FAMILY PLANNING FAILURE

Sunday Herald - November 2, 2003
http://www.sundayherald.com/37766
Advice clinics 'increase sexual diseases'
Teenage family planning sessions linked to a rise in sexually transmitted infections
By Sarah-Kate Templeton

Family planning clinics are encouraging the spread of sexually transmitted diseases, according to new, in-depth research. The research into the government’s sexual health policy has shown that, in areas where contraception and advice on sex is made more widely available, rates of sexually transmitted infections actually rise. Sexually transmitted infections among teenagers increased by around 15% between 1999 and 2001. Over the same period, the number of adolescent family planning clinic sessions rose from 27,075 to 33,369, an increase of 23.2%. Nottingham University business school has calculated that the increase in clinics for teenagers is responsible for one tenth of this rise.

Dr David Paton, head of industrial economics at Nottingham University, said: “Across the country, the estimates imply that the increase in clinic sessions between 1999 and 2001 caused sexually transmitted infection rates to increase by 1.42% Given the myriad of potential influences on STI rates, this seems to me a surprisingly large effect. “We are pretty sure, statistically, that the increase in clinic sessions was associated with an increase in diagnosis rates. Sexually transmitted infection (STI) diagnoses increased by about 15% between 1999 and 2001 – one tenth of this was due to clinics. “If clinic sessions had the impact of increasing STIs, even by a small amount, and did not decrease teenage pregnancy rates, then the money and resources would have been better spent elsewhere. Indeed, even doing nothing would have been a better tactic.”

Paton believes pressure on teenagers to have sex from peers and magazines, as well as the erosion of religious and social taboos about underage sex, have contributed to increased sexual activity and consequently higher levels of disease.

The research, to be presented at a House of Commons meeting later this month, will coincide with the launch of Scotland’s sexual health strategy, which is expected to recommend opening family planning clinics either in or linked to schools. The findings will fuel the debate over whether wider access to contraception and advice encourages children to have sex or ensures that the sex is safe.

Paton looked at the 99 health authorities in England and compared the number of teenage family planning clinic sessions with the levels of sexually transmitted disease. He found a correlation between the two. In one inner city area, the number of clinic sessions increased by 81%, while the diagnosis rate of sexually transmitted diseases in the under-20s rose by 70%. In a commuter belt area, clinics went up by 26% while sexually transmitted diseases also went up by 26%. Most surprisingly, in another inner city area there was no increase in sexual health clinic sessions and the number of sexually transmitted diseases actually went down by 1.53%.

Paton said: “The lesson is that government policies can often have an impact that is not expected. Unfortunately, some people can change their behaviour in response to policy change. When we promote condoms we think that might have the effect of preventing passing on disease but it may encourage people to have more partners. “Distributing condoms offers protection in preventing disease but people change their behaviour and tend to take more risks. It seems to me that setting up sexual health clinics is easy. Social exclusion and deprivation are more difficult to deal with.”

In 1999, the year in which the teenage pregnancy strategy was introduced in England, 61% of 16 to 19 year-olds were sexually active. This increased to 67% in 2000 and 73% in 2001. Over the same period, conception rates among all teenagers fell by 3.5% while rates of sexually transmitted infections rose by 15.8%.

The report, which will be published in an economics journal, concludes: “The provision of family planning services for young people appears to have little overall impact on teenage pregnancy rates, but leads to significantly higher rates of diagnosis of sexually transmitted diseases among teenagers.”

Paton’s results will be discussed at a meeting at the House of Commons next week organised by the Maranatha Community, a Christian organisation, and MPs Jim Dobbin and Andrew Selous. The meeting, under the title the Sexual Health of the Nation, will also raise the example of how a reduction in casual sex, and not just wider access to contraception, has been responsible for success in fighting HIV in Uganda.

Uganda has adopted what it calls the ABC approach to reducing HIV. The country’s Aids commission’s all-inclusive motto runs: “Abstain (from sex), Be Faithful (together), Condom Use (every time).” HIV rates in the country have reduced from 21% to 9.8% from 1991 to 1998. Dr Daniel Low-Beer, of the Health and Population Evaluation Unit at Cambridge University, will tell the Commons’ meeting that Uganda has successfully reduced sexually transmitted diseases because it has tried to reduce casual sex instead of focusing on the Western safe-sex approach based on wider access to contraception. “We don’t do what we say in the UK,” Low-Beer said. “The safe-sex policy has not been safe in the UK and, when exported to Africa, it has become quite dangerous. In the last 10 years most countries that have followed the safe-sex approach have not seen a decline in HIV.” A study by Low-Beer and colleague Rand Stoneburner, published in the African Journal of Aids Research, found that developing countries are most successful in reducing HIV when they concentrate on reducing casual sex. The study found that, between 1989 and 1995, casual sex in Uganda declined by 65%.

Low-Beer believes the UK could learn from Uganda’s success in tackling sexually transmitted disease. “We have got to look at the reality of safe sex in the UK,” he said. “There is inconsistent condom use and an increase in casual sex. “The context is very different in the UK but we need to listen to what has happened in Uganda. We need to put risk avoidance into the sexual health strategy. Avoidance is the reduction in casual sex and, in some cases, abstinence and considered condom use.”

The Family Planning Association (FPA) last night disputed the findings of both Paton and Low-Beer. A spokeswoman for the FPA said: “As far as the FPA is concerned, the message is that one way to reduce STIs is to have fewer partners but the important thing is not what you do but the way that you do it. There are many ways to have sex safely. The most important element is careful and consistent condom use. “STIs have been on the rise since the early 1990s. This is part of an ongoing trend, it did not start in 1998 as Dr Paton is suggesting. There aren’t enough clinics for young people who want access to them. “The rise in STIs is due to a multiplicity of factors including poor sex and relationship education, a lack of health education campaigns and greater diagnosis. Just to link the rise in STIs to an increase in clinics is a weak argument.”