Monday, 30 December 2013

How did young people and sexual health fare in 2013?

I enjoy the end of year reviews. They are always partial, sometimes flawed and always interesting archives – the films, the songs, the books – which ones made it and which ones bombed.  So, here is mine for young people, sex, sexuality and sexual health. I put a shameless health warning on it - it is not scientific and the 'good year for, bad year for' doesn’t quite work, but I am going to squeeze a round peg into a square hole. And the only issue I am not going to put in a box is young people's voice - I think we are getting better at involving and hearing them and young people at Brook have felt heard by a number of senior politicians and decision makers this year. But it is so so important and we just have to keep getting better and better at it all the time. 

I hope you enjoy reading my review as much as i have enjoyed writing it - I don't necessarily expect you to agree but I hope it triggers your own assessment of the year to give space to congratulate yourself, build your optimism and reignite your determination to succeed for young people in 2014.

A bad year for;

1. Trusting young people to be responsible about sex 
The general view of immoral young people behaving more and more badly continued in 2013. It seems despite the evidence we continue to believe all young people are having sex before 16 and that far higher numbers of young people are getting pregnant whilst completely drunk or high. 

At Brook this year we have worked with over 280,000 young people, and it is clear that the absolute vast majority want to be good at relationships and want to be good at sex.  The National Survey of Attitudes and Lifestyles showed the average age of first sex remains at 16, and teenage pregnancy rates continue to decline.

2. Fear of technology
Technology is changing the way we live. The younger we are, the more likely it is our on and off line lives will be increasingly integrated. Technology is generally a force for good.   It’s the fear of technology - not technology itself that is on the bad list.  Online pornography, cyber bullying and ‘sexting' have been high on the agenda this year.

Three reasons fear of technology is on my bad list:

a) We need to think more about the way we protect, equip and empower across the spectrum from very young children and young adults. How we protect an 8 year old is very different than protection and empowerment of a 17 year old.

b) We need to listen more effectively to diverse groups of young people -including those who use new technologies well and without harm to understand the good as well as the bad.  It is too easy to exclusively hear the bad experiences and believe that is the norm.  Over Christmas I learnt how to use SnapChat from a 16 and 18 year old.  We talked about how they and their friends use social media. It was interesting to hear their experiences of the fun and the good and how they and friends respond when it is used badly. 

c) I worry we expect too much 'protection' from technological solutions such as blocking and filters alone and that we need to focus on creating a culture where young people, parents and other trusted adults know how to use technology well and to be discerning about 'good and bad content'.

3. Contraception and abortion 
A few years ago the importance of contraceptive choice for women and the economic value of investing in contraception moved up the policy agenda significantly.  Whilst its still early days in the heath reforms, too often at national level, contraception isn't getting the attention it deserves. 

Abortion continues to be politicised and abortion providers, already well regulated, have been subject to disproportionate scrutiny this year. The law on abortion  in Northern Ireland remains out of step with the rest of the UK and beyond our borders Spain's legislative changes are a worrying retrograde step in women's reproductive rights. 

At Brook and FPA continue to collect stories of people’s experiences of sexual health services and it’s a mixed bag. Some local areas are continuing to provide excellent contraceptive choice in their services and others less so. The All Party Parliamentary Group on Sexual and Reproductive Health report on contraception and commissioning will be published in 2014.

Given 75% of contraception is provided by GPs and commissioning of abortion services remains with Clinical Commissioning Groups it will be important to ensure contraception and abortion are on NHS England's agenda as well as the agenda of Public Health England in 2014. 

4. National PSHE Policy 
We know from research with children and young people and from Ofsted report, ‘PSHE, not good enough yet’, that PSHE, particularly the SRE elements, are still not good enough and leave young people vulnerable.

That is why Brook and many of our partners were so disappointed and angry that the long awaited Department for Education PSHE Review concluded no change was needed and maintained the status quo wit PSHE as a non statutory subject.  As the UK enters its 25th year since ratification of the UN Convention on the Rights of the Child, the Children’s Rights Alliance for England 'State of Children's Rights in England' report was really damning about the state of SRE.

That said the National Curriculum states PSHE is important.  Ministers have repeatedly state PSHE is vital and insist it is now up to schools to decide how to do it.  It is therefore time for us to work differently  and for the experts to support schools and provide leadership and expert guidance. 

5. Sexual Health Commissioning
Since taking on public health in April 2013 some Local Authorities have had ambitious aspirations for service redesign - innovation and ambition will be absolutely vital to meet both the services people need and the economic challenges we face. 

However some of those early off the starting boards have had challenges with making change work. This led the British Association of Sexual Health and HIV and Royal College of Physicians to jointly write to all Councils to warn them of problems to service continuity in some areas as a result of commissioning decisions.  

6. Counselling and early support for young people 
Evidence from Youth Access and partners is showing that in many areas young people are finding it increasingly difficult to access counselling and early support. This early help is important for young people, extremely cost effective and provision is diminished at young people and society's peril. 

7. Violence against Women
Rape, violence and sexual assault against women continues to be unacceptably high in the UK, and whilst there is a very welcome policy focus on violence against girls and women follow @countingdeadwomen and @womensaid to know just how much there is to be be done. 

A good year for

1. The Sexual Health Improvement Framework 
This long awaited framework  was published in March ahead of the April 1st transition by Anna Soubry, then Public Health Minister.  The Framework takes a Life Course Approach and sets out aspirations for people across the life course and its aspirations for young people which match Brook's goals for young people: good SRE for all, high quality information and services.

2. Consent, Sexual Exploitation, abuse and violence against women
These important issues have received significant policy attention across central government and the Local Government Association. The Office of the Children's Commissioner published their report on sexual exploitation; the Home Office 'This is Abuse' campaign won an award at the UK Sexual Health Awards. The PSHE Association published draft advice on teaching and learning about consent to support schools in addressing this important area.

3. Data and Evidence 
The findings of the NATSAL 3 survey - the largest dataset on sex and sexuality undertaken once a decade - were published which showed the importance of sexual health services, the central role of education and a positive culture in creating positive, happy, healthy sex lives. 

The first six NATSAL 3 papers provided rich sources of data and information, and there will be much more to come. 

Brook and FPA,  in collaboration with Reckitt Benckiser, published an important report Unprotected Nation which demonstrated the economic benefits of investment and the potential costs of disinvestment.

4. Sex and Relationships Education
2013 was the year that so many influential and sensible people acknowledged sex and relationships education makes a real difference to young people, and that talking about sex and relationships in the home, school and community is part of the solution to national and local concerns about teenage pregnancy, sexualisation, abuse and exploitation, FGM and online pornography.  

NATSAL showed school based sex and relationships helps reduce teenage pregnancy and that receiving sex education mainly from a non-school based source almost doubled the odds of having an unplanned pregnancy.

Notable support for SRE came from;

UK Youth Parliament said they need a Curriculum for Life; Office of the Children’s Commissioner and Child Exploitation Online Protection (CEOP) part of the National Crime Agency said sex and relationships education should be statutory in all schools as part of national measures to reduce sexual exploitation; David Cameron said SRE is important to address the issues of online pornography in the Telegraph; Home Office supported SRE as part of its This is Abuse campaign; Department of Health emphasised the importance of SRE in their sexual health improvement framework and Department for Education said SRE was important as part of a balanced curriculum. The Teacher Unions said SRE was important to address sexualisation, pornography and ‘sexting’

Two important campaigns showed just how deep the consensus in support of SRE is;

The Telegraph Wonder Woman launched a campaign to get government to update its SRE Guidance and over 50,000 people supported their petition.

A Coalition for Consent - #yes2NC20 was established by Stella Creasey, Lisa Nandy and Sharon Hodgson to get a New Clause 20 for statutory SRE as part of the Children and Families Bill. Like the Telegraph campaign it was a galvanising moment online and in the media, and highlighted just how broad and deep support for better SRE is. It was inspiring to see bring together charities, pressure groups, MPs across the political spectrum, the public, and education bodies. 

With growing support from those with influence and a recognition of its increasing urgency there has to be a step change in the provision of SRE ahead. Surely, its time has come.

5. Social media
This year has seen young people, adults and organisations use social media to provide information, to challenge, to hear oft silent and unheard voices and to campaign for change - from challenging sexism and transphobia to raising awareness of FGM. 

At Brook our young people led twitter account @BeSexPositive has continued to grow and to share articles and posts about gender, sexuality, and what it means to be #sexpositive. @besexpositive made a lot of noise on #IDAHO 2013 -

Our @brookcharity Brook focuses on policy and evidence - for example live tweeting the #OBRUK debate in Parliament on SRE. The highlights are storifyed here:

The #safeXESmas @XEScampaign in partnership with @fpacharity and @durex has been very successful in getting people's attention and spreading the safe sex message. With engaging content on Twitter and Facebook and prizes to be won, it's shown how social media can get the word out to people who might not otherwise have heard it.

6. Equal Marriage 
Despite the promise from some that the world would end if the Marriage (Same Sex Couples) Bill became law, it did receive Royal Assent and another equality milestone is reached.  Interestingly as @ruthhunt from Stonewall predicted the world didn't end. In fact it became a better place.

7. Teenage Pregnancy
The teenage pregnancy rates continue to decline in England. Polly Toynbee's article in the Guardian in December highlighted the success of the teenage pregnancy strategy in reducing teenage pregnancy rates and supporting young parents. Alison Hadley established the Teenage Pregnancy Knowledge Exchange based at Bedford University to maintain the knowledge and momentum from the national strategy in the new environment. 

In Scotland,  the Health and Sport Committee Inquiry into Teenage Pregnancy made a series of helpful recommendations and a strategy is being developed for Scotland. 

As with everything 2013 has been a mixed year with good and bad when it comes to young peoeple's sexual health.  2014 will continue to see significant change that brings enormous challenge and opportunity.  Brook turns 50 next year. We will be doing all we can with partners and collaborators to apply our best learning of the past 50 years to achieve our goal of enabling young people to enjoy their sexuality without harm. 

Thank you to everyone at Brook as well as our partners, collaborators, funders, commissioners and supporters for hard work, commitment and support in 2013. Happy New Year. Hope 2014 brings much happiness and laughter. 

Friday, 27 December 2013

Some statistics on teenage pregnancy, abortion and sexually transmitted infections

I am just preparing a a review of the year, and these statistics were pulled together for me so I thought you may find them useful in one place.

Teenage conceptions

  1. The under 18 conception rate for 2011 is the lowest since 1969 at 30.9 conceptions per thousand women aged 15–17.
  2. The estimated number of conceptions to women aged under 18 also fell to 31,051 in 2011 compared with 34,633 in 2010, a decrease of 10%.
  3. The estimated number of conceptions to girls aged under 16 was 5,991 in 2011, compared with 6,674 in 2010 (a fall of 10%).


  1. The percentage of conceptions leading to a legal abortion varies by age group.
  2. Over the last two decades this figure has generally increased for women aged under 20 but decreased for women aged 35 and over.
  3. For women in their twenties and early thirties the percentage of conceptions leading to a legal abortion generally increased between 1991 and 2001 but decreased steadily until 2009-2010 before increasing slightly in 2011.
  4. There were 196,082 abortions notified as taking place in England and Wales in 2011
  5. Of these, 189,931 abortions were to residents of England and Wales. This represents a rate of 17.5 per 1,000 resident women aged 15-44.  
  6. The abortion rate increased from 5.2 in 1969 to a peak of 18.6 in 2007. The rate fell to 18.2 in 2008 and to 17.5 in 2009 and has remained at 17.5 since then.

Sexually Transmitted Infections

The Annual Health Protection Agency report showed the largest increases of new diagnoses between 2010 and 2011 was found in men who have sex with men:

  1. New STI diagnoses rose by two per cent from 2010 to 2011 with nearly 427,000 new cases
  2. Primarily associated with increased rates of gonorrhoea, syphilis and genital herpes
  3. Young heterosexuals and men who have sex with men remained at highest risk, with increases in testing and continuing high levels of unsafe sexual behaviour contributing to the rises recorded.

  • Gonorrhoea increased by 61 per cent
  • Chlamydia by 48 per cent
  • Syphilis by 28 per cent.

Amongst heterosexuals overall rates remained highest in young adults (15-24 years old), accounting for:

  • 57 per cent of all new gonorrhoea diagnoses
  • 56 per cent of all new genital warts diagnoses
  • 43 per cent of all new genital herpes diagnoses.

Saturday, 14 December 2013

Saturday morning rambles: leadership, young women, body image and more

Other titles for this blog could have been 'end of month brain dump', 'saturday morning couldn't sleep in because I went to bed too early'.  Essentially a collection of reflections as I process the week gone by.

1. Leadership and optimism

I am interested in how different people and organisations are responding to the opportunities and challenges of the political, commissioning, and economic landscape.

We need to be both optimistic and make realistic assessments about the difficulties and challenges.  We also have to be pleased with good enough when good enough really is good enough.

If I crudely categorise those perspectives I hear and see;

  • everything is getting better
  • everything is going to be alright in the end
  • everything will be alright if we get busy with the difficult conversations and look at how we collaborate for change
  • we need to make sure what I/my organisation does and how we do it stays the same and investment stays the same
  • we have taken the biggest hit we can, we cannot take anymore
  • we are all doomed 
All have some validity depending on where you sit and what outcomes you are looking for. It seems to me our biggest leadership challenge is to operate with a strong values and outcomes focus so we can focus on what we know works, be confident enough to bin that which doesn't and use this as the basis for discussing the really important choices that have to be made.

New challenges require models of bold and collaborative leadership; providers, commissioners and 'consumers' (people) come together to develop and build solutions that really work.  I am excited to be part of and watch us all step up to the plate and make this happen.

2. Addressing the needs of young women

I have been in a number of meetings recently where I or somebody else has emphasised the need for a focus of time, energy and resources on supporting young women's personal and social development.
I have been interested/surprised at how often the conversation is very quickly moved on to how 'its not just young women' and it is equally difficult it is for young men, or for LGBT young people.

In none of the cases has anybody been arguing that the needs of LGBT young people or young men are not important, simply that we need to think about young women and gender, about structural inequalities and the impact of these on young women; and that resources, time and energy are required to truly meet the needs of young women.

I enjoyed reading this article on the fourth wave of feminism last week  I hope this social action will form part of a culture shift where people think hard and well about gender identity and structural inequalities as part of our work to build resilience and well being, and to help all young people shoot for their dreams.

3. Body image
Last week Jo Swinson MP held a round table event on body image.  We have heard a lot about online pornography and sexualisation in recent months. I have had numerous conversations with colleagues about both issues.  As you would expect people have different perspectives about the potential harm that may be caused by easy access to the internet, pornography and sexualisation of the young. 

As I listened to people at the round table it brought it home to me that do need to be talking about and paying particular and more attention to how we support young women and young men to develop a positive body image against a backdrop of 24 hour access to the internet and social media. How we feel about our bodies impacts on our self confidence, self belief, what we believe we are capable of and what we can expect.

Coming out of the round table one of my work 2014 resolutions is to find out more about the evidence, and more about the work of organisations like Beat, and Body Gossip to see what and how Brook may be able to do to build on our existing work in this area as part of sex and relationships education, and how we can work collaboratively with other organisations to ensure we are doing the best for all young people. 

4. Different world views

I went to Marrakech a few days after the Office of the Children's Commissioner report on Child Sexual Exploitation (read it here) for a friends 50th birthday (best DJ ever).  With consent high on my mind you can imagine how unpleasant it was being in a discussion on the Sunday morning with a local man and a slightly fuzzy head about how gay people would go to hell, how alcohol made men rape women, and how the weirdest thing ever was men who wanted to be women.

It was very clearly one of those discussions in which neither of our minds were going to be changed. I brought the conversation to a close with a swift 'in my view you are very definitely wrong for a number of reasons and I cannot talk about this with you anymore.'

This combined with India's ruling this week about gay people, Australia's U turn on equal marriage remind us how much there is to do not just in the UK, but also across the world.  Chris Bryant MP wrote a great article in the Independent about making sure each and everyone of us keeps the pressure for a fairer, better world on.  Read it here

This will likely be my last blog before the holidays start to kick in. I, like I am sure most others, am looking forward to a bit of down time over the holiday period.  Whatever you are doing - opening Brook or other health and community services for young people, resting in front of the fire, sleeping and watching crap TV for a week - I hope you have a good time and some down time with people you enjoy. 

I will be writing my traditional 'how did sexual health fare in the past year' blog in front of a wood fire in Cornwall on NYE. As one colleague said about this year 'its not all sunshines and lollipops'.  That may be true Polly Toynbee's excellent article about the impact of the teenage pregnancy strategy in both reducing teenage pregnancy, and supporting young people to be good parents published yesterday is definitely a good reminder there are some lollipops and we mustn't let go of them. You can read it here - Happy holidays!

Monday, 2 December 2013

Love social media: admire Tom Daley

Over the last twenty years or so I have seen lots of people come out - and or be outed - by various parts of the press.  So it was with pleasure that I watched Tom Daley's You Tube video today.  A video in which he told everyone he had met someone and he felt 'so happy, safe and everything just feels great - (and) that someone is a guy'.

The fact that social media gave Tom the power to say it in his words, without  'pro or anti gay' interpretation should be celebrated and that power really must not be under estimated.  It is an example of how social media - so often vilified for causing problems - enables the truth to be told in a direct, forthright and human way.  Even the very best journalist with the very best of intentions could not have conveyed Tom's reality and story in the moving and honest way he did.

So next time you are part of a discussion in which social media is demonised please don't collude. For every harm people tell you social media potentially causes I can show you multiple of goods.

And to those who have been cynical about Tom's 'coming out' video don't be. He is brave.  It is no surprise or secret that far far too many people in public roles do feel the need to keep their sexuality hidden. Who does that serve?

Coming out should be easy and in Owen Jones (@owenjones84) words 'when 'coming out' ends the fight for equality will be total'. Owen helpfully puts Daley's video in the context of the journey for LGBT rights. You can read it here

February 2014 is the 11th LGBT History Month.  Daley made history today and showed us that slowly but surely we are edging step by step, mile by mile towards proper equality.  That is the good news, however for the cynics and those who listen to Daley's story and say 'I told you so', the truth is that right now we are a very long way from equality. To belittle or trivialise anyone's story is wrong.

I know Tom Daley is a role model and a lifeline for hundreds and thousands of young people around the world today.  For that, and for Tom's happiness, we should all be truly grateful.  Let use this moment to recommit our efforts to ensure equality not just in the UK, but across the world and to embrace social media as a positive force for change.