Social Issues
2.1Schools exist in a social context and there is some contradiction in the care with which programmes of sex education are tailored to the age and stage of young people and their daily exposure to sexual imagery and messages through the popular media. Instead of adequate information and open discussion, young people are often faced with sexual stereotypes which are reinforced by social structures. In combination these can influence the behaviour or override the personal decisions of some young people.
2.2Research suggests that expectations of young women are often contradictory. They are expected to be both submissive and assertive in setting the parameters for sexual contact, while simultaneously relinquishing control. Contraception and pregnancy is often viewed as their responsibility. In contrast young men are often influenced by a ‘macho’ culture of bragging and competition with regard to sexual activity, with little in the way of meaningful discussion, either with friends, partners or family. These stereotypes are often reinforced through the mass media.
Public Health Issues
2.3At the start of the twenty first century, Scotland faces two main issues relating to the sexual behaviour of young people:
"Towards a Healthier Scotland"1 identifies these as priority areas for action, the Scottish Executive is taking forward a number of issues, including a demonstration project "Healthy Respect" this will develop best practice in the promotion of sexual health and the prevention of teenage pregnancies. It will build on the principles of the Scottish Needs Assessment Programmes "Overview of Teenage Pregnancy in Scotland".2 The Scottish Executive is also providing funding to enable the voluntary sectors expertise to be made available to many more schools in Scotland and so promote a more informed and responsible approach to sexual matters on the part of young people.
Teenage Pregnancy
Figure 1:Teenage pregnancy in Scotland, 1989-1998, by age group at conception.
Source:ISD Health Briefing (1999)
2.4The rates of teenage pregnancy in Scotland have remained relatively stable over the last 10 years (see figure 1), with provisional figures for 1998 indicating that 8.4 per 1,000 of 13-15 year olds and 67.6 per 1,000 of 16-19 year olds became pregnant. However, compared with other countries in Western Europe, live birth rates in the UK, which has almost identical rates to Scotland, remain high (see figure 2).
Figure 2:Live births per 1,000 women aged 15-19 in European countries, 1996 (or latest available year)
Source:Kane and Wellings, 1999 Reducing the rate of teenage conceptions: data from Europe
2.5Live birth data for younger teenagers aged 13-15 years is limited. Estimates have been calculated on the basis of young women under the age of 20 rather than 16. Again the UK remains higher than most other Western European countries.
2.6A range of factors has been associated with varying rates including demographic factors such as age at marriage, economic factors, patterns of social expenditure, employment and educational opportunities, provision of housing and other benefits, legislation governing sexual behaviour and religious and social factors.3
2.7In Scotland there are clear links between teenage parenthood and poverty in later life as a result of exclusion from education and subsequent employment.4 What is unclear, however, is whether low educational attainment leads to higher rates of teenage pregnancy or whether teenage pregnancy leads to school drop out. Although it is difficult to determine cause and effect, reducing inequalities in life circumstances, such as housing, poverty, or employment, would help reduce inequalities in unwanted teenage pregnancy.5
2.8Certainly, teenage pregnancy rates in areas of deprivation are higher than elsewhere. The following table illustrates the differences in pregnancy rates between the least deprived and the most deprived 13-19 year olds (1 indicates least deprived, 7 indicates most deprived).
Figure 3:Teenage pregnancy in Scotland by deprivation category, 1987-1996.
Source:ISD Health Briefing (1998)
2.9While not all teenage pregnancies are unintended, it can reasonably be assumed that under the age of 16 years, pregnancy is not planned. This assumption is based on research with teenage mothers6 and also on the percentage of conceptions ending in termination for this age group, which remains high compared with other age groups. In 1998, just over half of all conceptions in the 13-15 year old age group ended in termination. This figure dropped to one in four 16-19 year olds opting for a termination. There are also differences in the outcome of a pregnancy between social classes. Delivery rates increase with levels of deprivation.
2.10While homeless young people and those in public care are susceptible to all kinds of health-related problems, they are particularly vulnerable when it comes to relationships and sex. Indeed, pregnancy in some instances can lead to homelessness. Research7 indicates that the experience of public care is a major factor in teenage conception. High proportions of young women leaving care are pregnant or have a child when they move on, with estimates ranging from one in four to one in seven.8 Further research indicates that within 18-24 months of leaving care, almost half the young women in their sample had a child.9
2.11Clearly socio-economic factors, life circumstances and expectations have a strong influence on outcomes such as teenage pregnancies. This should not be taken to suggest a diminishing of the role of schools in sex education but to clarify that a range of social changes will also be important to provide a supportive context for school sex education.
Sexually Transmitted Infections
2.12Sexually Transmitted Infections have often been used as proxy measures for sexual behaviour and rates of HIV transmission. Moreover, they are in themselves important causes of ill-health. If undetected or left untreated they can have long-term consequences, including infertility, ectopic pregnancy and genital cancers.10
2.13Although the incidence of Sexually Transmitted Infections had been steadily falling since the mid 1980s, by 1996 this trend had been reversed with figures indicating an increase in reported incidence among teenagers, especially young women. In 1997/1998, young women accounted for 23% of all women reporting Sexually Transmitted Infections. The equivalent figure for young men was 6%.
Figure 4:Rates of Sexually Transmitted Infections by gender
Source: ISD Genito-urinary Medicine Statistics Scotland (1998)
2.14Chlamydia is of particular concern given the increased incidence, the implications of long-term effects and the ease of treatment when diagnosed. In Scotland, the number of new infections diagnosed through genito-urinary clinics increased by 13% between 1995/6 and 1996/7. This is likely to be an underestimate for two reasons. First, figures from primary care are difficult to collect; and second, only one in four men has symptoms and the majority of women experience no symptoms. Additionally, levels of awareness about Chlamydia are low, with estimates of three in four 16-24 year olds being unaware of it.11 Opportunistic screening among high-risk groups has been recommended as a way of increasing detection.12
Figure 5:Incidence rates of Chlamydia by gender.
Source:ISD Genito-urinary Medicine Statistics Scotland (1998)
2.15HIV remains a concern in Scotland, with no evidence of a significant reduction in the number of people infected by the virus. Between September 1997 and September 1998 there were 168 new cases of HIV infection, 134 of which are through three major transmission routes: men who have sex with men; heterosexual sex and injecting drug users. Figure 6 outlines HIV infection trends between 1986 and 1998.
Figure 6:HIV infection rates by transmission route, 1986-1998 HIV/AIDS in Scotland.
Source:ISD (1998) Genito-urinary Medicine Statistics Scotland.
(Sibm = sexual intercourse between men; Sibmw = sexual intercourse between men and women; idu = intravenous drug user.)
2.16While young men who have sex with young men are still at high risk, HIV is increasingly transmitted heterosexually, accounting for almost half the new cases in 1998/1999. Cumulative figures for the number of heterosexually acquired HIV infections have increased to over 5 times the total number infected in the whole of the 1980s (89 cases to more than 500 cases). The number of people infected with HIV while abroad has also increased from 1996 to 1998.
2.17The yearly transmission rates among people under the age of 25 years remains low, nonetheless, cumulative figures to the end of September 1999 indicate 883 HIV infections in this age group.
2.18Society generally recognises the importance of providing sex education for young people, though most of the information is targeted at young women, and contraceptive services tend to be located within typically female domains.
The Role of the School
2.19Schools have an important role in sex education. School is the context for the education of almost all pupils between the ages of 5 and 16 and for many beyond these years. This does not mean, however, that such an important responsibility can be left to the school alone. Sex education is a community and family responsibility and should therefore involve the various partners who have different, but complementary roles.
2.20The way young people feel about school in general may be as important as any specific learning and teaching in the classroom. There is some evidence that even where there is conflict between young people and parents, if the former feel good about school then this is associated with a lower likelihood of being involved in high-risk behaviours.13 There is also evidence that the life expectations of young people influence the extent to which they take part in high-risk behaviours, such as drinking or unprotected sex, and there is often an association between these activities.
2.21Schools have a key role in improving the expectations of these young people and it is acknowledged that the concept of healthy living has to extend beyond the classroom. This is reflected in the concept of the ‘Health Promoting School’ which views the whole life of the school as promoting the physical, social and emotional health of pupils and all school users. There is now a general recognition that schools have to be sensitive to the needs of young people in very basic areas of provision and that the condition of school toilets, provision of soap, towels and sanitary bins are indicators of the school’s commitment to this important agenda.
2.22The curricular review of 5-14 referred to earlier acknowledged that education about sexuality and relationships should be viewed as part of the wider curriculum because of the interconnections which exist in the various topics and themes; eg the link between alcohol and drug use and sexual activity.14 In addition there are other areas of the curriculum, which can make an important contribution such as Religious and Moral Education, Personal and Social Education and English.
2.23Any curriculum on sex education must recognise that the school's influence is one of many and that young people, as they mature, need the opportunity to explore the various beliefs and attitudes that may influence their behaviour. This could be particularly important in an area such as sex education, where informal sources of information are more important than, for example, in nutrition education, where the school and family are often the main sources of information.15
2.24When developing policies and practice for the delivery of sex education, authorities and schools have to take into account the various duties and responsibilities placed on them to educate and protect children, while at the same time recognising the rights and responsibilities of both the parents and young people. Pupils should be made aware that teaching staff cannot guarantee absolute confidentiality in relation to any disclosures that they may make to them. All local authorities should therefore devise a policy in relation to confidentiality and ensure it is incorporated into school handbooks. Within the framework of this policy there is also a need for schools to develop shared protocols with external agencies. Consideration should be given to the production of national advice.
Parental Responsibilities & Rights
2.25Parents have an important role to play in sex education. They are considered in law to have the prime responsibility for the education of their children. These responsibilities are balanced by certain rights, some of which relate to education and are enshrined in Scottish and European law. In effect, the law has moved away from adults exercising rights over children. Parental rights exist to allow parents to fulfill their responsibilities towards their children. The following Acts etc set the context for this.
The Education (Scotland) Act 1980
2.26This Act places a duty on parents of children of school age to provide their child with efficient education suitable to their age, ability and aptitude either by causing them to attend school or by other means.
Human Rights Act 1998
2.27This Act will allow the courts to take into account, and effectively enforce, some of the rights contained in the European Convention of Human Rights (ECHR), including the right to liberty and security (article 5), and the right to education (article 2 of the First Protocol). The ECHR "right to education" is expressed in the following terms:
"No person shall be denied the right to education. In the exercise of any functions which it assumes in relation to education and to teaching, the State shall respect the right of parents to ensure such education and teaching in conformity with their own religious and philosophical convictions."
2.28Article 2 of the First Protocol is subject to a reservation entered by the UK, and reflected in section 28 of the Education (Scotland) Act 1980, to the effect that the second sentence quoted above is accepted only in so far as it is compatible with the provision of efficient instruction and training and with the avoidance of unreasonable public expenditure.
2.29Tensions may exist between the rights of parents to have their children educated according to their own religious and philosophical convictions and the right of a child to education.
2.30This is an area which requires further clarification at a national level.
The Children (Scotland) Act 1995
2.31The Children (Scotland) Act 1995 requires that parents take responsibility for young people up to the age of sixteen. Parents are expected to:
Standards in Scotland's Schools Bill
2.32This Bill will allow Ministers to issue guidance to authorities on the conduct of sex education in schools. This guidance will take the form of a Circular, which is currently in draft form, makes it clear that all schools should adopt the practice of consulting parents when they are developing or reviewing their programme of sex education. It also makes it clear that schools should have in place simple direct procedures for parents to raise concerns. Schools and authorities have to be sensitive to the rare cases when a parent has a conscientious objection to particular programmes in sex education. There are significant negative academic, social and emotional consequences for the child in such a situation. Since aspects of sex education are delivered in subjects such as science and Religious and moral education as well as in health education, withdrawal will inevitably restrict attainment in these subjects. The child will be isolated from peers and this separation may well adversely affect the child’s confidence and self-esteem. In practice, there are significant management implications for schools around this issue. It will not always be a simple and straightforward matter to make suitable alternative arrangements because sex education is ideally integrated into teaching across a number of curriculum areas. It would seem prudent that schools make every effort to consult parents in advance on the programme and ensure that all parents understand the relevance and appropriateness of sex education. In the event of a parent seeking to withdraw a child from the programme, it would be important for headteachers to ensure that the parent and child are fully aware of the available withdrawal arrangements. Ideally, implementation of the package of safeguards alongside the guidance should eliminate the need for parents to exercise this right.
2.33The best arrangements are found in effective partnerships which are often exemplified by early consultation and good communications between school and home. There are other organisations such as health agencies and churches, which participate in partnerships with schools in the field of sex education and there is great potential for developing a community of interests where all partners acknowledge and celebrate their interdependence.
Young People’s Views, Responsibilities and Rights
2.34There is evidence that young people want better quality sex education at school. Young people often state that what they do get is ‘too little, too late’. Evidence of this desire for information comes from two national telephone helplines. For example, 27% of the calls to Childline during 1997/98 were related to sexuality and relationships, while Sexwise, a telephone helpline, which provides 12-18 year olds with information and advice on sex and relationships, receives between 8,000 and 9,000 calls a day from the UK.
2.35Given the fundamental links between expression of sexuality and well-being,16 education needs to include emotional as well as physical aspects of sexuality. Further, education about relationships, which young people suggest is often the weakest part of their school sex education experience, is important because sex is experienced within relationships and social structures
2.36Although some parents may be concerned that providing education about sex and relationships only serves to encourage young people to engage in sexual activity, research evidence does not support this view.17 In fact there is some evidence that effective sex education can actually delay the onset of sexual activity.18 Further, providing an open and positive environment for young people to discuss sexual health issues will be beneficial in their developing sexuality.19
2.37Young people report four main sources of information and education about sex and relationships: friends; the media; schools and parents as outlined in table 1.
|
Boys |
Girls |
|||
|
1990 |
1998 |
1990 |
1998 |
|
|
Friends |
41% |
33% |
37% |
31% |
|
Media |
24% |
23% |
25% |
32% |
|
School |
21% |
31% |
14% |
18% |
|
Parents |
8% |
7% |
18% |
14% |
|
Books |
2% |
2% |
3% |
4% |
|
Other |
3% |
3% |
2% |
4% |
|
Total (n=) |
564 |
691 |
689 |
730 |
Table 1:Main source of information about sexual health matters.
Source:Todd et al 1999.20
2.38Whilst the importance of friends in passing on information is similarly important for both girls and boys, other sources differ in their importance. Girls increasingly rely on the media, reflecting the range of publications available for young women which touch on issues of sexuality and relationships. While the media have less of a role for boys, schools have become progressively more important. This is despite the fact that, in reality, young males often feel marginalised in formal sex education settings.
2.39Young people discuss sexual and personal matters, mostly with friends, but other family members are also important.21 While young people may feel comfortable discussing issues with each other, the information passed between friends may not always be accurate. There is a need to draw on a range of sources of information and to make this accessible to young people when they need it.
2.40There is a widespread expectation from young people and parents that schools will be the main route through which young people receive information about sexuality.22 Partly this is because some parents do not feel adequately supported or knowledgeable to deliver sex education to their children.
2.41Children and young people enjoy certain rights which are enshrined in law. The following Acts etc set this in context:
Standards in Scotland's Schools etc Bill
2.42The Education (Scotland) Act 1980 places education authorities under a duty to secure adequate and efficient provision of education for their area. The Standards in Scotland's Schools etc Bill will establish a complementary statutory right in favour of every child to have a school education provided by, or under arrangements made by, the authority. It describes a key aim towards which school education must be directed by the education authorities. The aim is to make the development of the personality, talents etc of the child or young person central to the direction of school education. This new provision puts education authorities under a statutory duty to look beyond general provision to the development of the individual child.
2.43This Bill also introduces a right for pupils at a school to have the opportunity to make their views known when the school is preparing its development plan which sets out the education objectives for the school.
The Human Rights Act 1998
2.44This Act which comes into force on 2 October 2000, aims to make more directly accessible the rights conferred by the European Convention on Human Rights by allowing the enforcement of Convention rights and freedoms through domestic courts in the United Kingdom. These rights include a right to education.
2.45As indicated previously there may be some tension between the rights of parents to have their children educated according to their own religious and philosophical convictions and the right of a child to education.
The Children (Scotland) Act 1995
2.46The Children (Scotland) Act 1995 sets a framework within which local authorities are required to devise a Children's Service Plan. The Act sets out a number of key principles:
2.47This last point is particularly significant in that the Act requires the parental role to change at the age of sixteen. Parents cease to give direction, instead they offer guidance. This point of transition has to be borne in mind when schools and local authorities are considering provision for young people aged sixteen and over.
Age of Legal Capacity (Scotland) Act 1991
2.48This Act describes the circumstances under which a child is considered to have reached the age of legal capacity to consent to medical treatment on his or her own behalf. This is determined according to the child’s capacity to understand the nature and possible consequences of the treatment concerned.
Vulnerable Young People
2.49For sex education to be effective, schools and support agencies have to acknowledge the diverse nature of cohort groups within schools, and where possible, respond to the individual circumstances of pupils. There are a number of groups who require particular consideration. These include young people:
This report highlights one such vulnerable category as an example.
Young People with Special Educational Needs
2.50Many young people with special educational needs can now benefit from a supported placement in a mainstream setting, but those who are educated separately have the same right to information and support as their peers. The provision of sex education for some pupils in special schools may have some distinctive features:
2.51There are also specific considerations:
2.52The policy of inclusion means that an increasing number of young people with special needs are likely to be educated in mainstream schools. Staff in these mainstream schools may therefore require additional support or specialised training to help them tailor sex education to the specific circumstances of pupils who may spend some time in a support unit and the rest in mainstream classes.
Social Inclusion and Diversity
2.53Scotland is a diverse society. Within that society, there is a range of different family relationships. The most common relationship is that of marriage. This is supported by churches, religious groups and others in Scottish society. They see marriage as the ideal to which they aspire. However others in Scottish society have different styles of relationships and family life which they regard as equally valid.
2.54Teachers will be aware that each class will contain pupils from a variety of family backgrounds. Teachers should ensure that they treat all children with respect and sensitivity when covering these areas of the curriculum. Lack of awareness of diversity can lead to prejudice and discrimination which may lead to bullying. Bullying of any type affects self-esteem and can impact on educational achievement.
2.55School sex education has a role to play at the appropriate age and stage in discussing the myths and stereotypes around gender, sexuality and sexual orientation issues, both as a means of preventing harassment and bullying and as an opportunity to engender a respect for and understanding of diversity.
2.56School sex education needs to be sensitive to the fact that young people may find it particularly difficult to speak openly with their parents or carers about their sex, sexuality and sexual orientation matters. It is therefore important that school sex education provides accurate and factual information about sexuality and sexual orientation matters as well as developing a strong anti-bullying stance on this matter.
2.57Children living in a range of different family groupings might also be vulnerable to bullying as a result of their home circumstances and schools should be aware of the needs of these children and give sensitive recognition to their family units. Schools, parents and pupils can refer to the Anti-Bullying Network23 for advice and guidance on these matters.
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CONSIDERATIONS ARISING
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