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Summary
1. Context
The last decade has seen increasing efforts by central and local government to target sexual health services and initiatives at young people in order to improve their sexual health. In order that the Sexual Health Strategy for Scotland and associated initiatives are effectively implemented, more information is needed about children and young people's own views, concerns and experiences regarding their sexual health and well-being.
To this end, a research study was funded from ChildLine Scotland ( CLS), working collaboratively with academics at the Centre for Research on Families and Relationships ( CRFR). Calls to CLS about sexual health and well-being issues have increased steadily over the years; represent one of the top three concerns expressed by children and young people; and, including sexual abuse, are the primary reason for calling in approximately 26% of all calls. These calls, which are anonymised in the database, reflect children's own agendas, supporting an approach which treats children and young people as competent reporters on their own lives.
2. Research Methods and Aims
This study was conducted between February 2005 and January 2006. It examined, qualitatively and quantitatively, two years (2003 and 2004) of the CLS database and conducted a detailed, thematic, content analysis of a sample of the more extensive archived records, written by counsellors at the time of the call. 14,244 records were extracted that featured, as the main problem, one of the five sexual health issues: facts of life, sexual abuse, pregnancy, relationships, and sexuality. Quantitative analysis was, however, conducted on the cases (10,716 in total); these featured individual young people who were identified by a unique case reference number. The vast majority of records examined in the study are those of children in Scotland: 95% of all calls to ChildLine Scotland in the 2003-2004 time period came from children and young people living in Scotland. Three quarters of callers were female; ages ranged from 5-18 years; the mean age of callers was 13.5 (13.9 for boys, 13.4 for girls). Analyses focussed on the nature, range and content of expressed concerns; gender and age differences; and callers' strategies and sources of support. A pro-active dissemination strategy is an integral part of the research aims, given the practical implications of the findings in terms of sexual health and wellbeing services for children and young people.
Main findings
3.1 In the facts of life records many calls involved seeking explanation or advice about puberty and development. Some children and young people indicated that it was difficult to talk to friends or parents, that they had a poor relationship with parents, or that they didn't have anyone to talk to. The key themes were: explanation, is this 'normal', peer comparison, and peer exclusion/inclusion. A substantial number of calls were from girls asking about starting, preparing for and dealing with their period. Calls asking for explanations came mostly from 8 to 13 years. From as young as 8 years, and through to age 16, callers described being teased by friends and/or peers either for not being developed or for being too developed.
Many calls were about body image and appearance; these were heavily dominated by female callers, with few males expressing these concerns. The main concerns presented within this theme were: weight concerns, size of breasts, penis size, stretch marks and cellulite, spots, body hair, and generally feeling unattractive or ugly. Apart from weight, concerns about body image and appearance were not expressed by any callers under the age of 9 years. At every age children and young people used the ChildLine service to obtain definitions of terms of a sexual nature. Peer communication was the most common way that callers indicated having heard a number of terms. However, terminology heard from partners was also asked about, predominantly by females, and in the context of a request to perform a sexual act or participate in a sexual act of some kind.
3.2 Children and young people communicated about their sexual abuse experiences in very different ways. The majority presented their concerns directly, while others were hesitant, taking time to build up to disclosure, sometimes only hinting at sexual abuse. Many described the abuse in detail, using explicit language, but amongst the youngest callers the language was often innocent and euphemistic. A substantial issue was the perpetration of additional violence and physical abuse, often to ensure compliance and punish resistance. There were four different styles of communicating sexual abuse concerns: direct, indirect, explicit and implied. As the age of callers increased, so did the tendency toward an indirect style of communication. These data are particularly important as we know relatively little about how children communicate about these experiences at the time when they are happening to them.
Many strategies by abusers were described by callers as forcing or ensuring compliance: 'grooming', 'normalising', blackmail and manipulation, and threatening violence. Some callers consistently tried to explain or justify the abusor's behaviour, detailing, as in our previous study, factors such as divorce, separation, bereavement, alcohol and drugs misuse. Callers also detailed impacts on themselves, most commonly emotional such as: fear and worry, feeling annoyed, used, cheap, dirty, degraded, shocked, surprised, terrible, bad, ashamed, disturbed, embarrassed, trapped, worthless, and numb.
All of these calls to CLS can be viewed as the child or young person trying to problem solve or cope with their experience. Feelings of shame and embarrassment might also have been lessened by communicating about abuse over the phone, where face-to-face communication might be more threatening. Many callers, usually females, said they had disclosed the sexual abuse to someone, usually their mother. Sometimes support and action was taken to address the abuse, but one third of the callers who had disclosed abuse said they had not been believed. Although almost all callers wanted the abuse to stop, complex reasons for non-disclosure included: feeling responsible for the abuse; caring for the abuser; fearing break-up of their family or parents' relationship; upsetting others; causing trouble; not being believed.
3.3 In a substantial proportion of calls regarding pregnancy, young people stated that they knew themselves, or a female partner, to be pregnant. Approximately a third of those whose pregnancy was confirmed indicated that they had been seen by a health professional. However, large numbers of callers said they had done a test (presumably a home pregnancy test) which was positive. Very large numbers of young women and a proportionately large number of young men stated that they thought that they or their girlfriend was pregnant, or that they were worried about the possibility of pregnancy, but a test had not been done, often because of fear or lack of knowledge.
In addition to detailing physical changes and symptoms, the major reason given by a large proportion of callers for thinking that they were pregnant was having had unprotected sex. In the minority of cases where the context of sex was described, this was most commonly at a party and/or when they had been drinking. However, most callers indicated they had had sex with their partner, suggesting this had been an ongoing facet of this relationship. Fear and worry were regularly described, as were confusion, conflicting feelings about the pregnancy and the need to know more about options (identified by most) of abortion, adoption or keeping the baby.
Most young people indicated having told someone that they were, or were concerned about being, pregnant. Disclosure was, however, strongly tied to relationships with peers, partners, parents, and other relatives and fear about reactions. The ratio of callers who had not yet told their parents they were or might be pregnant, to those who had, was approximately 3:1, suggesting that disclosing pregnancy to parents was, for many, a greater concern than the pregnancy itself and was often related to other problems in the family. The CLS calls are, unsurprisingly, skewed towards a greater number of young people reporting problems about support from parents. However, many were receiving such support and from a variety of other relatives. Nevertheless, a major source of support, both emotional and practical, for young women concerned about pregnancy came from their friends; very few male callers, though, described support from their peers.
3.4 Partner relationships appeared to have great significance for many children and young people; many callers, both female and male, described wanting to have a boyfriend or girlfriend. Many calls were about attraction to a particular person but also about other priorities, such as: fitting in with peers who had partners; addressing feelings of being left out or lonely; and providing opportunities for sexual experiences. The substantial numbers of calls about attraction were from all age groups and mostly involved talking through strong feelings, though both sexes asked advice about how to act on these. Ending relationships, dealing with hurt and loss, abuse and cheating partners were major topics of concern for males as well as females.
3.5 A large proportion of the sexuality calls were from young people who 'thought' they were, or 'might be', gay, indicating feelings of uncertainty and ambivalence about their sexual orientation. There were few calls from young people under the age of 10, and no calls from children aged 5-8 years old. Many young people described themselves as confused about their conflicting feelings, for example between the sexual feelings and attractions they were experiencing and those that they thought were 'right' or 'normal', i.e. heterosexual. Only a very few callers described feeling comfortable with their sexual orientation; notably, none of these were male. Rather, a strong sense of embarrassment and shame was expressed and implied across many narratives in relation to sexuality and a large proportion of young people stated that they didn't want to be gay.
Worries about reactions from peers and parents were central. Indeed, in contrast to the peer support reported in other areas, very few positive peer experiences were reported by either sex. How to tell parents was a further concern with only a few callers reporting supportive parental reactions. As was evident from the facts of life and partner relationships sections, many young people struggled with aspects of the transition through puberty, of which developing sexual feelings was just one. The stigma surrounding sexual orientation, therefore, appeared to add a considerable burden to these concerns, making adolescence all the more difficult to negotiate for these young people.
4. Conclusions and Recommendations
- Children and young people across and within the 5 to 18 age spectrum express a wide range of concerns about their sexual health and wellbeing, exhibiting differing levels of knowledge and experience.
- The range of concerns vary enormously from seeking explanation, advice and clarification about normal development, sexual terminology and sexual identity to seeking help, support and counsel on pregnancy, relationships and sexual abuse. Very few calls were about STIs.
- Callers to CLS communicate in a wide variety of ways about sexual issues. Their verbal repertoires are enormously varied and can differ considerably from that which is acceptable to adults.
- Children and young people's concerns about their sexual health and wellbeing are often interwoven with their experiences and relationships with peers and partners, normative values within the peer group and lay communication about sexual issues within peer settings.
- Relationships with peers, whether sexual or non sexual, are extremely significant in the lives of children and young people. Sexual or 'romantic' relationships and emotions whether heterosexual or same-sex, are experienced by young people with a similar level of personal significance to those experienced by adults.
- Children and young people draw extensively on support from peers as a source of help and support during times of sexual crisis.
Policy recommendations
- To meet children and young people's ongoing needs for information, learning and support, needs based sex and relationships education must be provided continuously throughout the years in education.
- To alleviate anxieties about being 'abnormal' and promote children and young people's acceptance of self and others, a discursive sexual health curriculum is essential to challenge young people's conceptions of normality.
- Children and young people must be provided with a clear understanding of their rights, for example to be safe from harm and to express their own needs , in the context of their sexual health and wellbeing.
- Confidential services that enable children and young people to disclose concerns at their own pace and which give consideration to children and young people's expressed needs and wishes, are essential. This is particularly important since a major barrier to disclosing sexual abuse described by many young people is the fear of not being believed.
- Only a very small percentage of calls to CLS about sexual abuse talk about abuse by strangers. Greater social recognition and associated education is needed concerning abuse perpetrated by those children know and love, including by females, to help children recognise what is happening to them and seek help.
- It is vital that services and interventions address sexually aggressive behaviour by other young people, particularly partner abuse perpetrated by young men against young women.
- Young people worried about pregnancy are often primarily concerned about their parents'/ carer's reactions, which may feel risky or unsafe to them. Universal access to confidential services is crucial to allow young people think through such a major life event.
- Specific attention is required to challenge the stigmas that threaten young people's sexual health and wellbeing, such as that surrounding homosexuality.
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