The UK Sexual Health Awards 2014

Me opening the ceremony @ #SHUK2014!

The UK Sexual Health Awards 2014 took place at the glittering 8 Northumberland venue last Friday 14 March. The third time the Awards have taken place, they were bigger and better than ever - thank you to all who attended, and to the Brook and FPA staff who worked so hard to make the Events the stunning success that they were. I have lost count of the number of people who have congratulated me and the team on the Awards and all the organising team, the judges and the venue staff really deserve a lot of credit. I am already looking forward to the 2015 Awards.

I urge you all to read through the list of winners: a totally inspirational lot.

I hope you like the photo at the top of this post - it and all other official photos from the Awards can be viewed and freely downloaded from our Flickr page.

Brook Ambassador Zoe Margolis

In between enjoying a delicious meal, laughing at brilliant host Jenny Eclair's jokes, chattering away with old friends and new faces, congratulating all our brilliant winners and finalists, admiring the beautiful décor, and applauding until my hands ached we did some tweeting. You can read a Storify that tells the story of my #SHUK2014 here.

Below are the two speeches from the winners of the Lifetime Achievement Awards from this year's ceremony: Dilys Cossey OBE, and Dr David Paintin. Dilys delivered her moving and scintillating speech herself, while sadly David was too ill to attend the Awards - I was honoured to deliver his speech in his stead.

As Brook celebrates its 50th birthday year, it is wonderful to hear from two people who were there at our founding in 1964. Dilys and David gave sharp and poignant reminders of exactly why Brook was established, of how much the world has changed (in terms of sexual health as well as gender equality, acceptance of gay people, social mores and much, much else) in half a century, and of what still remains to be done. Both speeches moved many of those watching to tears, and gave us goosebumps - especially when David spoke of the behind the scenes work required to pass the Abortion Act in 1967, and when Dilys called for abortion to be decriminalised.

Speech by Dilys Cossey OBE, recipient of a Lifetime Achievement Award

Dilys Cossey OBE delivering her acceptance speech

It is a great pleasure and honour to accept this award and to receive it with my long-term colleague David Paintin. I have known David for half a century – we started off together in the Abortion Law Reform Association in 1964. It has been a huge privilege to be a member of the team working for so long in this field with committed colleagues – with people like David and Ann Furedi. There was never any doubt about the value of what one was doing.

It is a particular pleasure because it comes from friends and colleagues in FPA and Brook known over many years. I have always valued Simon Blake’s attentiveness and courtesy to a Brook ‘oldie’. And Audrey Simpson and I go back a long way in FPA and Brook. I would like to congratulate both of them: Audrey on her persistence in tackling the thorny issue of the precise legal status of abortion in Northern Ireland, and Simon for his imaginative and confident leadership of Brook and piloting change in choppy waters.

I would also like to say thanks to Ann: she and I had unforgettable years working together in the Birth Control Trust fighting the forces of darkness.

It is good to see here tonight a few familiar faces: Alison Hadley, Harriet Gill, Mary Crawford, Jackie Boath and Jane Hughes. These are the people who have made Brook work so well at the grassroots.

This year Brook is 50. Next year is the FPA’s 85th birthday and in four years time Bpas will be 50. So, as everyone is getting older, just as I am, Simon granted me a special dispensation to say a few words. I thought it would be appropriate to make some observations about how times have changed.

In sexual health terms the 1950s, when I was growing up, were the Dark Ages. Contraception was not part of NHS provision – it was patchily available for married women through FPA and some local authority clinics; abortion was illegal (Mike Leigh’s film Vera Drake is an excellent illustration of the situation); male same-sex relationships were illegal; divorce was difficult and expensive; there were two choices for single young women who got pregnant: a shotgun marriage or giving up your baby for adoption. Many resorted to backstreet abortion. Some gay men committed suicide. Looking back sex, other than in heterosexual marriage, was closely connected with guilt, fear and shame.

Set against that background, my experience in 1961 just before I got married of visiting the FPA clinic in Walworth, South London, later a Brook clinic, is unsurprising. Alas, I did not sport a sparkling engagement ring on the third finger of my left hand, and the volunteer receptionist was suspicious, to say the least, thinking I was up to no good. So, she grilled me not only on my personal details, but those of my intended, and of the date, time and place of our nuptials and our future address. Reluctantly I was allowed in and joined other women sitting minus knickers, suspender belts and stockings. I finally got my diaphragm and cream, after a couple of brisk questions from the doctor about enjoying sex and when I was going to have a family. I subsequently learned that care had been taken to check whether I actually did get married.

(l-r) Jenny Eclair, Dilys Cossey, and Ann Furedi

But things were beginning to change. The sexual Zeitgeist is captured in the opening lines of Philip Larkin’s poem, “Annus Mirabilis”:

Sexual intercourse began

In nineteen sixty-three

(which was rather late for me) –

Between the end of the Chatterley ban

And the Beatles’ first LP.

 The 1960s were a period of substantial social and sexual reform – mainly in the 1966-70 Labour government under Harold Wilson - and set the legal framework still broadly in place today for abortion and same-sex relationships. I was witness to Brook’s birth at the FPA 1964 AGM, and over the years it has grown into a sturdy adult. In the 1970s contraception became available free-of-charge on the NHS – and by some miracle remains so. But the sands constantly shift: in the 1980s HIV AIDS was a huge challenge, as were Mrs Gillick’s legal action against the Department of Health and the anti-abortion lobby’s bitter opposition to legalisation of embryo research. Section 28 was a long, long struggle. Financial cuts and structural changes in the NHS continue to threaten provision. And the issue of sex and personal relationships in education remains unresolved.

Although society and its attitudes have changed profoundly in the last half-century – I think this is an instance where the phrase ‘Things ain’t what they used to be’ is positive, not negative – there will, in my view, never be a time when one can relax. That is why Brook, FPA, Bpas and Education for Choice are so important because they are the main guardians of the legacy. I like the message in the ‘XES: We Can’t Go Backwards’ campaign and Brook’s 2019 aim on sex, sexual equality and sexual health.

At the same time there is, in my opinion, a duty to push boundaries for what we believe in. My personal view is that we should be talking about broadening the terms of reference of discussion on sexuality to include the concept of sexual rights as well as sexual health, and on the abortion front about the decriminalisation of abortion - I think that this is something Wendy Savage will be talking about at the Abortion Rights AGM at the end of March.

Many battles are won, but the war continues. And, looking around, I am encouraged to see so many young people and from such a range of different interests. I am confident that together you are a formidable group. Thank you again for my award. Good luck – may the force go with you!

Speech by Dr David Paintin, recipient of a Lifetime Achievement Award

I am very honoured that Brook and the FPA have chosen me to receive a Lifetime Achievement Award. There have been great advances in sexual and sexual rights during my lifetime. In 1930, the year I was born, women were expected to become wives whose role was to support their husband, become his sexual partner and the mother of his children — he earned the family income and she was his housekeeper. Marriage was costly for women— in 1930, 356 died from the complications of unsafe induced abortion and a further 2,126 died in childbirth. When I qualified as a doctor in 1954, pregnancy was much safer but the status of women had hardly changed. Their sexual behaviour was regulated by the stigmatisation of unmarried mothers and their children; safe abortion was available only at considerable cost from a “Harley Street” gynaecologist. Few family doctors would advise on contraception and family planning clinics were strictly for women who were married or were about to be married. Embarrassed men obtained condoms from barbers, chemists’ shops or by mail order for delivery in plain brown parcels. Even when used carefully, the barrier methods were relatively ineffective — failure rates are estimated to have been from 5 to 15% per year.

There have been great advances since then. Oral contraception and IUCDs became available in the 1960s — making love could now be enjoyed without risking an unplanned pregnancy. This tuned in with an increasing awareness that women should have equality at work, and the right to run their own social and sexual lives. There was growing acceptance of premarital sex and long-term relationships that resulted in children. But unwanted pregnancy remained a problem — the sexual response is instinctive, powerful and difficult to control — it is challenging to be “responsible”, especially when young and inexperienced. This is still true in 2014. But help is at hand —contraceptive methods have improved dramatically — hormone -releasing IUCDs and subcutaneous implants that are acceptable to most women, last for several years and are almost 100% effective.

Up to the early 1970s, women were still dying from unsafe abortion — about 29 each year from 1960 to 1964. David Steel’s Abortion Act of 1967 put the back-street abortionists out of business. Now, women with unwanted pregnancies had only to convince two abortion providing doctors that having a child at this time would threaten her or her children’s physical or mental health and could take her actual or foreseeable circumstances into account. The annual numbers of legal abortions increased dramatically. Deaths from unsafe abortion fell, ceasing altogether in 1975 —the need for unsafe abortion had gone. The NHS could not meet the demand for terminations and some private gynaecologists charged disproportionately large fees. This was remedied by members of the Abortion Law Reform Association when, in 1968, they founded the not-for-profit organisations, Bpas in Birmingham and PAS in London. From 1981, now joined by Marie Stopes International, these charities were allowed by the Department of Health to provide free abortion through contracts with the NHS. Abortion services improved nationwide — in 2012, the NHS provided 97% of all the abortions for women living in England & Wales, 35% by NHS staff and 62% through contracts with Bpas and MSI (PAS had merged with Bpas in 1998).

The beautiful venue, 8 Northumberland

Community family planning services expanded rapidly. The need of young people to have a service of their own was recognised by Helen Brook —she opened her first centre in 1964. In 1973, Parliament voted for contraception to be provided by the NHS, free of charge and irrespective of marital status or gender. Offering help with contraception has become a routine part of post-abortion and post-natal care. The Margaret Pyke Centre, founded in 1969 by Lady Medawar, has pioneered specialist training for health professionals. Contraception and legal abortion are now part of the basic education of doctors and nurses.

A network of dedicated people initiated and developed these improvements in reproductive health. The Abortion Law Reform Association —ALRA— founded in 1936, was at the centre and Professor Dugald Baird, Regius Professor of Obstetrics and Gynaecology in Aberdeen, the most medically influential of the pre-war members. My conviction that abortion should be legal and accessible was the result of joining his unit as a trainee gynaecologist in 1956. At that time induced abortion in Scotland was controlled by common law; Dugald Baird had been advised that, acting in good faith to preserve the health of the woman, he was able to provide abortion for social reasons. He convinced me that unwanted pregnancies should be terminated safely by a doctor. He understood that many women had very limited control over the sexual demands of their partners, found diaphragms and condoms difficult to use and that unwanted pregnancies were inevitable. For him, health was as declared by the WHO in 1948, “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”— a woman’s health was clearly in danger if her present social circumstances made her pregnancy unwanted. It was after spending an afternoon with Dugald Baird in the autumn of 1966 that David Steel finally decided the wording of the crucial clause in his Abortion Bill.    

                                                           

I joined ALRA in 1963 when I moved to London as a lecturer in obstetrics and gynaecology at St Mary’s Hospital Medical School. ALRA had just been reinvigorated by Diane Munday, Madeleine Simms, Vera Houghton and Dilys Cossey. It was Vera Houghton, the chair, who recruited me in 1965 as one of the medical advisors during the parliamentary debates that resulted in the Abortion Act of 1967 — my support for abortion provision and fertility control continued from then until now. I was free to speak and support legal abortion in writing, in public meetings and interviews on radio and television, because I had no private practice — my clinical work was entirely within the NHS. Over the years, I have been a member of many committees and advisory groups. These include the Birth Control Trust, PAS, Bpas, Brook Advisory Centres, the Department of Health and the Royal College of Obstetricians and Gynaecologists. With the support of Richard Beard and Connie Smith, I provided an NHS abortion service for Paddington and North Kensington — ably continued by Kate Patterson after my retirement — a Paintin Unit for early medical abortion was opened at St Mary’s in 2005. I made legal abortion part of the teaching of medical students at St Mary’s, and was a regular speaker on the Margaret Pyke family planning courses and at medical meetings all over the country.                 

                                                                                       

Ann Furedi, Bpas

As soon as abortion became legal, the ALRA team realised it was necessary to defend the Act from restrictive amendments, and to make contraception more accessible. The Birth Control Campaign, led by Alastair Service and Dilys Cossey, successfully lobbied Parliament in 1973 to make free contraception available through the NHS to all persons irrespective of gender or marital status. The Birth Control Trust was formed in 1972 by Vera Houghton, Alastair Service and Madeleine Simms — I was a committee member and a trustee. Caroline Woodroffe was the first chair and was followed by Vera Houghton when Caroline replaced Lady Brook as chief executive of Brook Advisory Centres. I took over from Vera in 1981 and remained in post until 1998, but the achievements of BCT were due to initiative and energy of Dilys Cossey, with a major contribution from Ann Furedi in the 1990s. Our objects were to help women to find abortion services and to inform politicians and journalists whenever fertility control was in the news. We organised meetings for health professionals, journalists and for parliamentarians in committee rooms at Westminster, and published a series of booklets. The BCT draft contract for abortion services in the early 1990s became the outline for contracts between the not-for-profit organisations and the NHS, and was the forerunner of the RCOG Guideline: The Care of Women Requesting Induced Abortion. We supported the introduction of many services, such as clip sterilisation, emergency contraception and medical abortion. The Co-ordinating Committee in Defence of the 1967 Abortion Act (CO-ORD) was an ALRA/BCC/BCT initiative and brought together the many pro-choice pressure groups during the procession of restrictive private member’s bills in the 1970s and 80s. Doctors for Women’s Choice (DWCA) was begun by Judy Bury who saw the need for a group of doctors willing to support legal abortion, and to take part in radio phone-ins and television discussions. Wendy Savage has kept the membership together for many years and, through her vigorous and sustained initiatives, has made DWCA an influential public voice.

Many others have had important roles, particularly, Lord Houghton (Douglas Houghton), Malcolm Potts, Peter Diggory, Wendy Savage, John Guillebaud, Ian Jones, and the professors trained or inspired by Dugald Baird — Sir Alec Turnbull, Sir Malcolm MacNaughton, David Baird and Alan Templeton. I was only one of the many behind the improvements in reproductive health and sexual rights.

David Paintin, 8 March 2014

What’s in a name?

About 10 years ago, I went on a sex education study tour to the United States. At that time, the debate about Sex and Relationships Education (SRE) was far more polarised in the States than back at home and I spent time with both the pro and anti SRE lobbies. One of the most striking things I noticed was how important, and fascinating, the language both sides used was in framing the debate. Those who supported SRE had created a new name for it – ‘comprehensive sexuality education’ - this was to counteract the opposition who had started to claim that abstinence education was a form of sex education.

Ever since that study tour I have been a bit more of a pedant about the language we use when talking about sexual and reproductive rights. So over the last few weeks, I have considered carefully the way we talk about our views of abortion. Following Mr Hunt’s statement about reducing the time limit to 12 weeks (and Mr Cameron’s swift reassurance that that government had no intention of changing it) there has been some truly exceptional journalism. It has been full of empathy and trust for women and their circumstances and for the health professionals who help women through their decision making processes and beyond.

But I have looked carefully at everyone’s language and I have decided it’s time to make some changes.

For a start, I am pro-life, in the true meaning of the word. I like life, I like living and I want my fellow citizens to enjoy life and enjoy living.  Life is a wonderful thing and I am therefore completely pro-life.

I am also pro-choice, and I am pro-abortion.  Pro-choice speaks for itself but, just to be absolutely clear, I believe that women should have the autonomy to make their choices within the framework of the law, and I think the law should reflect medical opinion and the evidence on both the time limit - which is 24 weeks in the UK - and on patient experience and safety. This means I think the UK could improve women’s access to abortion through, for example, home use of early medical abortion.  My pro-choice beliefs extend to respecting people’s right to not want an abortion and to disagree with it.

I am pro-abortion. This does not mean I believe that I want everyone to have one (though I am often accused of that view). It means that because I believe in choice, I should support abortion in those circumstances it is chosen. Some people shy away from calling themselves pro-abortion.  I am not of their number.

So if I am embracing the terms ‘pro-life’, ‘pro-choice’ and ‘pro-abortion’, what language should we use to describe people who believe that abortion is wrong for them AND for everybody else and that it has no place in a civil society?  How do we describe those people who believe it is right to provide false information about abortion and pregnancy to children and to harass women outside services? It’s not enough to say ‘anti-abortion’ because there is much more to their beliefs and behaviours than that. I haven’t found a short and snappy term yet, but I have an accurate one. They are “people who are ideologically opposed to safe and legal abortion in all or all but the most extreme circumstances (extreme circumstances dictated by their view, not the woman’s)”.  I’m not sure it’ll catch on.

I also think it would be helpful to remove the terms ‘early’ and ‘late’ from the language when it comes to abortion. We can simply say medical abortion, surgical abortion, first trimester, up to 13 weeks, between 20 and 24 weeks.  None of it makes our sentences shorter, but the terms ‘early’ and ‘late’, are a little like ‘innocent’ and ‘guilty’ in that they carry a sense of judgment. There is no room to be judgmental when it comes to a woman’s right to choose.

Of course, none of these musings on language will change anybody’s position on abortion, but using the right language at least means that discussion can be had from a position of understanding, and from a position of accuracy.  Pro-life does not accurately describe people who are opposed to legal abortion.  It positions the pro-choice majority in a particular place. Pro-choice is accurate for many people, and none of us who support choice should be afraid to say that we are pro legal abortion.

Ultimately, the other thing missing from the debate is that if all of us can agree that preventing abortions when possible is a laudable aim then good quality sex and relationships education as defined by the Sex Education Forum and access to contraceptive services that provide choice are absolutely vital. But the language of those issues is for another time.

This blog is also included on the 40 Days of Choice blog
You can follow 40 Days of Choice on Twitter @40DaysofChoice

It’s time we learned to trust

Last month I was at the lively, energetic Bloomsbury Pro-Choice Alliance counter protest to the 40 Days of Life vigil that was held outside the BPAS service in Bedford Square. It was fantastic to see hundreds of men and women out to defend and protect women’s reproductive rights. The pro-choice movement should be proud of the numbers and the positivity of those came out to show their support.

But the Bloomsbury event and the ongoing noise about sexual rights including gay equality makes me angry: Angry that women’s right to choose is under such attack yet again and angry at the lack of trust in young people, women and health and education professionals.

I shouldn’t really be surprised. This lack of trust in young people and their developing sexuality is perennial. The persistent attacks on abortion provision have always demonstrated a lack of faith in women’s ability to make their own reproductive choices. And public trust in professionals is constantly undermined by insidious reporting on the sexual health and education of children and young people.

This lack of trust results in a vocal, spiteful and noisy minority in despair about the immorality of youth. They lay the blame squarely at the feet of organisations like Brook, on sex and relationships education, the availability of contraception, the internet and what is now increasingly referred to as the “sexualisation” of young people. Their moral outrage drives their desire for a return to the illusionary halcyon days when young people waited until marriage for sex; when women didn’t have abortions because they weren’t legal; when a child of 7 didn’t need to know what a penis or vagina was because the wicked internet didn’t exist and neither of course did sexual abuse. They long for the days when pregnant women went into hiding and had their children taken away, whilst gay men and women had the decorum not to flaunt their love in public.

Whilst this small, ill-informed and vocal minority increasingly find their voice, it is critical we remember there is a broad consensus in support of fair and equal rights, good quality sex and relationships education and access to services, including abortion services. And despite this consensus there is still a risk that the trust in young people and the professionals who work with them will continue to be undermined. At Brook week in, week out we see thousands of young people who are making moral and responsible decisions about sex and relationships. Yes, they need a guiding hand, an empathic and well trained professional who can ensure they understand their rights, have the information they need, and the confidence, skills and abilities to make choices that are right for them.

Of course there are also some who are frightened or confused, who don’t know how their bodies work, or feel uncomfortable in their skins. We also see those who are exploited, hurt, those settling for sex or relationships that aren’t good enough. These young people need more from us and need help and support at home, at school and from other services.

Young people know they are not trusted by many and their trust in us can also be frail. We know that for young people to continue accessing services, they must trust they will not be judged, that they will be cared for, supported and respected and they will be treated in confidence. They also expect us to protect them from harm and take all necessary steps to do so - a responsibility I know professionals take very seriously

The trust young people have in Brook, and other agencies including the NHS must be protected and maintained at all costs, and that is why I am so angry at people who undermine it whether by myth making about sex and relationships education or by harassing people entering sexual health services – something we know young people can find intimidating or frightening.

It is not acceptable under any circumstances to stand outside an abortion clinic or a young people’s sexual health service, and harass people as they enter. I was recently told of a confident and assured young woman who had to cover her face with a coat, and have support from by a member of staff to get through the door because she was being prayed for loudly and –worse still – photographed. That is simply wrong.

My concern that we are seeing a subtle change with the vocal minority becoming more vociferous was reiterated at a parliamentary briefing yesterday morning. If, at the same time as we are seeing an increase in anti-abortion protests, sex and relationships education in schools becomes politicised and undermined; if GPs are not supported to provide what young people want in sexual healthcare, and specialist services for young people reduce because of funding cuts we will have some serious work to do to protect young people’s sexual health.

All of us want to stop that happening because we want young people and women to be safe. Our critical starting point then is one of trust – we must trust women to make their choices, trust parents, teachers and health professionals to do their jobs, and trust young people to be responsible about sex, sexuality and relationships.

24-week limit intact

I waited for the vote on abortion time limits last night with what my family fondly describes as my 'Blake face'. That's the face I pull when numbers don't make sense or when I just don't get someone's point. I was sitting with a friend who was explaining that she, as a woman who supports choice, knows a 12-week time limit is ridiculous, yet was starting to believe there was science to back a reduction in the time limit.

My friend is a clever, discerning woman who supports women's right to choose and yet she had begun to believe the stories and she is far from being the only one.  Reporting about abortion and the time limit in recent months has, it seems, blurred the line between scientific fact and anti abortionist fiction for some of the general public.

So today at Brook, an agency that has as a core value the right to safe and legal abortion, we celebrate and applaud parliamentarians who chose science over dogma in support of women. We thank colleagues and friends who have worked tirelessly in recent months, and we are thinking seriously about what we need to do to ensure young people know the facts as they are, not as they have often recently been reported.