As Sexual Health Awareness Week 2018 draws to a close, Dr Debbie Fallon blogs for us on the current state of sexual health issues, education, and services in the UK. 

• Sexual health awareness and education campaigns are of great importance, especially for young people who are navigating their independence for the first time.
• Rates of STI infection in young people remain worryingly high relative to comparable nations across Western Europe.
• Cuts to sexual health support services are also playing a role in increasing service pressures and concerning trends in health outcomes.
• Effective sex education, including better understanding of consent, should be a significant element of young people’s education.

The week after Fresher’s might just be perfect timing for the Family Planning Association (FPA) ‘sexual health awareness week’ as thousands of young people leave their homes for a taste of independence at universities up and down the UK.

The campaign this year focuses on consent and follows previous campaigns around sexually transmitted infections (2016) and porn (2017).

I welcome the campaign which aims to promote informed conversations about consent and healthy relationships because as a mother, a children’s nurse and a university lecturer I have serious concerns about how prepared young people in the UK are for safe sexual independence. My concerns are not just about the health choices they make, but about their ability to navigate relationships, avoid sexual exploitation, or recognise and successfully deal with experiences of sexual harassment (or their own unwitting complicity in sexual harassment) whether in public spaces, in school, in sport, on campus, or in the workplace.

Cause for concern

Heterosexual, gay and bisexual young people aged 15 to 24 years and men who have sex with other men are particularly at risk of sexually transmitted infections. This is a real concern given that the rate of syphilis has increased by 20% between 2016 and 2017 and gonorrhoea, with an increase of 22% during the same period has reached a level not seen since World War II.

In addition, while England celebrates its lowest rate of teenage pregnancy for 40 years it is acknowledged that there is ‘more to do’ if we are to match comparable countries in Western Europe.

Cuts to services

Such stark statistics are published against a backdrop of severe and continued cuts to sexual health services which a recent BBC report suggested will result this time in many reduced or closed services across the country, citing restrictions to free access to emergency contraception for women under 25 in one council and the loss of funding for a student clinic on one university campus. If a reduction in the under-18 conception rate is one of four priorities in the Sexual Health Improvement Framework such measures will undoubtedly come back to bite.

There are already reports of reduced provision of chlamydia testing and delays in HIV diagnosis – indeed the Local Government Organisation (LGA) suggest that sexual health services are currently at a ‘tipping point’. If you have concerns, the Health and Social Care Committee has recently launched an inquiry into sexual health eliciting evidence about issues such as demand, access or funding. The inquiry is open to submissions until 1 October 2018

Why consent matters

Cuts to services are not the whole story because sexual health is not just about physical illness – and this is why the FPA campaign focus on consent is so important. The Crime Survey for England and Wales figures for the year ending March 2017 estimated that 20% of women and 4% of men have experienced some type of sexual assault since the age of 16.

However, the survey also highlights that around 5 in 6 victims (83%) did not report their experiences to the police, highlighting the complexity of these experiences for individuals.  Confidence to report sexual harassment appears to have grown following the entertainment industry #metoo campaign and there are now almost daily media reports of individuals of all ages and genders and from all walks of life declaring their own experiences of sexual harassment in an attempt to throw light on the deficits in sexual safety.

It is important to capitalise on the zeitgeist and have meaningful conversations about sexual safety – even if this is just some clarification about what counts as banter and what constitutes sexual harassment.

Sex education

These conversations need to take place before adulthood and the obvious place to start is in school. However, the road to compulsory statutory relationships and sex education has been a bumpy one and the provision of sex education in England at the moment can be described ‘patchy’ at best with the topic squeezed into a packed curriculum and teachers feeling unprepared to deliver such complex content. Although the Teenage Pregnancy Strategy (Teenage Pregnancy Unit, 1998) generated much debate about the best approach to young people’s sexual health and wellbeing, in terms of sex education this was followed by a number of reviews and consultations rather than policy change highlighting how difficult it is to harmonise the competing agendas of abstinence versus information.

However, in 2017 The Children and Social Work Act placed a duty on the Secretary of State for Education to make Relationships and Sex Education (RSE) compulsory in secondary schools, and Relationships Education compulsory in primary schools with additional power to make Personal, Social, Health and Economic Education (or elements of the subject) mandatory in all schools. We are now once more in a consultation phase and views are sought in the Relationships (and sex) education and health education consultation until 7 November 2018. Importantly, this consultation includes whether the department decides to make Health Education rather than all of PSHE compulsory.

I hope that the government grasps the nettle and includes the ‘sex’ component – although the bracketing of the word ‘sex’ in the document does not fill me with confidence.