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Sexual health: was it really different in your day?

Mary Crawford
Director, Brook NI

The cultural politics of Northern Ireland are important in looking at how society views sexuality and sexual health. There is no mainstream political party in the North that consistently supports women's right to reproductive autonomy. In fact, women in Northern Ireland are able to exercise less control over their reproductive capacity than women in most other western European societies. Politicians who would normally divide along Republican/Nationalist/Unionist/British lines have formed a united non-sectarian front in opposing sexual reproductive rights and services here.

According to Professor Phil Scraton from Queen's University in Belfast, in this climate "young people are assumed to be asexual, where they are socialised into gender appropriate roles from birth and they are expected to retain sexual naivety".

Professor Scraton goes on to argue that the messages young people receive are confusing. "Television, newspapers, advertising, music and cinema guarantee a popular culture obsessed with heterosexual relations and intrigue in which the boundaries of fantasy and reality are purposefully blurred. Young people are expected to remain passive onlookers, locked in a kind of unquestioning childhood innocence. It is as if their age confers immunity from matters sexual, that by some mysterious process they will know the right time to ask appropriate questions and receive informed answers."

It is within this context that those individuals and groups opposed to the public provision of sex education and services have attempted to argue that Northern Ireland is special in its pro-life culture, and that religion itself should have a privileged position in the shaping of public policy.

Modern day issues facing young people
Advertising has a huge impact on all of us - sex is used to sell a variety of products from perfume to chocolate, orange juice, cars and jewellery. A large store was recently selling a lap-dancing kit for 11-year-olds, while bras are produced for younger and younger girls, and stilettos are seen on the feet of many celebrities' children. The problem facing those of us working in sexual health services is that although these images are portrayed everywhere, there is often a furore about the "age appropriateness" of many of the publications on sexual health produced by reputable organisations and groups.

For young people in Northern Ireland, the Sexual Offences Order, which was introduced in February 2009, brought in a number of changes in terms of how the law defined the expression of sexual activity.1 The first was the lowering of the age of consent from 17 to 16 in line with the law in England, Scotland and Wales. However, when the legislation was introduced in the 1970s, politicians argued that young people in Northern Ireland were different to those in the
other jurisdictions.

The legislation also made the law gender neutral; no consent for those aged 12 and under made any sexual activity between under-16s, including kissing and touching, illegal. The tariff for those aged 18 and over having penetrative sex with those aged under 16 is five years, requiring mandatory reporting. There is much to be commended in the legislation but in seeking to protect young people from adult predators the legislation has also criminalised young people. Using age as a gauge for maturity may not always be the most appropriate or sensible guide.

The caveat with the legislation is: "It is not intended that young people should be prosecuted or issued with a reprimand or final warning where the sexual activity was entirely mutually agreed and non-exploitative. The overriding public concern must be to protect children and it is not Parliament's intention to punish children unnecessarily or for the criminal law to intervene where it is wholly inappropriate."2

While the legislation clearly defines its remit, it presents difficulties for those of us working with the real issues experienced by the young people using our services. This is where the issue of confidentiality begins to become blurred; the implementation of the law leaves us with many questions.

Confidentiality
For those of us working in this area, there are codes of practice for health professionals who have a duty of confidentiality to patients of all ages, including the under-16s. Only in exceptional circumstances may confidentiality be broken. Such a situation may arise if the health, safety or welfare of the patient, or others, would otherwise be at grave risk. Whenever possible, the patient should be informed before confidentiality is broken, unless to do so would be dangerous to the patient or others.

The whole issue of confidentiality is complex, contradictory, worrying and with no easy answers. To provide the best service possible for young people, Brook NI works on a needs-led approach, within the legal framework, using safeguarding policies and procedures to ensure best practice. So how do we get the balance between offering a confidential service and keeping young people safe?

Trust
Securing the trust of young people is vital — if it can be done at all — and it takes time, sensitivity, patience and sound professional judgment. We advocate that young people should be at the centre of what happens - informed and as in control as possible. The model we currently use is the traffic light system: Abuse; Risk; Okay. Each young person visiting the clinic can be identified by any member of staff into the above three categories. Once the young person is identified as orange or red, policy and procedures are immediately enacted to ensure the safety of that young person. Each client is viewed individually and a course of action is agreed to meet the needs of the particular person.

There are four possible options available with regard to patients when considering referral to
social services:

  • They do it.
  • We do it, they want us to.
  • We do it, they know, but don't want it.
  • We do it, they don't know.

We work to ensure that referrals to social services without the consent or knowledge and understanding of a young person are few and far between. When trust has been established it means that once safeguarding proceedings are over we can continue to work with the young people to help them recover and go on to lead healthy, happy sex lives.

"If you are not personally free to be yourself in that most important of all human activities - the expression of love - then life itself loses its meaning" - Harvey Milk, American activist and politician (1930-78)

Staff support
There are important aspects to be considered when working with young people in the field of sexual health:

  • Recruitment.
  • Training.
  • Supervision and support.
  • Protecting young people.
  • Policy.
  • No one makes decisions alone.
  • Be prominent within local services - "a voice for young people".

Staff need support and back-up to ensure positive outcomes for all those working in this area. All too often the provision of services is seen as: "Handing over contraception too easily/it was not that way in my day/young people never had it so good/young people have far more information than I ever had/they have no discipline ..." the list goes on and on.

Informed choices
At Brook, we believe that young people need boundaries, frameworks, guidance, advice and support in making decisions. Without these, making informed choices and dealing with peer pressure, and access to pornography, drugs and alcohol may be overwhelming for many young people.

Professionals play a vital role and may want to take some of the following into consideration in their work to help young people to:

  • Address and build strong friendship skills.
  • Build a sense of self-esteem and encourage aspirations.
  • Address gender issues.
  • Work imaginatively with parents.
  • Work on sensuality and the senses.
  • Give young people the whole picture.

Conclusion
Hopefully this article has reminded you of what it was like "in your day". Young people face numerous challenges that were not around for many of us; but the one thing we all have in common is the range of emotions that we experience. We all want to belong, to be loved and to have resilience and self-esteem. It is up to us as adults to ensure that our services provide confidentiality, do not stigmatise, are young-person centred and encourage a positive view of sexuality.

References
1. Office of Public Sector Information. Sexual Offences (Northern Ireland) Order 2008. London: OPSI; 2008.
2. Home Office. Guidance on Part 1 of the Sexual Offences Act 2003. London: DH; 2004.