Protect and Respect Conference

We ran our "Protect and Respect" conference last Friday 18th July at the Salford Innovation Forum, and it went really well. Evaluations were excellent and we are now putting together a short film about the day. Keep an eye on http://www.contraceptioneducation.co.uk/news.asp for the presentations and video clips as they're completed.

Julie Wray writes about Children with HIV

I read with sadness the article in The Observer on 13.7.08 ‘HIV children turned away from schools’ by Jacqui Thornton. My attention was drawn to the ignorance and controversy facing many children living with HIV and their right to be educated. According to Thornton many teachers, schools and local education authorities are practising with fear and ignorance about the consequences of allowing children with HIV to attend school. It appears that some children are being refused a school place, or upon learning that a child has HIV, are asked to leave, or breaches of confidentiality are occurring. Examples from real cases highlight that the main issues are mostly based upon fear, fear of transmission and confidentiality in relation to the child and family. I have to say I was quite shocked that such fear exists especially as such practice is contrary to the facts and knowledge that are well known and published about HIV.

A few facts:

• There are about 1,500 children living with HIV in the UK, including 1,000 under 15.
  
• On average just over 100 children are diagnosed with HIV in the UK each year.
  
• HIV cannot be passed on by spiting, biting, small cuts or grazes, sharing utensils or toilet seats.


• Resources for teachers about HIV in schools are available from http://www.nat.org.uk/
  
  The National Aids Trust is campaigning to improve things for individual families and children. If you are able to support and make comment do contact the National Aids Trust at http://www.nat.org.uk/
  
  Contraception Education works with schools and teachers provides resources and workshops to inform and educate people about all sexual health matters, including HIV, in particular "Safer Sex: An Interactive Learning Resource" on Video and DVD produced in collaboration with Brook Manchester and "Play-it-Safe" a CD game developed specifically for South Africa

Are condoms not sexy enough to be news?

This past few weeks has been quite busy, with National condom week (http://www.contraceptioneducation.co.uk/nitem.asp?news_id=403) and the debates in the House of Parliament on late abortion. Of course for last weeks blog Barbara found an excellent link to her MP Tom Levitt's blog and his reasons for voting to keep the 24 week limit for late abortion.

Overall the media has had a field day on late abortion with a range of emotive reporting, but very little has featured in newspapers and TV about National condom week. I wonder why this is the case. Clearly, the important messages about protecting ones sexual health by using a condom is simple enough to understand and yet evidence suggests that this message is not fully applied in practice. Sexually transmitted infections continue to affect many young people with rates increasing and in some parts of the UK epidemics exist ( http://www.nwph.net/nwpho/_layouts/1033/searchresults.aspx).

Young people need good information more than ever about protecting themselves, staying safe and in control. Being able to make your own decisions and choices about your sexual health requires first and foremost knowledge and confidence. One of the most powerful ways to get positive and long lasting messages to young people is through the media. I think more could have been done for during National condom week – what do you think?

Welcome to Thailand.....

Here I am in Thailand, speaking at the 5th Siam Care International Conference on Sexual Health "East Meets West". This conference is in Bangkok, and the first 3 days are at the Pullman King Power Hotel. The second part is an adolescent conference in Mukdahan at the Ploy Palace Hotel, a study tour of local schools, a chance to see the Siam Care Team at work in Mukdahan and a visit over the border to Laos.

A short video about the AIDS work of Siam Care can be seen here

The Bangkok programme begins tomorrow 14th January and is looking excellent. I will link to any on-line papers when I can so that you can read and share what the experts have to say.

Tomorrow morning sessions are chaired by Jyoti Dhar and Kathy Phipps. The conference begins with an offical opening by Khunying Kobchitt Limpaphayom, and an overall theme of Sexual Health and HIV. We will hear UK and Thai view of Sexual Health issues, from Angela Robinson and Mechai Viravaidya.

The following session is by Bolton's consultant Emile Morgan who is looking at STI's and HIV in primary care. Will Ford Young's session is very interestingly entitled "Primary Care Cock-Ups and Dark Holes in GUM". Christine Evans is the last speaker of the morning and is presenting about the effects of male circumcision.

The first afternoon session on 14th is chaired by Angela Robinson and Will Ford Young and kicks off with Sris Allan's session on Vertical Transmission of HIV. This is followed by Anne Greenwood on Contraception and HIV, and then Kathy French who is looking at the extended role of the nursing. The final slots of the afternoon are being taken by Paddy Horner - Managing Urethritis, Nuntawun Yuntadilok - Sexual Health Care for Sea Farers and Anthony Pryce "Text us your Body Parts".

On Tuesday 15th January the morning's theme is Sexual Health Uro-Gynaecology, chaired by Paddy Horner and Anne Greenwood who will introduce Jyoti Dhar speaking about Genital Dermatology, Sue Reed Homeopathic on approaches to PMS and Pansak Sugkraroek - Sex Management in Elderly Men. Nikki Seddon will be looking at HPV and cervical cancer prevention, Ahmos Ghaly Lower Genital Tract and the Use of Ultrasound and Christine Evans vaginal fistula.

In the afternoon of 15th the overall topic is entitled Sexual Health and Marginalisation is chaired by Olwen Williams and Barbara Hastings-Asatourian. It begins with Cardiologist Walter Rhoden presenting "Sex and the Heart",then Mala Majora - Female Genital Mutilation and Justin Gaffney - the SohoBoyz and MSM innovation. Anthony Pryce is presenting about Premature Ejaculation in Bengali Men, and last on Tuesday is Anne Greenwood - Managing Rape and Sexual Assault.

The last day of the conference, chaired by Emile Morgan and Brian Whitehead, is focussing on Sexual Health and Adolescence and features Kathy Phipps, on Adolescent Health, Kathy Phipps and Richard Burack on Child Protection, confidentiality and consultations, Olwen Williams adolescent and primary care HIV, Hilary Piercy "Coming to do the Sex Talk", and Barbara Hastings-Asatourian Sex Education and the Web. There will be a panel session of all speakers at the end of the morning.

How Contraception Saves Lives worldwide

Last month I was asked to write an article for The Practising Midwife in which I explored some global perspectives on contraception. Here is an extract from that article.

World population currently stands at more than 6.6 billion, and half of the world’s population is under 25 years old. The United Nations predicts that, if couples average 1.6 children, the world population will peak at 7.7 billion by 2050, and decline to 3.6 billion by 2150 (United Nations 1999). By averaging two children, the world population will rise to 9.4 billion by 2050 and reach 11 billion by the next century before stabilising. By averaging 2.5 children, the world population will increase to 11.2 billion and increase to 27 billion by 2150.

In 1994 the United Nation’s International Conference on Population and Development (the Cairo Conference) identified that population control required an holistic perspective, considering socio-political agendas and economic factors, rather than a focus on contraception alone.

Mortality and morbidity
Birth rates today are highest in the poorest regions (UN 2006). At present, average
expectation of life at birth is 63 years in Latin America, 57 years in Asia and only a little over 46 years in Africa, compared with more than 71 years in the developed regions. Although on average fewer than one in 40 children dies before reaching the age of one year in the developed countries, one in 15 dies before reaching one year in Latin America, one in 10 in Asia and one in seven in Africa. Because of major health threats such as AIDS and malnutrition, in some parts of Africa average life expectancy at birth is estimated to be less than 40 years, and one in four children dies before the age of one year. AIDS has changed the sexual health and contraceptive needs of women, and now protection from infection as well as from pregnancy is required.

Every year, around 530,000 women die during pregnancy or in childbirth. Lifetime risk of maternal death is one in six in Afghanistan, one in seven in Niger, one in 13 in Uganda and one in 14 in Ethiopia.In more developed countries this risk is one in 2,500 (WHO 2004). Additionally, each year 3.3 million babies are stillborn, more than 4 million die within 28 days of birth, and another 6.6 million children die before the age of five, the majority from preventable causes. Less than 1 per cent of these deaths occur in the more developed countries.

Women who are in poor health are more likely to give birth to unhealthy babies, and often cannot provide adequate care. Studies in Bangladesh in the 1980s found that when a mother died, her newborn baby had a very small chance of surviving the first year (PAI 2006). The spacing of births therefore has a powerful impact on the chances of a mother and her child’s survival. In less developed countries children spaced less than two years apart are about 2.5 times more likely to die before the age of five than children spaced three to five years apart. Babies of mothers who have pregnancies close together are often born underweight or premature, develop slowly and have an increased risk of childhood diseases (PAI 2006).

Older children surviving their mother’s death are less likely to eat a balanced diet, and girls often leave education very young to care for younger siblings. Young girls who are not in education are more at risk of teenage pregnancy. Teenage girls are less likely to get antenatal care and are at greater risk of birth complications. Girls aged 15 to 19 are twice as likely – and girls under15 five times as likely – to die in childbirth than young women in their twenties (PAI 2006). Young women are also more at risk of developing sexually transmitted infections and HIV/AIDS. Every year, almost half of all new HIV infections and at least onethird of all new sexually transmitted infections occur in women under 25 (Panchaud et al 2000).

Abstinence is often the only form of sex education and contraception available, and coitus interruptus (withdrawal of the penis prior to ejaculation), natural family planning (fertility awareness) and lactational amenorrhoea are still widely used. Their efficacy is low, although better than nothing, and they offer no protection from infection......

Barrier methods such as the male and female condom are more expensive than the traditional methods, but offer good protection from infection when carefully used. They need to be positively and sensitively promoted as there are myths surrounding contraceptive use in many cultures, and inaccuracies are disseminated sometimes for religious and political reasons. Papers have been published to persuade people not to trust condoms, but to abstain in preference, sometimes falsely claiming that condoms let through infection

Contraception provision in remote areas is more complicated as more resources and expertise are required for hormonal methods, diaphragms and IUDs.

Abortion
Approximately 87 million unintended pregnancies occur each year; more than half end in abortion. About 18 million of those abortions are thought to be unsafe. About 68,000 women die from unsafe abortions every year; more suffer serious complications (WHO 2005). Studies show that contraceptive use correlates with a considerable decline in the abortion rate, and a corresponding reduction in abortionrelated deaths (Senlet et al 2001). In Russia between 1998 and 2001, contraceptive usage increased by 74 per cent and the abortion rate declined by 61 per cent (PAI 2005). In Kazakhstan, contraceptive prevalence increased by 50 per cent in the 1990s, and
abortion rates decreased correspondingly (Westoff 2001). Abortion rates in the Czech Republic have fallen from 116,000 per annum in the late 1980s to 27,600 per annum now, as the percentage of Czech women using birth control pills has quadrupled (Henshaw et al 1999). Women needing abortions will often risk unsafe conditions. The provision of legal abortion helps save lives, but does not increase the use of abortion. In many Latin American and African countries where abortion is illegal or severely restricted, abortion rates are higher than in Western Europe where it is legal. In poor countries, women face a higher risk of death from unsafe abortion. For example, in Africa, one in 150 abortions leads to death compared with one in 85,000 in more developed countries (WHO 1998). It is estimated that 350 million women in developing countries lack access to effective contraceptives (Henry J Kaiser Family Foundation 2004). Politicians can have immense control over access to contraception, abortion and sterilisation. Restrictive abortion policies affect poor people more than wealthy because poorer people rely on the public sector for their health needs whereas women who have money can usually pay for an abortion privately and bypass public policy.

Nevertheless, the United States has a contentious policy known by its opponents the ‘Global Gag Rule’ which denies US Family Planning funding to any national or international organisation that supports abortion. Many international governments condemned the restriction as detrimental to women’s health and a breach of the right of citizens to participate in their own democratic political processes. This is seriously restrictive, as most organisations that deal with contraception do refer for abortion on contraceptive failure.

In the UK, abortion is relatively safe. In 2005 a total of 186,400 abortions were performed on residents of England and Wales; 84 per cent of these were funded by the NHS (ONS/DH 2005). Eighty-nine per cent of abortions were carried out at under 13 weeks’ gestation; 67 per cent at under 10 weeks (ONS/DH 2005). Women seeking abortion do so under the Abortion Act (1967) Amended, which requires two registered medical practitioners to be of the opinion that an abortion is justified in the light of their clinical judgement of all the particular circumstances of the individual case.

Empowering women
Modern methods of contraception can empower women to be independent; economically active; live a longer, healthier life; and provide better for a limited number of children, enabling them to have a much better chance of survival (PAI 2006).
Contraception in the hands of women also enables them to make choices independently of their partners whenever necessary; and when domestic abuse prevails in a culture, contraception and access to abortion can be crucial to a woman’s ability to survive and move on. Women who are not pregnant or bringing up small children on the whole are able to engage in uninterrupted work more easily, and in more developed countries make career progress more quickly. However, some women may feel pressured to work because welfare benefits and maternity and paternity leave provision are inadequate. Fertility and contraceptive use and increased autonomy are linked to the education of women in developing countries (Castro 1995, Saleem and Bobak 2005). This link plays an important role in the development of family planning policies in lower-income countries.

Enforced population control
There is evidence at the structural level that
extreme cases of ‘population control’ have forced women to use contraceptives, have abortions or to be sterilised. Incentives and education The population of India is set to rise above 1 billion by 2050, and this has occupied politicians for decades (National Commission on Population 2000). India was the first country in the 1950s to start a National Family Planning Programme, and in the 1970s the role of the Auxiliary Nurse Midwife (ANM) expanded into population control. ANMs had targets to recruit people to take up contraception and sterilisation, and were denied payment if they underachieved. Another method of persuasion employed in India was the use of incentives. The Indian Family Planning Council in the early 1970s recommended an incentive of food to anyone undergoing vasectomy. Female sterilisation was incentivised again in 2000. Opponents criticised the temporary nature of the incentives. A more recent policy in India discourages marriage before the age of 21 because teenage marriage contributes to population growth. India no longer sets targets on contraceptive use or sterilisation but now strives towards better access to healthcare and a focus on female literacy.

Involuntary sterilisation
Involuntary sterilisation has been reported in Eastern Europe since the 1970s, and was again highlighted in the media in 2003 when it was reported that Romani women in Slovakia continue to be subject to violations of their human rights. A three-month study revealed that coerced and forced sterilisation practices continued in Slovakia against Romani women. The New York Center for Reproductive Rights (2003) conducted interviews with more than 230 women in almost 40 Romani settlements throughout eastern Slovakia. They found instances of coerced, forced and suspected sterilisation of Romani women, along with racially discriminatory standards of care including denial of access to medical records (CRLP 2003).

Social change
Human rights and law can be used as instruments for social change. In Colombia, an organisation called Profamilia established a legal service for women to help them secure reproductive and sexual rights. The service addresses abortion services, prevention of sexually transmitted infections, informed consent, emergency contraception and gender-based violence. As a result of this initiative, the Ministry of Health in Colombia changed some policies and guidelines.

Urbanisation and coercion
By the end of this century the majority of the world’s population will be living in urban areas. Urbanisation is an element of the process of modernisation. Some countries manage this well, but others do not – and in these parts of the world it is uncontrolled, accompanied by overcrowding, slums, deterioration of the environment, unemployment and other socio-economic factors.

China is particularly renowned for its very strict one-child policy. The country’s population is expected to increase to 1.6 billion by 2050 (Heilig 1996). The one-child policy was introduced in the late 1970s and claims to have prevented at least 250 million births since 1980 (Zhu 2003). In the early years of the policy, women who were visibly pregnant for a second time were encouraged to have an abortion, even late into the pregnancy. In addition, hundreds of thousands of women have been sterilised.

The one-child policy restricts couples to having one child, unless either is from an ethnic minority or if they are both ‘only children’. With one child, families receive free education and benefits, which are withdrawn if couples have another child, and they face a fine for every additional birth. In most rural areas, a couple may have a second child after a break of several years. It is therefore more common to find couples in the countryside, where 80 per cent of the population live, with a large number of children. Sons are often preferred as they carry on the family name. More than 90 per cent of all aborted fetuses in China are female (Zhu 2003). Some maintain that this policy has led to the killing of female infants. Men are thought to outnumber women in China by more than 60 million – some estimate 100 million (McCurry and Allison 2004).

For the full article and references please click here or email barbara@contraceptioneducation.co.uk

Media and commercial influences on teens

When I started Contraception Education I would never have imagined the ramifications of the development of Contraception the Board Game.

I am in education, and was originally trying to improve knowldge and awareness of contraception, to prevent unintended pregnancies. The Teenage Pregnancy Strategy (TPS), however goes much much further than that. The thrust of the TPS is to help all young people achieve their full potential, raise their aspirations for their futures, learn delaying, consenting and permission-giving and permission-asking skills, of course also learn how to manage the risks of alcohol and drugs in relation to sex, and learn how to navigate services and systems to get what they really need, improving life chances and tackling poverty and inequality.

In February 2007 I made another connection when I was asked to comments in the MEN about the sexualisation of girls through play and toys. A recent report published by the American Psychological Association showed that our culture delivers many messages about sexualization of adult women and that this in turn influences girls. Parents, schools, and peers sometimes contribute to this, and that girls themselves sometimes take on a sexualized identity . One theory has suggested that this sexualization of may have negative consequences for all young people. The report suggests that images of girls and young women in advertising, merchandising, and media is harming girls' self-image and healthy development having cognitive and emotional consequences, consequences for mental and physical health, and impact on development of a healthy sexual self-image.

It goes on to suggest that parents have a role to play in encouraging girls to value themselves for who they are, rather than how they look, and to teach boys to value girls as friends, sisters, and girlfriends, rather than as sexual objects. The report proposes that with the help of their carers and parents, young people can learn “media literacy skills”, which in turn will help them to resist the message that how girls look is what matters.

Meanwhile, along came the Bratz, a prime example of a commercial enterprise which may well insidiously reinforce the very messages which have been highlighted by the APA as potentially harmful – the tiny bodies, the flawless complexion, the symmetrical features, the immaculate hair – looking a certain way, but not actually doing that much. It was said with tongue in cheek that my alternative was “Geekz”, dolls who would care about the environment.
I said, amongst other things "I'd prefer it if a manufacturer somewhere came up with a doll which reinforced the importance of being healthy, happy and looking after your fellow human beings…..Why can't there be a doll which is concerned about reducing its carbon footprint."

I would dearly love to see a doll representing an ordinary person (I mean someone like you and me, not a model) achieving extraordinary things and really challenging male and female stereotyping.

Read the APA report and associated comments at http://www.manchestereveningnews.co.uk/news/s/1000/1000689_bratz_dangers_or_role_models.html