HJFWhat role should schools play in curbing teenage pregnancies? Anat Arkin looks at the arguments while, overleaf, a teacher explains how the morning-after pill could have helped one of her pupils.
When school nurse Viv Crouch heard that a teenager at her school had had a baby she was shocked. She had not even known the girl was pregnant; no one had, not even the young mother's parents. The girl had told no one about her pregnancy until the day she gave birth.
She had wanted to use emergency contraception but her GP could not see her until the following week. Too embarrassed to explain why she needed an earlier appointment, she crossed her fingers.When that did not work, she simply kept quiet about her condition.
Determined that other students at the Bath secondary school where she ran a clinic would not suffer the same fate, Mrs Crouch decided to set up a contraception service. A local GP agreed to see girls before or after school, and she would provide counselling.
That was nine years ago, and the arrangement is still working well."Managing it this way in school means it's easy to check up on the girls afterwards - and there is always an open door for them," says Mrs Crouch, who has received hate mail from people opposed to what she is doing.
These days nurses who have received appropriate training can issue the morning-after pill - and other medicines - in strictly defined circumstances, so it is easier for schools to make sure students have access to emergency contraception. But schools still need to work with health authorities because - contrary to some misleading reports - teachers cannot hand out contraceptive pills.
Health authorities that have teamed up with schools to provide emergency contraception include East Kent, which has one of the highest teenage pregnancy rates in the south-east, and Oxfordshire, which runs drop-in health clinics in or near several secondary schools.
These Bodyzone clinics advise young people on a range of health-related issues, including smoking, diet, stress and bullying, as well as contraception.
David Wilson, head of Faringdon community college, which piloted the first Bodyzone four years ago, says: "We have good programmes to help children develop and gain knowledge in terms of their physical and emotional growth - but that is at class level. What was lacking was an opportunity for students to talk to someone who was knowledgeable and could help if they had individual issues they wished to take further."
Although students will sometimes confide in their teachers, Mr Wilson believes most prefer to discuss problems with people they know less well - such as school nurses.
According to Elizabeth Greenhall, director of family planning services in Oxfordshire, teachers are often relieved to know young people can take their problems to health professionals. But she says teachers can only encourage students to visit the Bodyzones; the clinics are run separately from schools.
Like most of the schools with Bodyzones, Faringdon community college serves a small market town with no health care facilities geared specifically to young people. While youngsters can go to their GP, they are often reluctant to visit a surgery where someone in the waiting room is likely to know their family.
Usually held once a week at lunchtimes, Bodyzones are run by health professionals and youth workers, and provide a confidential service. But they do encourage students to talk things over with their parents - especially when it comes to prescribing contraceptives to girls under 16 (see box).
"The younger the girl, the more effort we make to persuade her about the advisability of telling her parents," says Dr Greenhall. "But, ultimately, if the girl doesn't want her parents to know, we act in what we feel is her best interests."
Dr Greenhallsays that from April 1999 to April 2000, Bodyzones prescribed emergency contraception on just over 60 occasions - not a huge number, given that the clinics saw 12,000 pupils over that period.
Parents, who were consulted when the Bodyzones were set up, are mostly supportive. But there is opposition to making contraceptives, especially emergency contraceptives, more widely available to young people.
Baroness Young, whose move to ban chemists from selling the morning-after pill to over-16s was recently defeated in the House of Lords, says: "It's an encouragement to unprotected sex, which, of course, is exactly the opposite of what everybody in the sex education business has been saying for the past 20 years - and it's an encouragement to promiscuity."
But even Lady Young concedes that it is better for young girls to receive emergency contraception from a school nurse than from a pharmacist who knows nothing about them.
It was concern that older girls would soon be able to buy the morning-after pill over the counter that prompted the governors of John Port school in Derbyshire to start making it available through a trained nurse practitioner last autumn.
the school's head, Michael Crane, says: "Parents were generally very positive and recognised that the protocol was actually going to provide a much safer and more secure environment, with support and counselling, which a chemist would not provide."
As with the Bodyzones in Oxfordshire, the drop-in facility provided by Val Oborn, a nurse with South Derbyshire health services, helps students deal with a wide range of problems, including bullying, anger management and bereavement, as well as contraception.
She issues emergency contraception only after studying a student's medical history and discussing relationships, sexual health and the right to say "no". The service is confidential, with Mr Crane becoming involved only if there are reasons for believing a child could be at risk. Staff were taken aback by the amount of media interest that this low-key initiative generated. But Mr Crane says the furore has not dented parental support for Val Oborn's work.
"At the annual parents' meeting in November, the vast majority offered their support and recognised that this really was a commonsense decision based on pragmatism," he says.
Since January 1 this year women over 16 have been able to buy emergency contraception from chemists without a doctor's prescription.
The drug that has been deregulated is a progestogen-only form of emergency hormonal contraception (EHC) - deemed to be safer than previous drugs and without the side effects of nausea and vomiting. The pharmacist provides two pills (instead of the previous four), which must be taken within 72 hours of having unprotected sex but preferably within 24 hours.
"It is very safe and very effective, with few, if any, side-effects," according to the family planning agency Marie Stopes International. The British Medical Association and the Royal College of Nursing say that EHC, which prevents conception, is not a form of abortion. Women aged 20-29, rather than teenagers, are by far the greatest users.
Doctors can give contraceptive advice or treatment to under-16s without parental consent provided they are satisfied that they will understand the advice, cannot be persuaded to tell their parents, are likely to carry on having sex with or without contraceptives and are likely to suffer damage to their health unless they receive advice or treatment.
The DfEE says "trained staff in secondary schools should be able to give full information about contraception, including emergency contraception". Teachers can also give pupils information on where to get counselling and treatment. But, unlike doctors, they cannot promise pupils confidentiality.