Too much sex talk

A mother has mounted a legal challenge to the UK government’s rules on confidentiality for teenagers accessing sexual health and abortion services (1). Sue Axon, aged 50, won the right to a judicial review of this policy in December 2004, following the release of new government guidelines and the high-profile case of a 14-year-old girl, Melissa Smith, who was given an abortion without her parents’ knowledge (2). Almost a year on, Mrs Axon’s complaint has reached the High Court.

Debates about policy involving teenagers, sex and confidentiality are always fraught. The notorious Gillick case of 1983, in which family values campaigner Victoria Gillick challenged the government’s guidelines on contraception, established that this area would remain high profile, sensitive and confusing. Now, other developments in policy and the law have made the issue even more complicated.

Sue Axon’s complaint relates to Department of Health guidelines, updated in summer 2004, which state that all services providing contraceptive advice and treatment, including abortion, should make it clear that under-16s have the same right to confidentiality as adults. For some years, such rules have governed the prescription of contraception and sexual health advice; and as a practical aspect of sexual healthcare, they make some sense.

Teenagers, in many cases, do not discuss their sex lives with their parents, and worry a great deal about what might happen should they find out they are in a sexual relationship – let alone that they are pregnant. In an ideal world, perhaps, adolescents and their parents would feel comfortable discussing these issues with each other, and confident that their decisions would be respected and supported. As we all know, however, the reality of teenager-parent relationships is generally more conflictual and secretive than this.

As family planning practitioners and abortion providers have pointed out, if the law required them to notify the parents of any underage girl seeking contraception or abortion, this would be unlikely to result in the greater involvement and support of parents in their daughter’s sexual health. It would be more likely to mean an increased reluctance by teenagers to use effective contraceptive methods, because of worries about what their parents might say, and might mean that girls are pushed into carrying unplanned pregnancies to term because they put off telling their parents before it is too late to obtain an abortion.

Even Sue Axon admits that her daughters, aged 16 and 13, are not convinced by their mother’s stance on this issue: ‘They’re teenage girls and girls do believe that parents shouldn’t know what they’re up to’, she told BBC News. And the fact that Mrs Axon is reportedly partly motivated by her own personal experience – she regrets having had an abortion at the age of 30 – means she can hardly be seen as the voice of parents everywhere.

But. In her criticisms of Department of Health policy, many of Mrs Axon’s arguments strike a nerve. ‘If my daughter needs two paracetamol at school I have to give permission yet the Department of Health has issued this guidance that we parents don’t need to know [about abortions]’, she says – highlighting the way that the exclusion of parental consent for abortion directly contradicts the tightening of consent rules for every other procedure, however minor.

And when Mrs Axon states ‘the Department of Health seems to assume that every parent in Britain is a bad parent and will not support their child if they get themselves in a mess’, she identifies the central problem with the government policy on teenage confidentiality. While there are good reasons for confidentiality from a teenager’s point of view, it is safe to assume that the government is not motivated solely by empathy for the finer feelings of hormonal adolescents.

The official assumption is that teenagers and their parents do not talk to each other; and that, if they did, parents are liable to forbid their children to use birth control and push them into having a baby that they do not want. Therefore, the aim of the government’s commitment to confidentiality is rather different to that of many of those working in the field of sexual health.

Family planning practitioners and abortion providers tend to believe that teenagers who are old enough to have sex should be treated as adults in matters relating to sexual health. They recognise that teenagers are easily embarrassed by discussing their sex lives with their parents, and want to ensure that this embarrassment does not stand in the way of them receiving contraception and abortion when they want and need it. The government’s agenda, on the other hand, is quite consciously to push teenagers away from discussing these matters with their parents, and to make it the business of a host of other official agencies – whose respect for confidentiality is latex thin.

Two weeks ago, a number of influential British organisations, including the British Medical Association, the Royal College of Nursing, and the Family Planning Association, issued a joint statement warning against changes to confidentiality rules when advice and information is given to young people on sexual matters (3). The statement, publicised by the organisation Action on Rights for Children (ARCH), explained that ‘some local authorities have already adopted protocols that require professionals to conduct personal assessments on all under-18s believed to be in sexual relationships, to share information about those relationships with others and to make police checks on young people and their partners. The Information Commissioner is investigating complaints that the police will hold all enquiries that they receive about young people on “soft” intelligence files.’

What has motivated this multi-agency interest in adolescents’ sexual fumblings? It seems to be a combination of the authorities’ prurient obsession with sexual offences on the one hand, and its determination to expand the field of child protection to encompass every agency on the other. As the joint statement states, ‘It should be noted that the definition of “sexual” is unclear. Within the terms of the Sexual Offences Act 2003, this can cover any kind of activity that a “reasonable person” would consider to be sexual, including kissing’.

When the Sexual Offences Act was passed, there was some discussion about whether two underage teenagers snogging in the park would be seen to be somehow abusing each other in a criminal fashion. So far as some local authorities are concerned, it seems that this question has been answered. And given that this would fall under the rubric of child protection – which these days seems to include protecting children from each other – it is seen as only right and proper that the authorities should share information about Josh and Chloe’s First Time with every other agency under the sun. It’s what the government calls joined-up services. It’s what the rest of us should call unwelcome and unnecessary surveillance.

The signatories to the joint statement are concerned that the intrusive protocols currently used by local authorities may become government policy, when the government brings out the new version of the national guidance, ‘Working Together to Safeguard Children’. This, they claim, would be detrimental both to young people’s sexual health, and to teenagers’ privacy and right to confidentiality: ‘The duty to safeguard children and young people’s health and wellbeing, including being alert to potential abuse, is regarded by all professionals as a matter of the utmost seriousness, and it would be highly regrettable if measures designed to protect children from possible abuse were of themselves damaging to children’.

The extent to which teenagers would know, or even care, that their every foray into the sexual unknown was being logged by the state is an interesting question. One of the ironies of the confidentiality debate is that teenagers tend to be far more bothered about discussing their sex lives with the people who love and care for them than with faceless officials – and this is easily seized upon by an opportunistic government wishing to promulgate the view that state surveillance of intimate life is benign. But as the concerned signatories indicate, such intrusion is deeply damaging to teenagers’ privacy. It also formalises a deep distrust of parents.

Teenagers under age 16 should be entitled to privacy and confidentiality. Exactly how much, and from whom, is a question of ongoing debate. The issue of whether it is right to conceal an abortion, in particular, from the parents of a girl under 16 surely deserves more discussion. We can hope that Mrs Axon’s campaign will at least bring this debate back into the public domain, and illuminate all the different political agendas that are played out whenever policy tries to regulate teenagers and sex.

(1) Mother seeks abortion rule change, BBC News, 8 November 2005

(2) Not in front of the parents, by Jennie Bristow

(3) Professionals issue warning on threats to confidential advice for teenagers, 23 October 2005; Confidentiality of adolescent sexual health services: joint statement. For more information, see Action on Rights for Children.