are thoroughly modern. They play football, get spots, fall out with their friends and worry about exams. Like their peers up and down the country, some of them have sex with boys.

Unusually though, this school has both a well-developed sex education programme and links with the doctors' surgery next door. As part of their co-operation, school nurse Viv Crouch runs a drop-in clinic on Monday mornings. If a girl comes and says she has had unprotected sex over the weekend, Mrs Crouch can help the pupil get a same-day appointment with a GP for advice on emergency contraception.

So far, so sensible, you might think. While Britain's teenage pregnancy rate is the highest in western Europe - with almost one in 100 13 to 15-year-olds conceiving - only two girls from this school have become pregnant in the past year, both in the summer holidays. But when the story emerged in the press last month - under the inaccurate headline "Girls' school offers morning-after pill" (The Guardian) - a violent storm broke over headteacher John Bartholomew.

In tortoiseshell specs and a dark suit, the mild-mannered 53-year-old (who has a daughter and two grand-daughters of his own) doesn't look like a malign influence. "We have the same problems here as everybody else and we're trying to deal with it in an adult, mature and helpful way," he says. But the school was doorstepped by television cameramen and parents were offered money to appear on a chat-show condemning the links with the GPs. Mr Bartholomew was forced to write a calming letter to parents and fielded press enquiries with a prepared statement from the governors.

The hypocrisy on the part of the sex-obsessed press is more than worthy of the Victorians. But this millennial morality tale illustrates all-too clearly one of the reasons why teenage sexual health is in the poor state the figures indicate. Operating in one of the most competitive catchment areas in the country, Mr Bartholomew had every reason to be nervous about misinterpretation of what the school is doing. "There are 11 schools here competing for custom," he says. "The governors are desperately concerned about image. Numbers in school are up, and it's very precious that we've achieved that. But one thing like this can really set you back." No wonder many schools still keep PSE to a bare minimum.

Mr Bartholomew, who was willing to talk to The TES, stresses that links to the doctors' surgery are only a part of the picture at Hayesfield. Ten years work has gone into the school's personal, social and health education programme. All staff have received in-service training to teach it, with the aim of helping the girls develop all-round life skills. "If we're doing anything for the kids here I think we're making them confident," says Mr Bartholomew. "That's absolutely vital."

The school brings in speakers ranging from young mothers from the nearby Bristol Unit for Schoolgirl Mothers to National Childbirth Trust members, paediatricians and experts on sexually transmitted diseases. No girl is likely to leave this school believing that "you can't get pregnant the first time" or that "if you're standing up you won't conceive".

But the coherent approach to sexual health which is the school's hallmark - and which recently attracted a fact-finding visit from the Social Exclusion Unit - was not the story. "What created excitement was the notion that we had a conveyor belt shipping large numbers of girls in for emergency contraception," says the head. "In fact, sexual matters are a small part of what the girls see the school nurse about. But the guiding principle is that no young person is going to be left in distress without support."

According to Mrs Crouch, even the best-informed young people can still find it excruciatingly difficult to talk about sex. "We might think they're very blase about sexual isues," she says, "but often they're very embarrassed. Confidentiality is a huge issue - they can feel dreadfully exposed and quite vulnerable."

She helps girls to make appointments with the doctors and has on occasion accompanied girls home to talk over difficult issues with parents. Any pupil who has emergency contraception has a follow-up talk with Mrs Crouch to discuss their contraceptive needs. Parents are involved wherever possible. It's responsible - and effective. Only one girl has ever re-presented herself for the morning-after pill in the five years the scheme has been running.

Few young people in this country are getting the same package of education, support and access to services. Teenage pregnancy rates, after dropping slightly in the first half of the 90s, rose in 1996 and '97, the last years for which figures are available. The conception rate in the UK is double the rate in Germany, four times the French rate and seven times the rate in the Netherlands.

Although births to teenage mothers have dropped over the past 20 years, the cost, socially and financially is high. "A year after the birth, half (of the mothers) were no longer in a relationship with the father of their babies, and the overwhelming majority were dependent on social security benefits," found Isobel Allen of the Policy Studies Institute in a recent study.

The Government has made plain its desire to "Do Something" - but what remains unclear. Initially, New Labour seemed to be building up a head of steam on the issues. Minister Tessa Jowell of the Department of Health and Estelle Morris of the Department for Education and Employment co-chaired a joint advisory group on PSE, widely welcomed by both the sex education and health lobbies as new and constructive co-operation.

At the same time, four task groups were set up under the aegis of the Department of Health to look at different aspects of improving the sexual health of young people. Indeed the enterprising Nurse Crouch was invited to be a member, as was Tricia Kreitman, agony aunt of MIZZ magazine who, on page 6, describes research into young girls' needs. But when early last summer the Prime Minister suddenly transferred the brief to the Social Exclusion Unit, people in the field - and even reportedly civil servants at the Department of Health - were taken completely by surprise.

Since then a feeling of drift has set in, with the momentum of a year ago now lost. The Social Exclusion Unit has consulted widely - with 700 respondents to its lengthy questionnaire and replies still arriving - but publication of its report has been delayed and is now not expected to be made public until Easter. How their recommendations will fit in with the deliberations of the Qualifications and Curriculum Authority on "Preparation for Adult Life" is unclear. "There is a feeling of depression and paralysis," admits Gill Frances of the Sex Education Forum, an umbrella group representing 43 organisations, based at the National Children's Bureau.

Both government and educators know that the best contraceptive is the prospect of a future. Few teenagers heading for university become mothers instead, and regional variations in underage conception speak volumes about disadvantage. But some fear that with its remit to concentrate on the most marginalised, the SEU may have little to say on the subject of how to help all teenagers safely negotiate their first sexual relationship. Yet this is what is needed. A new report from the Public Health Laboratory Service (PHLS) on sexually transmitted infections reminds policy-makers that teenagers are desperately at risk here too. Cases of chlamydia - an often symptom-less infection which if left untreated can cause infertility - rose last year by more than 30 per cent among young people aged 16 to 19. The PHLS found "substantial rises" in a whole range of sexually transmitted infections among teenagers.

Until and unless the Government makes it clear that it is rightly the business of all schools to help young people assert themselves in relationships, avoid unwanted pregnancies and guard against sexually transmitted infections, both head teachers like John Bartholomew and children will continue to be at risk.

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