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Chapter 8: Conclusions

8.1 Calls to ChildLine Scotland from children and young people about their sexual health and well-being have steadily increased over the years and now represent one of the top three concerns that children and young people call about. The research reported here therefore offers a vital source of information from a young person's perspective that could substantially assist the implementation of the Sexual Health Strategy.

8.2 Calls to CLS represent unsolicited communications from children and young people, directly reflecting their own agendas. This research therefore reports sexual health and well-being concerns that are pertinent to children and young people, but which, as is evident from the analysis, many feel unable to raise directly or satisfactorily with family members, friends, or within the context of school based sexual health education. Indeed, some of these calls contain information that might be considered ethically problematic had they arisen with teachers or during interaction with researchers.

8.3 In most of the age groups, particularly from approximately 9-16 years, there were notable within-age differences, such that a wide spectrum of knowledge, experience and concerns were expressed and explored by callers of the same age. Moreover, there were many between-age similarities, such that the same concerns could be expressed by callers who were wide apart in age. The absence of calls about STIs from all age groups is particularly noteworthy. This considerable spectrum of concerns and of knowledge and experience provides a continuing challenge for those developing sex and relationships education, perhaps suggesting the importance of a wide-ranging curriculum of sex-education delivered continuously throughout children and young people's years in the education system.

8.4 Greater attention is needed to the similarities and differences in concerns and associated support needs expressed by male and female callers. In some instances, it seems that boys may be feeling particularly lacking in support, such as in sexual orientation and how to deal with a pregnancy; in others, for instance girls suffering sexual abuse from relatives or partners and boys being abused by older females, there appeared to be few places to turn.

8.5 A clear theme cutting across much of the data and across all age groups was the considerable salience of peers and social relationships in terms of children and young people's experiences and understandings of sexual development, relationships and related problems. Their experiences of going through puberty, and becoming sexual beings were in many cases inextricably intertwined with their social worlds and interactions. It seemed that children and young people's understandings of their bodies, sex, puberty, relationships, and so on, were constructed, in many cases, through these interactions. Some things, such as pregnancy, appeared easier to share with friends than concerns about sexuality or lack of knowledge. Peers were a key source of comparison, information, sanctioning, regulation and pressure. However, friends and peers also emerged as very important sources of support and advice, suggesting that these groups of young people may themselves require help for this role.

8.6 To a lesser extent, the research revealed families as also operating in some or all of these above roles. Both in what they communicated and failed to communicate, parents contributed considerably to the construction of experience and understanding amongst some children. In many cases siblings and wider relatives functioned similarly to peers, sometimes serving as a source of support and guidance. However, fear of family reactions, feelings of guilt and shame, or desires to protect 'the family' or family members often inhibited callers from confiding in their families; this was especially notable in calls about sexual abuse and sexuality.

8.7 Cultural discourses around sexuality, sexual health and sexual behaviour also affected what callers were concerned about and how they spoke about these concerns. Across all categories worry about 'being normal' and 'fitting in' was a recurrent theme in many calls; this could have considerable effects on self esteem. It appeared that such worries were often grounded in a categorical view of sex and sexuality, ie a 'you are or you are not' approach, in which heterosexual, monogamous, trusting relationships were priviledged. Fears and problems arose for young people who found or saw themselves as outside some of these apparently relatively inflexible circumstances.

8.8 The findings about sexual abuse represent a unique opportunity to develop greater understandings of what children and young people go through, why they do not disclose the abuse and conflicting feelings they hold about this. Work in this area has, necessarily, tended to rely on the accounts of survivors of sexual abuse rather than children's accounts as it is happening to them, unmediated by interactions with relevant professionals.

8.9 Calls to CLS also appeared to be a place where children and young people could voice the everyday realities of their experiences of growing up and their emerging and developing sexual feelings and attractions. For some, there was nowhere else that these could be articulated, for fear of rejection or bullying. A sense of powerlessness and lack of information/knowledge often accompanied such calls, adding to callers' feelings that they alone faced these problems. In these respects, relationships and lifeskills training could be helpful, particularly in the areas of pregnancy and partner relationships.

Policy implications and recommendations

Sexual health and wellbeing: information, education and learning

• To meet children and young people's ongoing needs for information, learning and support - clearly evidenced in the range of concerns they bring to ChildLine Scotland - a needs based sex and relationships education must be provided continuously throughout the years in education.
• The curriculum must recognise that children are subject to a wide range of social and cultural influences which shape their knowledge, values and behaviour and that they have easy access to a wide range of sexual information which they need to be able to understand, discuss and make sense of in the context of their own lives.
• Learning around sexual health and wellbeing must help children and young people develop healthy attitudes and values towards sexual health - as well as the practical life skills that enable them to put these attitudes into practice. Some of the key practical skills young people need support in developing, as evidenced by their concerns across the board in sexual health, include communication skills, negotiation skills, assertiveness both in peer and partner relationships, using sexual health services, supporting friends in risky situations ( e.g. at parties), negotiating condom use with partners etc.
• Learning and skills development must be underpinned by providing children and young people with a clear understanding of their rights in the context of their sexual health and wellbeing. This is vital in relation both to sexual health and to child protection. Understanding their rights to be safe from harm, their right to express themselves etc. may not only help children identify and disclose abuse but help empower them in relation to their peer and partner relationships.
• Peer relationships, both in terms of peer support and peer pressure/ exclusion, are central in many children and young people's sexual health and wellbeing concerns. Sexual health education must approach children and young people not only as individuals, but in relation to their roles as peers and partners in promoting or threatening the sexual health and wellbeing of themselves and others. In particular it might be of benefit to open up for discussion the ways that peers and partners can put pressure on each other, in order to help young people develop a critical awareness of these influences.
• Children and young people are extremely concerned about 'being normal' and fitting in. They both fear and experience peer exclusion and sanctioning for failing to fit with perceived norms. Learning must recognise the high value young people place on relationships and fitting in, and the considerable pressures upon young people arising from concerns and expectations about what is normal and acceptable in relation to peers and partners.
• In order to alleviate concerns about being abnormal and to promote children and young people's acceptance of self and others, a discursive sexual health curriculum that explores and challenges young people's conceptions of normality, such as the 'normal body', the 'normal' sexuality, what is acceptable within partner relationships - and encourages them to think critically about these concepts.
• In calls about pregnancy, sexuality, facts of life, and sexual abuse it is often indicated that callers' families may be in need of support, skills, and/or education in order to enable them to support their child.

Sexual Abuse

• Children and young people perceive a number of barriers to disclosing abuse including concerns about the consequences of disclosure and their deeply held feelings of responsibility for these consequences. 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.
• Only a very small percentage of the children and young people who call ChildLine about sexual abuse talk about being abused by strangers. The public discourse around evil paedophiles - and continued silence on familial abuse - must inevitably make it more difficult for children to understand and cope with the complex feelings they have surrounding abuse by those they know. There is a burgeoning need for greater social recognition of abuse perpetrated by those children know and love in society today - and education therein - to help children recognise what is happening to them and seek help.
• There is a need for greater recognition of sexual abuse perpetrated by females. This is particularly important since a major barrier to disclosing sexual abuse described by many young people is the fear of not being believed.
• Many young people talk about abuse perpetrated by other young people. It is vital that services and interventions are available to address sexually aggressive behaviour by young people - and particularly to address the issue of partner abuse perpetrated by young men against young women.

STIs

• Children and young people express an extremely wide range of sexual health and wellbeing concerns in their communications with ChildLine. Relative to concerns about relationships, development, pregnancy, abuse and sexuality, concerns about sexually transmitted infections are notably extremely rare.
• The importance of peer, partner and family relationships in children and young people's sexual health and wellbeing concerns suggests that strategies for addressing STIs need to be framed within these relationships. For example, young people's ability to negotiate condom use might be very limited within partner relationships which are unequal - particularly in relationships in which pressure or abuse are exerted. It may not be sufficient therefore simply to educate about the risk of STIs and the importance of condoms.

Pregnancy

• Young people worried about pregnancy are often primarily concerned about their parents'/ carer's reactions. Some young people do not have safe and supportive home environments and feel at risk of serious consequences if parents were to learn of their pregnancy. Universal access to confidential services are crucial to allow young people think through such a major life event.

Sexual Orientation

• Peer support, a vital element in helping young people cope with a range of concerns about sexual health and wellbeing, was notably absent in the lives of young people expressing concerns about their sexual orientation - making this a particularly vulnerable group of young people.
• Specific attention is required to challenge the stigmas that threaten young people's sexual health and wellbeing, such as the stigma surrounding homosexuality. Current measures to tackle other social stigmas such as those surrounding mental health must be reflected in an approach to homosexuality.

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