Tuesday, 20 November 2012

Tales from a big place: Australia's first national sexual and reproductive health conference

Yesterday I spoke at Australia's first national sexual and reproductive health conference in Melbourne - my presentation: Tales from a little place - learning from the UK.

I always get a warm welcome from colleagues in Australia, and this trip is no exception. It is always interesting to prepare a presentation, particularly for an international audience, and we really have learnt a lot over the last 15 years or so, and have an enormous amount to be proud of.  Our teenage births declined by 35% during the life of the teenage pregnancy strategy.  Whatever the small group of opponents claim about the teenage pregnancy strategy, that is a roaring success. 

But when asked the inevitable question about whether England will sustain the progress during the current political and economic environment, whereas two years ago I would optimistically say that we could with the right drive and leadership, it is much clearer now that a lot of the intelligence and knowledge held in people is being lost, and that the strategic leadership so critical is in often absent. Clearly that has potential dire consequences for young people's sexual health.  But what I am able to say, of course, is that Brook and FPA, along with other organisations and individuals will do our utmost to ensure we continue going forwards (cue plug here for www.wecantgobackwards.org.uk).

The conference has been truly outstanding and here are some of the things I am taking away so far;

That much more needs to be done to address and improve the sexual health of Aboriginal and Torres Strait Islander communities for whom the data shows much worse sexual health outcomes.  And the flip side of that is there is some truly remarkable work going on to promote positive sexual health and strengthen the resilience of communities.  I heard examples of stunning work helping communities get on with 'the business of living' and developing positive opportunities for open and honest discussion.  James Ward, a leading Aboriginal Health Researcher called his talk 'Focusing on the 'Rights' rather than the wrongs of Indigenous People to improve sexual and reproductive health outcomes'.  He emphasised powerfully that the starting point is always a deficit one when it comes to Indigenous People, but that it is to all our shame that sexual health outcomes are so much poorer in these communities. If you closed your eyes and listened to his passionate plea to trust in young people from Indigenous Communities it could easily have been anyone of a number of us talking about the poor perception of young people in the UK.

Professor Rob Moodie gave some lessons from for Sexual and Reproductive Health from his time on the National Preventative Health Taskforce.  His key messages - progress take time and if you watch any journey it is small steps. He showed the timelines and critical steps/points on the journey in relation to smoking and road trauma to illustrate his point. He followed this with key advice - need the three A's Advocacy, Advocacy and Advocacy, and three P's - Persistence, Persistence and Persistence.

He also asked where the men were in the promotion of sexual and reproductive health (having recently been at the centre of a heated discussion because I was one of three men discussing contraception and confidentiality on R4's Today Programme the irony wasn't lost on me that the first session of the conference was all men - and was therefore very pleased when todays plenary session was an all women line up!)

The afternoon panel on abortion was fascinating. Medical Abortion is just being introduced into Australia and there is a lot of optimism that it will do much to improve women's rights. I had not realised that Australia had such a diversity of abortion legislation and policy which ranges from positive following legislative change in Victoria in 2008 to incredibly restrictive in Queensland based on laws from the 1890s.  Some really incredible advocacy and determination to improve women's choice including that of www.childrenbychoice.org.au  and so much of the discussion albeit with nuance that is reminiscent of the challenges and issues familiar in the UK and Ireland.  And as with Northern Ireland, MSI has played an important role in improving women's choice here in Australia.

I was treated to an evening out by a group of people - old colleagues and new - from both South and Western Australia. One of the doctors in the group used to work at Brook in the East End and Brixton in the 1980s so that was a real pleasure to find out more about how Brook and working in sexual health services for young people used to be.  

This morning's session was incredibly inspiring - first up Professor Vansesenbeek from Rutgers in Holland.  Completely demonstrating everything she described about Dutch culture and ways of being in her presentation Ine explained that if you want young people to be responsible then you have to have three things - sexuality education, youth friendly services and an enabling environment such as openness in the family, good parenting, a robust health system. 

She showed how Dutch young women are the best at Double Dutch - using the condom and another form of contrception together and reminded me of the importance of renewed discussions in Brook and the UK more widely about how we help young people understand Double Dutch is important and even 'cool'.

Ine explained that whilst sexuality education is not mandatory there is a conviction that formal education is needed and that it must be rights based, pragmatic and positive. She reminded us that the importance of SRE cannot be measured simply in health outcomes - it is also about rights and emancipation and sexual self esteem.  And we also should not overestimate what it can do because behaviour is determined by more than SRE.

Ine talked about parenting and positive parenting, but I was intrigued by the research and stopped making notes so I will come back to this but here her key message is Dutch parents are good parents, they are authoritative not authoritarian and focus on connectiveness with a liberal morality, and that their children report being happy children.

Finally she emphasised young people must be taught by parents,schools and communities about internal control - the ability to think for oneself, to develop critical awareness and competence.  Look at the evidence, it speaks for itself that the Dutch have got a lot right and we can all really learn from them.  For my money its about the enabling environment - the prevailing culture that we can and must learn most.

Next up Anne Mitchell from Australian Research Centre for Health, Sex and Society.  Anne has done an enormous amount on gay young people and sexuality education and it was great to hear a presentation with the word excitement in it.  She outlined 4 concepts that excite her in improving sexuality education as we move forward;

1. Thinking about healthy sexual development and what it means so we can set some clear agreed goals for sexuality education
2. Taking a strengths based approach which recognises that in the main young people manage their sexual health well and generally make good decisions and that we need to develop SRE that can help develop those strengths
3. Using a sexual ethics framework as outlined by Carmody which builds the ability to care for self, being aware of the possible impact of desires and wants on others, being able to negotiate and ask, and reflect
4. Moving beyond sexual rights and recognising that sexual rights are human rights and that if you take this approach you recognise sexual health inequalities are often the basis of systemic discrimination - this really resonated with James Ward presentation yesterday.

Finally in this morning's session, Dr Ailsa Gebbie, all the way from Edinburgh who outlined the brilliant work that has taken place in Scotland to develop an integrated sexual health strategy, Respect and Responsibility, and the development of the Chalmers Centre, the fantastic integrated sexual health centre in Edinburgh. I felt proud to be British as Ailsa described the work, the commitment and the persistence that has been required to develop such a brilliant service and integrated approach more broadly. 

Ailsa emphasised the importance of leadership, agency buy in to shared and common goals, the investment in services, in training, in capacity and in data use to drive improvements. And she set out some of the challenges ahead including keeping sexual and reproductive health a priority - a constant challenge for all of us in the context of differing needs and limited resource - and ensuring that they reach those at highest risk of sexual ill health.

An inspired conference so far, and still an afternoon to go.  


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