HSE Crisis Pregnancy Programme
Submission: Department of Children and Youth Affairs Statement of Strategy
2011 – 2014
1. Introduction
This document is submitted on behalf of the HSE Crisis Pregnancy Programme. Its content
and recommendations have been drawn up by the HSE Crisis Pregnancy Programme and are
relevant to the work and experience of the HSE Crisis Pregnancy Programme. This
submission does not include the views of other areas of the Health Service Executive more
generally.
The HSE Crisis Pregnancy Programme welcomes the opportunity to make a submission to
the Department of Children and Youth Affair’s Statement of Strategy to cover the period
2011 – 2014. The Programme’s key recommendation is that the statement of strategy
acknowledges repeat calls from young people and young people’s representative groups
(including a 2010 Dail Na Nog report) that more emphasis needs to be placed on full
implementation of SPHE/RSE at primary and post primary levels of the education system. In
order to develop effective policies and safeguard young people’s well-being, we must
consider the views and solutions put forward by young people and young people
unequivocally talk about the need for better social personal health education, in particular
better Relationships and Sexuality Education in school.
Since 2001, the Programme (formerly the Crisis Pregnancy Agency) has established a robust
and extensive evidence base which supports young people’s views that implementation of
RSE is related to better sexual health outcomes in later life. Research supports the need that
young people should be enabled and empowered to make knowledgeable choices and
exercise their responsibilities with regard to sexual health and personal relationships, which
are core parts of their lives. Parents, teachers, principals, teachers, policy-makers and media
professionals all have a responsibility to assist young people on their journey from
childhood to maturity.
While sustained decreases in teenage births and abortions are very welcome trends and
impressive compared to international standards (see section 2.3 and 2.4), the reality for
children and young people today is that they are experiencing increasing pressures to
engage in sexual behaviour at an earlier age and negative sexual health outcomes are more
likely to be associated with young people who experience first sexual intercourse below the
age of 17.
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The new Department can provide much needed leadership to acknowledge the importance
of the work being conducted in this field but importantly to identify this area as a priority
and ensure interdepartmental and cross sectoral mechanisms work well in the interests of
children and young people. The Programme acknowledges the important work that also
needs to be done with parents, teachers, youth workers and the general public on
addressing this issue effectively.
2. The Evidence
The Programme has published over 35 research reports focusing on crisis pregnancy
prevention support, reproductive decision making and broader aspects of sexual health
improvement. Provided in this section is a short summary of top-line findings relating to
this submission.
2.1 Increasing pressures on young people to engage in sexual behaviour: Research has
found that the age of first intercourse has been consistently decreasing over decades and
that teenagers are under increasing pressures to be sexually active (Layte et al, 2006; Hyde
et al, 2008). Many children describe immense expectations and pressures to engage in a
range of sexual behaviours from a range of sources: television, the internet, advertising and
of course their peers. Qualitative research published by the Programme shows that
teenagers say that they experience pressure to have sex or engage in sexual activities from
boyfriends and girlfriends, but they also experience pressure from their friends or their peer
group (Hyde & Howlett, 2004). Research findings draw on concepts of social coercion and
interpersonal coercion, and argue that both female and male participants report a general
sense of social coercion to lose their virginity by a certain age (Hyde et al, 2008). The
evidence shows that several groups of young people are at increased risk of crisis
pregnancy, one of these is children who experience early first sexual intercourse below 17
years of age. These children are more likely to be from poorer socioeconomic backgrounds.
Qualitative research supports these quantitative findings. Mayock and Byrne’s (2004) study
of early school leavers showed greater levels of sexual activity and experience of pressure
among this group. Currently being commissioned by the Programme is a study of sexual
health and education needs of young people in care which is due to be completed in 2013.
There’s an expectation that groups at an increased risk of negative sexual health outcomes
will be identified here also.
However, notwithstanding the environmental and peer led pressures, Ireland has some
positive indicators regarding teenage sexual behaviour.
2.2 Most young people in Ireland wait until they are 17 to have sex: Data from the Irish
Study of Sexual Health and Relationships found that while the majority of young people are
17 when they engage in first sex, that 31% of men and 22% of women have sex before they
are 17 (Layte et al, 2006). This compares favourably to the UK (FPA, UK, 2009).
2.3 There has been a 35% decrease in the number of births to teenagers over the nine
year period 2001 – 2010: The birth rate for females aged under 20 years has decreased
from 20 (births per 1,000 females 15 – 19 years) in 2001 to 15 (births per 1,000 females 15 –
19 years) in 2010. In 2010 there were 2,019 births to teenagers, compared to 3,087 in 2001.
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This marks a 35% decrease in the number of births to teenagers over the nine year period.
(Central Statistics Office, 2001-2010)
2.4 There has been a 53% decrease in the number of abortions to teenagers over the nine
year period 2001 – 2010: The abortion rate for teenagers (15-19) giving Irish addresses in
UK clinics has also decreased from 6.0 in 2001 to 3.4 in 2010 (the abortion rate is the
number of abortions to 15 – 19 year old teenagers per 1,000 in the population). In 2001 the
figure was 944, in 2010 it was 459, marking a 53% reduction over the nine year period.
(Department of Health UK, 2001 – 2010)
2.5 Pornography and internet access: Irish research finds that approximately one third of
children have visited pornographic sites accidentally and approximately one fifth have
visited such sites on purpose. Boys and older children and more likely to have visited these
sites. Over one quarter of children said they had received unwanted sexual comments on
the internet, with those aged 13 to 16 significantly more likely to have received such
comments (National Centre for Technology in Education, 2009).
2.6 International concerns about our sexualised society and its impact on children and
young people: An independent review published by the Department for Education in the
UK on the commercialisation and sexualisation of childhood has called on businesses and
media to play their part in ending the drift towards an increasingly sexualised ‘wallpaper’
that surrounds children (Bailey, 2011). The report finds that parents feel that they have no
control and are unhappy about the increasingly sexualised culture surrounding their
children. Parents singled out sexually explicit music videos, outdoor adverts that contain
sexualised images, and the amount of sexual content in family programmes on TV (ibid).
This issue requires investigation and a Government response at national level in Ireland.
3. Recommendations for Department of Children and Youth Affairs
Statement of Strategy 2011 – 2014
3.1
Support the implementation of Relationships and Sexuality Education and Social,
Personal and Health Education in Schools: The Crisis Pregnancy Programme would ask the
Department to set out clear mechanisms in its statement of strategy on how it will work in
partnership with the Department of Education and Skills and other organisations to support
fuller implementation of SPHE in post primary schools. For example, the Department might
take a lead in coordinating the broader SPHE agenda in the interest of children, such as the
use of outside facilitators, to meet the overall health needs of children and young people in
areas such as sexual health and pregnancy prevention, sexual and domestic violence, sexual
identity, self esteem, teenage mental health, bullying, drugs and alcohol use. The aim would
be to ensure that young people receive accurate and appropriate information on a range of
health behaviours to support their physical and mental development into adulthood. By
providing a coordinated and structured approach at departmental level, cost efficiencies
working across areas would be achieved and the risk of duplicating efforts and outputs
would be minimised.
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Full implementation of Relationships and Sexuality Education at school level is one of the
key priorities of the Crisis Pregnancy Programme. There is a well established link between
educational aspirations, educational attainment, experience of sex education, sexual health
knowledge and age of first sex. The Programme believes that relationships and sexuality
education – incorporating a wide range of topics such as sexual consent, healthy
relationships, sexuality, as well as pregnancy and STI prevention – has a vital role to play in
ensuring that students are equipped with the skills and information they need to deal with
an increasingly sexualised society and to prevent against negative sexual health outcomes
during their teenage years or later in life. Research finds that younger age at first sex (under
17) is associated with negative sexual health outcomes. Data from the Irish Study of Sexual
Health and Relationships (ISSHR) found that later in life, those who had sex before the age
of 17 were 70% more likely to experience a crisis pregnancy; three times more likely to
experience abortion and three times more likely to report having an STI (Layte et al. 2006).
New data highlights the protective capacity of RSE; research suggests that young people
who received sex education in the school or home settings were over 1.5 times more likely
to use contraception the first time they had heterosexual intercourse, compared to those
who received sex education outside of the home or school environment (McBride et al,
forthcoming).
Ireland has experienced huge social and cultural changes over the last 50 years. Extensive
survey research now demonstrates near universal public support for sex education in
schools and in the home across a broad range of topics, from relationships, to STIs and
homosexuality. All schools are required to provide an SPHE/RSE programme in all classes at
post primary level and are required to develop an RSE policy in collaboration with parents
and students. Despite significant investment in the last 5 years on updating the curricula,
publishing new lesson plans, maintaining a dedicated school and teacher support service for
schools and setting up of a national team of SPHE/RSE subject inspectors, implementation
of the programme at post primary level is inconsistent and challenges to full
implementation are varied but well known. While implementation has improved slightly in
recent years, Mayock’s comprehensive study in 2007 showed that 41% of schools were
implementing the programme very well, 36% moderately well and 24% poorly (Mayock et
al, 2007). The literature does not single out one characteristic as being more important than
others, rather effective implementation will be facilitated by the present of all factors.
However, leadership is critical if change is to take place within schools effectively. Schools
with effective leadership, in the shape of a committed school principal, has been found to
overcome traditional barriers to delivery, such as teacher comfort, timetabling concerns or
the overcrowded curriculum. New research also shows that a majority of schools use
outside visitors or speakers to deliver elements of the SPHE/RSE programme (Weafer,
forthcoming).
Further supports and settings for RSE implementation include parents at home and youth
cafes. As part of its statement of strategy, the Department could set out how it can work to
develop a model of relationships and sexuality education and information in youth work
settings e.g. in youth café’s. The Programme has some excellent examples of where this
works very well. The Department could also coordinate as part of the Children Services
Committee action plans to ensure that youth services in the area of relationships and
sexuality information and education becomes a critical component.
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3.2
Highlight cross sectoral commitments: The Department of Children and Youth
Affairs has a key role in harmonising policy issues that affect children in areas such as early
childhood care and education, youth justice, child welfare and protection, children and
young people's participation, research on children and young people, youth work and crosscutting initiatives for children. These areas have relevance to a range of different
Government departments and statutory agencies. The statement of strategy should set out
a platform at a high level of what cross sectoral mechanisms or agreements will be put in
place with to ensure a whole-of-government approach to and improving quality of life of
children and young people and identifying who will be talking a lead in respect of specific
actions. These will need to be underpinned by a commitment to build research capacity
cross-sectorally. In addition the statement of strategy should address what mechanisms will
be used to agree priorities and formulate agreements with organisations to address
government priorities for children and young people.
3.3
Prioritise research: The Department of Children and Youth Affairs should continue
to commit to undertake research and data development to assist good policy formulation
for services for children. The Department and previously the Office of the Minister for
Children heavily invested heavily in research and the National Longitudinal Study on
Children and the publication of Data Strategy on children’s lives are excellent examples of
this. The statement of strategy should articulate the need to continue to deliver high quality
research on the lives of children and young people to support specific interventions. A
strategic objective might be to build evaluation capacity and information for decision
making. This needs to include cost-effectiveness research. The office should continue to
prioritise coordinating access to evidence on children’s lives through broadening the
children’s database. This might be achieved by assigning a coordinating role to a relevant
organisation working with the Department to establish systematic reporting for researchers
or funding organisations when research on children is being published. The statement of
strategy should include a commitment to complete research commitments outlined in the
DCYA Children’s Data strategy. The statement could also commit to working with other
statutory organizations with a remit for commissioning research with children to examine
the implications and recommendations from the research, e.g. the Programme is in the
process of commissioning a sexual health and sexual needs assessments of young people in
care – due to be completed in 2013.
3.4
Support the participation of children: A child centred approach is key to the work of
the Department of Children and Youth Affairs. The Department and previously the Office of
the Minister for Children, have led the children and young people’s participation agenda
through the continued development of Youth Councils at County and City Development
Board level and of Dáil na nÓg and other initiatives. The HSE Crisis Pregnancy Programme
consulted with over 150 young people to develop the B4UDecide.ie campaign aimed at 14
to 16 year olds. Teenage participants from a mix of backgrounds were contacted through
youth cafes, youth services and schools. The new Statement of Strategy should continue to
drive and further expand on the children and youth participation agenda by implementing
or coordinating a framework or a platform to facilitate the needs of statutory, voluntary and
profit-based organisations to access children and young people, so as to enable them to
participate in issues relating to their lives.
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3.5
Respond to the needs of particularly vulnerable children and young people – Early
Year’s Interventions: Research has identified a number of very vulnerable groups
particularly at risk of crisis pregnancy and negative sexual health outcomes. These are often
the same groups that disproportionately experience poor educational attainment, negative
health outcomes and come from low income backgrounds. While universal policies are
necessary to address the health and social care needs of all children and young people,
specific groups at higher risk to adverse life outcomes can benefit from targeted
intervention. These include:
Persons engaging in sexual behaviour before the age of 17
Research finds that 31% of men and 22% of women experienced first sex before the legal
age of consent in Ireland (i.e. before 17 years). Younger age at first sex (under 17) is
associated with negative sexual health outcomes later in life. Data from the Irish Study of
Sexual Health and Relationships (ISSHR) found that later in life, those who had sex before
the age of 17 were 70% more likely to experience a crisis pregnancy; three times more likely
to experience abortion and three times more likely to report having an STI (Layte et al.
2006). Early first sex is linked with lower educational attainment.
Social and Economic Risk Factors
Risk factors that can lead to pregnancy for sexually active teenagers include social and
economic risk factors; educational risk factors, such as low achievement and low
educational aspirations; risk-taking behaviour (alcohol and drug use), and specific social
demographic characteristics found to be predictive of teenage pregnancy (sexual abuse,
children of teenage mothers, children in care) (O’Keeffe, 2004).
Early School Leavers
Research undertaken by the Programme has made a strong correlation between leaving
school at a younger age and very early age of first sex (before the age of 14) (Mayock and
Byrne, 2004). Non-use of contraception at was also found to be more common amongst
this group (ibid).
Young People in Care
Evidence from other comparative jurisdictions suggests that young people in state care can
be more vulnerable to teenage pregnancy, sexual coercion, abuse or exploitation (Chase et
al, 2006; Hanlon and Riley, 2004). The CPP has commissioned the completion of a sexual
health and sexual education needs assessment of young people in care and will apply the
findings from this to implement future strategies to better support this vulnerable group.
Formal education and particularly early year’s education can act as protective factors,
related to better health behaviours and outcomes in later life. Adverse health outcomes
have similar antecedents and social determinants to a range of other health behaviours.
Interventions tackling social disadvantage require considerable long-term investment to
achieve improvements and there are strong grounds for investing in education, early
childhood and youth development programmes as strategies for reducing inequalities and
thus impacting on future outcomes. The Department of Children and Youth Affairs
recognises the benefits of such an approach and has established such Programmes in three
specific sites. The Programme would request that the Department of Children and Youth
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Affairs sets out in its statement of strategy a commitment to continue to implement and
oversee rigorous evaluation frameworks over such programmes with a view to assessing
children’s behavioural outcomes on a longitudinal basis. For young people who experience
an unplanned pregnancy, the Department might consider as part of its statement of
strategy how best to examine the role of family support in provision of services to support
parents and their children.
3.6
Respond to the contraceptive needs of sexually active young people: The
Programme would ask the Department of Children and Youth Affairs to consider in its
statement of strategy the sexual health needs of young people who are sexually active
before the age of consent. For young people who have already become sexually active
before 17, some of whom may be dealing with a range of negative social and psychological
risk factors, the Crisis Pregnancy Programme is of the view that they need to be protected
as far as possible from pregnancy and negative sexual health outcomes through messages
about safer sex and access to sexual health advice and consultation. As research confirms,
the reality of teenage sexual activity shows that a substantial minority have sex under the
current age of consent. In 2010, just under 2,500 young women under the age of 20
became pregnant1 (CSO and DOH, UK, 2010). While the vast majority of teenage
pregnancies occur to 18 and 19 year olds, there is a duty of care to ensure that the small
minority of very vulnerable young women who become pregnant under the age of 17 are
protected and receive appropriate supports and services and that future risks are
addressed.
As the current situation stands, healthcare services report feeling vulnerable if they are
required to provide crisis pregnancy counselling and contraceptive services to sexually
active young people who are under the legal age of consent for sexual intercourse. The issue
becomes more complex if a girl is under 16 years, the age of consent for medical treatment.
In some community care areas there is a responsibility on services to report every incident
of underage sexual intercourse to Social work staff in the Health Service Executive and in
certain circumstances the Garda Síochána, while other care areas require reporting of nonconsensual underage sex only. Services report that they find the issue of reporting confusing
as reporting requirements can differ depending on where the practitioner lives or where the
client lives. These difficulties can be compounded by uncertainty regarding the interaction
between legal age of sexual consent, the age of consent to medical treatment, ethical
principles of confidentiality and their responsibility to act in the best interests of the young
person and the parents/ guardians. As a result some young people are not attending
services and are making crisis pregnancy decisions without appropriate supports. Health
professionals in the area have requested greater clarity for practitioners
This is something that the Law Reform Commission has recently examined in their paper on
Children and Medical treatment. The Commission recommended that those under 16
should not be presumed competent to consent to, or refuse, medical treatment; but that, in
exceptional circumstances they may be able to give their consent or refusal, based on an
assessment of their maturity, and a presumption that their parents or guardians will usually
be involved. An assessment of whether a person under 16 is sufficiently mature to consent
to or refuse medical treatment would have to take account of the following factors: (a)
1
Under 20 pregnancy figure includes number of births and abortions to under 20’s in 2010
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whether he or she has sufficient maturity to understand the information relevant to making
the specific decision and to appreciate its potential consequences; (b) whether his or her
views are stable and reflect his or her values and beliefs; (c) the nature, purpose and utility
of the treatment; (d) the risks and benefits involved in the treatment; and (e) any other
specific welfare, protection or public health considerations, such as the mandatory
application of the 2011 Children First Guidelines.
While the Law Reform Commission’s recommendations are guidance as to the direction of
proposed legislation in this area, clarification for front line service providers and health care
professionals remains a priority. These issues need to be carefully considered and balanced
with the new Department’s work in the area of Children First.
For further information, please contact:
Dr. Stephanie O’Keeffe
Director
HSE Crisis Pregnancy Programme
[email protected]
01 8146292
Maeve O’Brien
Research & Policy Officer
HSE Crisis Pregnancy Programme
[email protected]
01 8146292
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References
Bailey, Reg. 2011. Letting Children be Children. Report of an Independent Review of the
Commercialisation and Sexualisation of Childhood. Department for Education publication,
UK.
Chase, Elaine; Maxwell, Claire; Knight, Abigail; Aggleton, Peter. 2006. ‘Pregnancy and
Parenthood among Young People in and Leaving Care: What Are the Influencing Factors,
and What Makes a Difference in Providing Support?’ Journal of Adolescence, v29 n3 p437451 Jun 2006.
Central Statistics Office. 2002 – 2010. Vital Statistics Yearly Summary Reports. Ireland.
Family Planning Association. 2009. Factsheet. Sexual Behaviour. UK.
Hanlon & Riley, 2004; The Impact of Placement in Special Care Unit Settings on the
Wellbeing of Young People and their Families. Centre for Social and Educational Research,
Dublin Institute of Technology.
Hyde, A, Drennan, D, Howlett, H, Brady, B. (2008) Heterosexual experiences of secondary
school pupils in Ireland: sexual coercion in context. Culture, Health & Sexuality, Volume 10,
Number 5, June 2008 , pp. 479-493.
Hyde and Howlett, 2004. Understanding Teenage Sexuality in Ireland. Crisis Pregnancy
Agency.
Layte, R., McGee, H., Quail, A., Rundle, K., Cousins, G., Donnelly, C., Mulcahy, F., Conroy, R.
(2006). The Irish Study of Sexual Health and Relationships. Crisis Pregnancy Agency and
Department of Health and Children.
Mayock, Paula and Byrne, Tina. 2004. A Study of Sexual Health Issues, Attitudes and
Behaviours. The Views of Early School Leavers. Crisis Pregnancy Agency.
Mayock, Paula; Kitching, Karl and Morgan, Mark. 2007. Relationships and Sexuality
Education (RSE) in the context of Social and Personal health Education (SPHE). An
Assessment of the Challenges to Full Implementation of the Programme in Post Primary
Schools.
McBride, Orla; Mongan, Karen and McGee, Hannah. Forthcoming. The Irish Study of
Contraception and Crisis Pregnancy 2. HSE Crisis Pregnancy Programme.
National Centre for Technology in Education, 2009. 2008 Survey of Children’s Use of the
Internet in Ireland).
O’Keeffe, Stephanie. (2004). Crisis Pregnancy and Pregnancy Decision Making: An Outline of
Influencing Factors. Crisis Pregnancy Agency, Report No. 1.
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Rundle, K. McGee, H. & Layte, R. (2004). Irish Study of Contraception and Crisis Pregnancy
(ICCP). A Survey of the General Population. Crisis Pregnancy Agency report No. 7.
Weafer, John A. and Weafer, Anne Marie. Forthcoming. Audit of RSE Visitors in Irish Post
Primary Schools. HSE Crisis Pregnancy Programme and Department of Education and Skills.
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alpublichealth/index.htm
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