Philippa Taylor

Latest NICE guidance on contraception could harm young people

Philippa Taylor is Head of Public Policy at CMF. She has an MA in Bioethics from St Mary’s University College and a background in policy work on bioethics and family issues.
The views expressed do not necessarily reflect those of CMF.

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New guidance from NICE recommends that Government provides free morning after pills, condoms (male and female ones) and other contraceptives, all readily accessible to school girls, including those under the age of consent, without parental knowledge. The guidance says that youngsters should be able to stock pile the morning-after pill in advance, keeping it at home in case they need it. All for free (for them, but at taxpayer expense). NICE proposes that pills should be immediately accessible from schools, pharmacies, clinics, colleges, youth clubs etc.

Before I comment on the proposals themselves, it is worth noting that those who designed the new guidance are closely linked to the major family planning organisations and abortion ‘charities’, FPA and Brook. Bias and vested interests cannot be ruled out.

In summary, this new guidance is not evidence-based, and it will be harmful.

Let’s briefly look at the evidence first.

The NICE spokesman says: ‘Evidence clearly shows that the availability of contraception reduces the rate of unwanted pregnancies.’  Actually, the evidence is far more mixed and some evidence ‘clearly shows’ that it has the opposite effect!

Research has found that UK Government schemes to give teenagers the morning-after pill for free at pharmacies has simply encouraged young people to have unprotected sex and failed to cut the number of teenage pregnancies. Professors Girma and Paton of Nottingham University compared areas of England where the scheme was introduced with those where it was not, or where is was implemented later. They found that pregnancy rates for girls ages under 16 remained the same.  His work has been published in the peer-reviewed Journal of Health Economics so cannot be easily dismissed.

In the US, a systematic review of twenty-three studies, published between 1998 and 2006, was analyzed by a team at Princeton University, measuring the effect of increased emergency contraception access on emergency contraceptive use, unintended pregnancy, and abortion. Not a single study among the 23 found a reduction in unintended pregnancies or abortions following increased access to emergency contraception

It could be argued that emergency contraception still is needed, to keep unintended pregnancies down, and while evidence is inconclusive, it can surely do no harm.

Or can it?  In fact, this policy is likely to cause more long-term harm than help. The immediate accessibility of free contraceptives leads to increased rates of sexually transmitted diseasesDavid Paton found that where there was an emergency birth control scheme operating, sexually transmitted disease rates for under 16s increased by 12%. Young people aged 16-24 are the most affected group, accounting for 50-65% of all newly-diagnosed STIs in the UK in 2007.

Why is this?

Risk compensation’ is a phenomenon where applying a prevention measure results in an increase in the very thing it is trying to prevent. In this case, some teenagers will take risks they would not otherwise take, because contraception and abortion are promoted as risk reduction measures. So if a girl is on the pill, or knows she has a stack of emergency contraceptive pills at home, then her sexual behavior will seem to her to be less risky or costly and so she will continue with it or even increase it, in the false belief that she will not suffer harm.  This growing reliance of teenagers on the pill means they are not protected against sexually transmitted infections such as chlamydia, which can cause infertility.

So, if Government endorses the NICE guidelines, what message is will it be sending? It will simply increase pressure on young girls to have sex while increasing the risk of infection.  This is not just a failure to do any good, it is to do harm.

The NICE guidelines want to ensure any child under 16 can also stock pile these pills at home (hidden from parents of course). Yet sex under 16 is not only illegal, it can also be profoundly damaging – physically, emotionally and spiritually. To facilitate such behaviour behind parents’ backs is unprofessional, irresponsible and morally wrong. It utterly undermines parental responsibility for their own children and exposes their children to risk.

There is evidence from research that teenagers often regret the age when they started having intercourse, and that over 40% of teenagers in the UK give peer pressure as the reason for first intercourse.[1] Who will be taking a detailed history from these girls to ensure that they are not being exploited, coerced or abused? Under these guidelines, no-one.

The only way that we will see long-term change is by promoting real behaviour change, as suggested by Dr Peter Saunders here. That will mean keeping parents involved. But actually it puts responsibility on us all. Young people live in a highly sexualised culture, putting them under enormous pressure to conform. Sexual imagery plays a very strong part in our culture today and sexual images are used in nearly all areas of advertising and the media, in fashion and dress, in order to generate interest and make money.

All too often teenagers are the ones who are blamed as being solely responsible for embarking on sexual relationships and for becoming pregnant. This happens regardless of the fact that it is adults who have exposed children of all ages to a society which is obsessed by sex, thus putting them under enormous pressure to conform. While these guidelines present an immediate danger, actually all of us must take greater responsibility for the underlying problem and the pressure society puts youngsters under.

[1] Dickson N et al. First sexual intercourse: age, coercion, and later regrets reported by birth cohort. BMJ 1998; 316:29-33

Posted by Philippa Taylor
CMF Head of Public Policy

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