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
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What did I learn at the Party Conferences?

So political party conferences are over for another year and as I sit writing this blog I do indeed have the annual post conference cold.

I went to Labour and Conservatives conferences. Both were fun, some interesting meetings, and good to catch up with colleagues and friends, but they were also disappointing in that young people’s health, let alone sexual health was simply not on the agenda.  The only session I attended when I didn’t have to shoe horn a question in was at the Local Government Association and Coop fringe meeting discussing the opportunities provided by the transfer of Public Health responsibilities to Local Government. 

The excellent Hackney councillor Jonathan Mcshane identified there are many potential benefits to public health moving across to the Local Authority, and also confirmed Brook’s fears that sexual health has the potential to be politicised in Local Government, and that work we understand to be mainstream and innovative work could be seen to be too risky for the electorate.  Jonathan gave an example of a Local Authority condom distribution scheme being ‘moved to health’ at the last meeting to avoid criticism and attack.  I know too many examples of Sex and Relationships Education guidance getting stuck at committee stage, and of Council Leaders taking far too active an interest in curriculum materials.  From April 2013 is going to be a different game with a whole lot of educating, influencing and helping those with these new responsibilities – elected members and officers - to understand the issue, and ensure that young people’s sexual health does not become a political football.

The small issue of clinical governance within Local Authorities remains unsolved, and there isn’t much time before handover day.  I await a response from the Medicines and Healthcare Regulatory Agency about which bodies will be able to authorise the use of Patient Group Directions which enable nurses to provide contraception and treatment for sexually transmitted infections. I am now writing to the CEO of LGA, Secretary of State for Health, and Secretary of State for Communities and Local Government to reiterate the importance of urgent action.  It would be embarrassing for all concerned if sexual health and other services ground to a halt on April 1^st because nurses aren’t able to operate within the law.  It would also be a disaster for the public’s health.

My highlight of the Labour Party Conference was Yvette Cooper unequivocally stating that under Labour PSHE including sex and relationships education would be made statutory.  Yes Labour should have made PSHE statutory during their 13 years in government but they didn’t and as Justin Hancock of Bish Training said ‘we are where we are, even if we don’t like it’.  Given how important sex and relationships education is for protecting and safeguarding children from sexual exploitation and harm, as well as reducing teenage pregnancy and preventing sexually transmitted infections this commitment is welcome.

At the Conservative Party Conference I attended a Health Hotel fringe meeting about delivering world-class health services, and from a young people’s organisation perspective it was terrifying simply by the omission of any reference to young people.  I know Mr Hunt is in the early days as Secretary of State for Health and I also know that professions and charities protect their own interests and are fighting for voice in these forums.  However I really struggle to understand how we can talk about developing a world class health systems and only focus on older people and long term conditions like diabetes to the exclusion of all other groups and issues, including that rather critical group that we don’t currently serve as well as we should - children and young people. I look forward to finding out more about the future of the children and young people health outcomes strategy over the coming weeks. 

The market alone cannot and should not drive world-class health services.  Professions and charities are going to have to change the way they work together to make best use of limited resources, and to understand how to do so in the best interests of patients.  At that particular meeting Clare Gerada got my vote as ‘hero of the match’ for a couple of reasons.  Having been absolutely vocal in her opposition to the Health and Social Care Bill she started her speech by saying lets not go over old ground - the Bill is now an Act, we have to make it work, and we will make it work.  Once that was out the way Clare was obviously feeling mischievous: first she reminded men that if you can’t see your penis you probably need to eat less and do some more exercise to avoid diabetes, then she threw in a curve ball when absolutely out of nowhere she asked the pharmacist on the panel what they thought about delivering services to improve health in the same place that cigarettes are sold. It’s a very good question, but unfortunately didn’t get an answer.

Clare continued to be provocative at a Patient Voice dinner hosted by Bayer Schering and chaired by Nick Golding from Health Service Journal that evening.  She rightly challenged the charities to consider the impact of single issue campaigning and advocacy on the effective delivery of health care.  Whilst I didn’t agree with all Clare was saying and I will be seeking to teach her about charity accounts and where they are published for public scrutiny, there is doubtlessly an issue about single issue lobbying, particularly now resources are tight about what the NHS can, should and will be paying for.  And those decisions cannot be based on ‘s/he who shouts loudest’.

Conservative conference was also of course where Lord Carey and Anne Widdecombe set out vile hypothesis that if we change the law so all people, gay or straight, have the rights to marry  – then we will be heading for a totalitarian state similar to Nazi Germany. The equally vile Coalition for Marriage had a stand at the conference. Against my better judgement I visited to find out a bit more about it, to understand the arguments a bit more and if anyone wants to know how homophobic bullying still exists in schools, you just need to stand by that stall for a while and hear some of the comments that were made about gay people by some of the conference delegates. A few of the pleasantries I overheard were “(they) don’t stay in relationships anyway”, “not safe with our children”, “(they) are everywhere now, on TV, in top jobs and they think they can shove it in people’s faces, marriage is just too far”.

So in the spirit of understanding I went over and asked exactly what their objections are.  There is a whole leaflet about it on their website, but some ‘facts’ stick out; 1. gay people have equal rights provided for by civil partnerships. 2. If you make it legal for two consenting men or women to marry each other it is a slippery slope - the implication being that there will be 'orgies' of people all wanting to marry each other, or people turning up wanting to marry their dog. 3. if you legalise equal marriage it will mean children will have to learn about it in school

Best of all is their proposition that it is a myth that gay people want equal marriage.  Only 39% of gay people say they would get married so its not worth it.  If I was being pedantic I think the same argument would apply to heterosexual marriage and I certainly wouldn’t be arguing against anything on the basis that not everyone wants to do it therefore it shouldn’t happen.

So after supper with Julie Bentley and Clare Laxton to celebrate the excellent work that Clare has done for both Brook and FPA and to wish her well in her new role at Arthritis Research UK, I finished party conference season 2012 very worried where children and young people’s health fits into the thinking of both government and the opposition, and worried that school based Personal, Social and Health Education is dropping off the agenda completely.

So it is timely and important that Brook and FPA have launched XES: we can’t go backwards. This three year campaign is currently focusing on access to contraception, and will turn to other issues over the coming years. Find out more at www.wecantgobackwards.org.uk or follow the campaign on twitter @xescampaign   

Great article from Prymface on being a teenage parent

Great article on the Telegraph website today from Prymface on the realities of being a teenage parent.

You can read the article here: http://www.telegraph.co.uk/women/mother-tongue/9582147/Teenage-mums-the-real-story.html