Yesterday evening (05_01_11) Channel 4 News featured a story about the contraceptive implant (Implanon). They revealed a number of NHS trusts have paid £200,000 in clinical negligence compensation to women who’ve become pregnant or experienced injury when using the contraceptive implant. 584 women have reported unplanned pregnancies, and 1067 complained about scarring or other injuries to the Medicines and Healthcare Regulatory Agency. At this time it is not clear how Channel 4 heard about this story. It could be through their own research, from a tip off within the MHRA, or direct contact from a law firm.

This story was hotly adopted by the rest of the media, particularly broadcast media and newspapers, with coverage like:

Evening Standard – Ban this contraceptive implant pleads mother scarred for life
Telegraph – Woman whose marriage collapsed after Implanon implant ‘failed’ among those suing NHS
Guardian – Hundreds become pregnant despite contraceptive implant Implanon

The majority of these reports were characterised by a lack of context for the numbers given, and no reproductive health care experts/medics to put this data into context. I’ll focus on why this is a problem shortly, but first, here’s what you need to know about the contraceptive implants.

Contraceptive Implants (Implanon)
Implants are small, flexible tubes around 4cms long that contain the hormone progestogen and are injected under the skin in a woman’s upper arm. They are a form of a hormonal contraception, so they release hormones over a period of time (3 years) and fall into the category of Longer Acting Reversible Contraception (LARC). (Implants used before 2010 go under the brand name Implanon, those fitted after this date are called Nexaplanon. The latter has reportedly been designed to be easier to insert).

This kind of contraceptive is suitable for women who find it difficult to remember to take the pill every day, and who are certain they don’t want to be pregnant for a set amount of time. It’s around 99% effective if fitted correctly and used according to instructions. But, as like any form of contraception it isn’t 100% effective and because it only prevents pregnancy, condoms should also be considered to protect against STIs.

It has a number of side effects including periods stopping (which some women see as an advantage), irregular bleeding, acne, sore breasts, mood changes, and reduced sex drive.

Its use is recommended only after considering other contraceptive options and a thorough discussion and health assessment with your GP/Family Practitioner or Reproductive Health Clinic.

You can find out more about the contraceptive implant here, here, and here. (A statement from the MHRA on implanon can be found here).

Why is the media coverage problematic?
Press coverage on this story has been largely context free. That has meant we’ve been told how many women have experienced problems but not within any timeframe; how many problems were reported as compared to women not experiencing difficulties; how the implant compares with failure rates of other kinds of contraception; how many of the pregnancies were present before the woman went on Implanon and how many occurred due to incorrect fitting of the implant?

Without this information the majority of media coverage suggests that the Contraceptive Implant is not an effective form of contraception, is always painful to fit and remove, will cause disfigurement when removed, and result in an unplanned pregnancy where women will be forced to have a termination.

Because this information is misleading, and doesn’t come with additional reproductive health details to put it into context, it fails to make clear the positive aspects of implants for women who choose this method, nor that the majority of women who select the implant do not experience problems.

The coverage is also irresponsible because of the timing of the story. The post-Christmas and New Year period is always busy within General Practice and Reproductive Health Clinics. Not least because of people who have had unprotected sex over the holiday season will be anxious about pregnancy and seeking advice about their options.

The difficulty in criticising the story as it stands, is that you can find yourself easily cast in an unsympathetic role. In healthcare terms proportionally 584 cases compared with the number of people using contraceptive implants (1.4 million according to the Department of Health) is pretty low. That is of no comfort to those who experienced an unplanned pregnancy when they thought they were protected by a contraceptive. So in critiquing the media coverage here we need to be mindful it is based on difficult and upsetting cases that will have had widespread impact on people’s lives.

It is negligent of the media to not report this within any appropriate context. The result is scaremongering and is not helpful to anyone. Including those who have had bad experiences with the contraceptive implant.

What does the data show?
The contraceptive implant was introduced in the UK in 1999. It has been used by around 1.4 million women over the past 11 years. This figure comes from the Department of Health although is still unclear if that means women in UK or Europe. Some practitioners feel the 1.4 million figure is high, even over an 11 year period. Part of the problem with this story is the uncritical media coverage is throwing numbers around like there’s no tomorrow, but health agencies have also been somewhat unclear on exact figures and where they’ve sourced them from. This leaves us with the less than ideal situation of matching unclear data from media coverage with unclarified data from the Department of Health/NHS. NHS advice is the 584 pregnancies reported seem to be mostly related to incorrect insertion of the device rather than the device itself being faulty. It is not clear how many of these pregnancies had begun before the device was fitted. Currently around 800,000 women in the UK are believed to be using this method of contraception. 14 women have been compensated for either getting pregnant while using the implant or being injured through incorrect insertion or removal (source info here). While the figures from media and health sources remain unclear what does seem to be fair to claim is the number of women who use the contraceptive implant without difficulty far outweighs those who have experienced problems.

Long Acting Reversible Contraception has been recommended for use by the National Institute for Clinical Excellence (NICE) (details here). This has resulted in reproductive health practitioners recommending the use of the contraceptive implant and other LARC options (e.g. the IUD) to women seeking contraception. The guidance states women being offered LARC should have this as part of ‘women centred care’:
“This guideline offers the best-practice advice on the provision of information and care for women who are considering or using LARC. Treatment and care should take into account women’s individual needs and preferences. Women who are considering using or who use LARC should have the opportunity to make informed decisions about their care and treatment. If a woman does not have the capacity to make decisions, healthcare professionals should follow the Department of Health guidelines, Reference guide to consent for examination or treatment (2001) (available from www.dh.gov.uk).
Good communication between healthcare professionals and women is essential. It should be supported by the provision of evidence-based information offered in a form that is tailored to the needs of the individual woman. The treatment, care and information provided should be culturally appropriate and in a form that is accessible to people who have additional needs, such as people with physical, cognitive or sensory disabilities, and people who do not speak or read English.”(p.5)

Whether this was always completely followed in a drive to encourage women to opt for LARC is not clear. Careful assessment of this should be made within the context of health care practitioners working hard to encourage their clients to have a range of contraception choices. It should not detract from wider discussions about uptake and overall safety, but is relevant if health practitioners or patients felt pressured towards LARC as opposed to other forms of contraception. This is a highly sensitive area to address and given the media’s poor record of talking about the issue so far is a worry that critical discussions around the promotion and uptake of LARC could be further used to devalue health professionals or scaremonger around contraception choices.

What could the result of this coverage be?
Perhaps unsurprisingly the media coverage has led to a lot of anxiety among the public. Women are worried about whether they were right to choose this method of contraception – and whether they might still find themselves pregnant or will face painful removal procedures resulting in permanent scarring.

Anecdotal reports from reproductive health clinics and GPs, as well as reproductive health charities suggest the number of calls from concerned women and their partners have risen dramatically today. We will have to see longer term what could also be the result of this coverage but it is not unreasonable to assume it could lead to women using the implant wanting it removed. Other women may be put off selecting this method, seeing it as ineffective and unsafe. It is reminiscent of the 1990s when media scares over the contraceptive pill led to widescale rejection of this method (and subsequent unplanned pregnancies).

Was the media wrong to cover this story?
No, they weren’t wrong. This is an interesting story. However it’s not exactly ‘news’ (problems with the contraceptive implant and legal actions have been noted for some years). It didn’t need to have been reported right now, particularly during a time when health services are under pressure. It should have been reported within a clear context to allow people to understand there have been problems with the contraceptive implant, but it is a method of contraception that suits many women, is effective and widely used.

What to do if you are worried?
If you are already using the Contraceptive Implant and are not experiencing any problems you probably don’t need to worry. However if this coverage has concerned you then you can speak to your GP, Reproductive Health Clinic or call the FPA on 0845 122 8690.

Remember this form of contraception is more than 99% effective and for the majority of women who opt to use it they experience no problems and are happy with it as their contraceptive choice.

If you’re using the Contraceptive Implant and are experiencing side effects or think you may be pregnant see your GP or Reproductive Health Clinic as soon as you can. Make your situation clear when you call so they can prioritise you for an appointment.

If you can feel your implant below the skin near where it was inserted it will continue to work effectively (but again do ask for a second opinion if you are worried). If you cannot feel your implant or are in any way worried it isn’t working then either avoid sex or use condoms until you have seen your GP or Reproductive Health Clinic.

It goes without saying that you should not try and remove the implant yourself. This has to be done by a professional and only if you are experiencing problems.

If you are thinking about using the implant but are now worried to do so, talk to your GP or Reproductive Health Clinic staff who can discuss your contraception choices and see which suits you best.

If you are not using the implant but still have anxieties about your contraception choices then do talk to a health professional about your concerns.

What health professionals can do
In the first instance you may need to recheck and advise women fitted with the contraceptive implant. It’s worth remembering the reasons why a contraceptive implant may fail and increase a risk of an unplanned pregnancy:
- Unrecognised non-insertion
- Unrecognised pre-existing pregnancy, or pregnancy risk, at the time of fitting
- Concomitant use of interacting medications
- Use beyond its 3 year lifespan.
If you are unsure about your skills in fitting implants or need retraining or support your local PCT or Sexual Health Service Provider should run courses. Book a place now if you feel underconfident or stressed by this story breaking.

You may find this story has increased your workload at a busy time so you may not be feeling inclined to tackle this story. However if you are able to do the following it could be very useful:
- Provide easily accessible information to your patients about the contraceptive implant
- Post resource information (such as the FPA details) around your clinic. A great resource has been created for you by @bishtraining (click here to download)
- Ask patients you know are using the implant or are considering using it if they have any concerns they need you to address
- Challenge poor or misleading media coverage if you are able
- Offer interviews with your local print and broadcast media to explain about the contraceptive implant and provide reassurance
- Request the DH/NHS who are circulating data about the use of contraceptive implants clarify the data (how long has it been collected for, where from, how much of an estimate is it) to help you put any questions your clients have in their proper context

What journalists can do
Much of this media coverage has been poor but there is still time for science/health journalists to challenge what has already been written and put a wider context on the story. Channel 4, after breaking this story, have now included more information on the Implant, but as others have noted this may be too little too late. All media covering this story in a simplistic and scaremongering way must bear responsibility of the repercussions on women’s reproductive health. It would be ironic if those papers gratuitously reporting on the NHS facing lawsuits over failed contraceptives could themselves be looking at similar lawsuits if they scare women enough to avoid contraceptive use and contribute to an unplanned pregnancy.

If you are in a position to rectify the poor coverage or explain more about the contraceptive implant that would be very helpful. This story, as with others on contraception, indicate journalists often have very basic understanding of contraception choices and how reproductive health services operate. If you know you’re not confident to cover stories of this time approach organisations like Brook or the FPA who can give you further information and advice.

Immediate tasks requiring attention from journalists are to:
- check the data that’s been talked about. Both from the MHRA and Department of Health. Source where the figures come from and put into specific context the number of problems women have experienced with the overall use of the contraceptive implant
- clarify the complaints made. How many of these were down to incorrect fitting of the device, faulty implants, pregnancy before the implant was fitted or injury from the implant or its removal (at present this information is not clear)
- try and track the source of this story. How did Channel 4 hear about it. In particular focus on whether this was brought to their attention by any law firms or a source within the MHRA.
- talk to the manufacturer of Implanon and identify from them their reports of problems/malfunctions/complaints recieved. So far most press coverage has focused only on MHRA and DH data (without clarifying those figures much). Additional attention should be paid to the manufacturers of the contraceptive implant who should have data on the number of devices provided along with complaints recieved and any legal actions taken. (They may, of course, not share this information, but it should still be sourced).
- provide information about the implant and what women can do if they want to use it, or are concerned about it, with links to sources of help
- give balanced accounts so while you may talk about women who’ve had awful experiences with implanon talk to those who may have had no problems and found it effective
- be careful not to make claims about the contraptive implant (or any form of contraception) without carefully investigating how it works.
- Talk to health professionals working in reproductive health to find out more about how the implant works, and which women it is suitable for (or not)

What everyone can do
If you spot poor coverage complain to the editor. If you are able to post comments to online coverage or call into broadcast media discussions do share accurate information about contraceptive implants and why this story is currently so problematic. The more we make it clear to the media we won’t put up with irresponsible reporting on our health, the less likely they may be to produce poor reportage in future. Obviously if you see good coverage, ensure this is flagged up and praised (some good examples here, here, here and here). If you have a blog, are on twitter or facebook you can also share accurate information and raise awareness over the poor media coverage.

With grateful thanks to
@DeborahAzizi for alerting me to this story and @dasilva_uk @K4Health @bishtraining @SexEdUKation @EdForChoice @bohaynowell @Abortion_Rights @NoRisks @BrookCharity @michaelgrayer @Matttskimo @dianthusmed for critical reflections on the coverage, data and health implications. And to my many friends working in reproductive healthcare and general practice for providing me with medical information for this post. (Please remember I’m not a medic and this isn’t a replacement for medical advice so speak to your GP or Reproductive Health Clinic or call the FPA on 0845 122 8690 if you are worried).

It’s nearly Christmas and you may have already got gifts for friends and family. But if you’re still wondering what last minute goodies to buy, or can stretch to one more present, then here’s a few suggestions for charities and organisations who could do with your support.

These are all programmes I feel are often not given much publicity and may not fit in the usual ‘good gift’ type Christmas promotions, but nevertheless do amazing work all year round and deserve our support.

I’ve picked 6 charities/groups who represent various different activities around sex, relationships and health. Some are faith based, some secular. Some are specifically focused to one region or country, others are international. You may want to support the one you feel most impressed by – or perhaps give a small amount to several of these very good causes.

As well as financial support there are also other ways to help these organisations so do read up on any that interest you and see if you can help them as a volunteer in the new year.

Hesperian Foundation
Hesperian is a non-profit publisher of books and newsletters for community-based health care. It produces free resources in various different languages on topics such as Where There Is No Doctor, Disabled Village Children and Helping Health Workers Learn.

Here are ways you can get involved, which don’t just involve financial donations – you can also volunteer, translate and review books, and let other people know about the work Hesperian are doing.

Jabulani Rural Health Foundation
Jabulani is a non-profit organisation that supports Zithulele Hospital and its surrounding community. Zithulele Village is situated in a remote part of the Wild Coast (Eastern Cape Province, SA). Founded in 2007 by four Christian doctors, our focus is on healthcare, education, poverty relief, environmental issues and care for those affected by HIV/AIDS.

Practitioners at Zithulele have introduced a number of innovative programmes for rural health which have been reported in The Lancet and SAMJ and include nutrition, maternal health, occupational therapy and education projects.

A short film about the hospital can be found here:

Donation information can be found here
Become a friend of Zithulele here

Scarleteen
Scarleteen is an independent, grassroots sexuality education and support organization and website. Founded in 1998, Scarleteen.com is visited by around three-quarters of a million diverse people each month worldwide, most between the ages of 15 and 25. It is the highest-ranked website for sex education and sexuality advice online and has held that rank through most of its tenure.

More info here

Donate here

Outsiders
Outsiders is a community for people with physical and social disabilities that enables people to meet, make friends, overcome isolation and form relationships. It coordinates local meet ups, provides advice and hosts numerous events to raise funds for greater advocacy for people with disabilities. It also operates a peer support network, lobbies for greater rights for disabled people, and informs health and social care practice around sex, relationships and disability.

As well as providing financial assistance there are other ways you can help Outsiders including lobbying on issues around disability rights, and assisting the organisation with research, advocacy and resources. More information on how to give here

Education for Choice
Education For Choice is the only UK-based educational charity dedicated to enabling young people to make informed choices about pregnancy and abortion.

When young people have opportunities to explore the decisions that can lead to and result from pregnancy they are better able to:
Protect themselves from sexually transmitted infections and unintended pregnancy
Make informed choices
Access appropriate services to support their choices.
Education For Choice’s work is focused on the word choice. Whilst we concentrate on the issue of abortion, as it is the issue that receives least attention, we believe that work with young people should value all pregnancy choices equally.
Our ethos is that the best outcomes of unintended pregnancy occur when the woman involved has been able to make her own informed choice.

Donate here

The New View Campaign
The New View Campaign was formed in 2000 as a grassroots network to challenge the distorted and oversimplified messages about sexuality that the pharmaceutical industry relies on to sell its new drugs.
The pharmaceutical industry wants people to think that sexual problems are simple medical matters, and it offers drugs as expensive magic fixes. But sexual problems are complicated, sexuality is diverse, and no drug is without side effects.

The goal of the New View Campaign is to expose biased research and promotional methods that serve corporate profit rather than people’s pleasure and satisfaction. The Campaign challenges all views that reduce sexual experience to genital biology and thereby ignore the many dimensions of real life.

The New View Campaign is devoted to education, activism, and empowerment. We invite you to benefit from the information on this website, and we invite your support and participation.

More information on donating and volunteering for the New View, as well as implementing its ideas into policy and practice can be found here

I hope you are able to support one or more of these charities/organisations financially or in some other way.

Thanks for your continued support for this blog. Your feedback, suggestions and ideas for content (and how to improve the blog) is always very welcome.

Wishing you a very Merry Christmas and all the best for a happy and healthy New Year.

To get people in the Christmas spirit – and the mood for giving, I’ll be sharing carols, seasonal songs and a few sketches on twitter between 1-4pm on 22nd December (GMT) on the hashtag #PsXmasCharityConcert.

If you missed it, here’s the concert in full – please consider giving to one or more of the charities/organisations listed above while you tune in!

We opened with Mariah Carey’s All I Want For Christmas Is You

Followed by Meryn Cadell’s The Cat Carol which you can listen to here. [Not really suitable for young children, anyone who feels a bit hormonal, or people who like cats]

Then it was time for a bit of reading, with the fabulous Joyce Grenfell’s Nursery School Nativity Play And George, Wise Men never do that…

I bet you’ve never heard a better (or madder) version of The Little Drummer Boy than this one by The Klezmonauts.

It’s a Christmas tradition in our house that my dad reads King John’s Christmas as part of our family concert (he does it beautifully). So it felt apt to include it in my virtual Christmas Concert.

Next it was time for some Christmas kitsch – and it doesn’t get much kitscher than Eddie Dunstedter and his organ. I feel like I need a pair of heels, a cocktail and a Christmas pinny to really get into this one…

And if that wasn’t camp enough, it was time for some innuendo with Larry Grayson asking ‘Who’s stuffing your turkey this Christmas?’ (Go on, you can tell me!)

Do you believe in reindeer and the magic of Christmas? Of course you do! It’s only those pesky physicists who try and spoil things with all their logical explanations. Bah humbug!

Another song due after that, and it was over to Si Cranstoun and a very jolly Miss Santa Claus (he’s part of the Dualers – who are fab!)

What could be more seasonal than a song about an Angel Gabriel by LAMB?
I can fly
But I want his wings
I can shine even in the darkness
But I crave the light that he brings

Hoping you have someone in your life who make you feel this way.

On a lighter note I asked if people were familiar with the term Camp As Christmas? You will be after watching Bearforce 1 and ‘Christmas is here’ (which frankly ought to be the Christmas number one IMHO)

Next it was time for an activity for all the family – and kids of all ages. The Santa Application form (which I use in teaching questionnaire design – only at Christmas obviously). Still time to get your application written!

Obviously it wouldn’t be Christmas without a bit of Judy Garland, and the tearjerker anthem Have yourself a merry little Christmas

Last up in the virtual concert was my favourite carol In The Bleak Mid Winter which has the most beautiful words written by Christina Rossetti. I have a bad habit of ruining carol services by blubbing my way through the final verse of this.

Thanks for joining in my charity concert – either here or on twitter, and remember this was all for the good causes listed above, so please give them your money or your time if you are able.

Merry Christmas!

Yesterday I was alerted to a worrying press release by @MrMMarsh (who has an amazing track record in critiquing commercial surveys). It was for Bounty.com – a parenting website, conducted by OnePoll. It claimed “one in 10 women have tricked a man into getting them pregnant with less than half actually wanting the person they ‘used’ to stick around once the baby was born” and went on to make further allegations about the women who deceive their partner into helping them conceive.

These women, according to this press release, are liars and tricksters, who use their seductive wiles to beguile men into parting with their seed.

Hmmm. Sounds similar to the way we used to accuse women of witchcraft – how apt for Halloween.

And apparently that was the reasoning behind this baffling campaign. According to Bounty (who had the story on their ‘entertainment page’) the poll was just a bit of ‘seasonal fun’. Doubtless they were only thinking of this in purely ‘fun’ terms, playing around the term ‘trick or treat’ with the suggestion women ‘tricked’ men into paternity. But due to a lack of forethought they inadvertently rehearsed other, far more sinister narratives about women’s sexuality that have been used to judge and harm women for centuries.

Perhaps unsurprisingly the campaign backfired. Massively. The outcry on Twitter and elsewhere online was uniformly negative about Bounty, OnePoll, and the ‘women as tricksters’ campaign.

However, that wasn’t before the story hit the headlines with coverage in both the Sun and the Daily Record.

What’s wrong with this poll?
The press release outlines 10 ‘most common ways women ‘trick’ someone’. Since we don’t have the original questions asked we can only assume they were based around these options, which include:
1. You just didn’t talk about it
2. You told them you were on the pill
3. You told them you’d had the injection
4. You weren’t very careful about taking the pill
5. You got them drunk
6. You told them you’d had the coil fitted
7. You put a needle through the condom / wrapper
8. You told them it was the wrong time of the month to conceive
9. You had a one night stand and didn’t make them use contraception
10. You told them you were infertile

These are a very odd mix indeed, and many of them describe common events that are not deliberate attempts at deceiving a partner into getting you pregnant. For example failed contraception (listed in 4) is a fairly common way for pregnancy to occur (although this survey presents it in a far more blaming way). Being confused over when you are fertile (which is one way of interpreting number eight) is also another reason women can find themselves pregnant. Simply not discussing pregnancy is not a definite sign of ‘tricking’ a partner. For many couples the topic of pregnancy is not always paramount unless they are particularly struggling with conception.

Not using contraception on a one night stand isn’t a great idea but it does happen and unless you’re specifically out to try and get pregnant from the encounter again is not a sign of someone deliberately tricking a partner into a pregnancy. It might, however, be a case of someone assuming they can’t get pregnant from a one night stand and discovering that’s a myth.

Knowing you’re fertile and telling someone otherwise (10) is not the same as thinking you may not be fertile and finding yourself pregnant – not unusual as some women will attest.

While options 2,3 and 6 involve lying about contraception use and 7 specifically describes scuppering a contraceptive, the remaining questions could easily happen without a person deciding to maliciously mislead another. Because there is no follow up to these questions there’s no way of knowing the context in which they happened.

From this the press release jumps to talk about how women continue to lie after they’ve got pregnant and talks about trapping ‘an unsuspecting male’.

While the press release does explain the majority of women don’t do this, the overwhelming tone of the story is that women are liars and out to trap men by getting pregnant. That they’re so deceitful they’ll continue to hide the secret that they tricked someone into getting them up the duff.

Why is this survey a problem?
Leaving aside the issues outlined above there are very real reasons why a survey like this is dangerous. Pregnancy and parenthood, while often positive, can also be stressful and difficult. Both can place considerable pressure on relationships. Adding to this any suggestion that women lie about getting pregnant could be devastating to many couples.

We already know that domestic violence is intertwined with paternity disputes (see here , here and here for example), although this is more often over concerns or accusations of whether a child is the biological offspring of a parent. Jealous and/or controlling partners can use accusations over paternity or the circumstances of a pregnancy to justify abuse.

At the very least this survey could put doubt into the minds of partners that they may have been conned into a pregnancy they weren’t ready for or perhaps didn’t want. Or make women feel their partners will distrust them. This might cause new parents to worry at one of the most vulnerable times in their lives. And if couples are already struggling because of distrust over conception this survey could provide unhelpful ammunition and widen the gulf between people.

Obviously it would be remiss to say no woman has ever misled a partner over a pregnancy – either with good intentions or maliciously. But this study was not robust or compassionate enough to explore this issue sensitively. Instead it overemphasises the likelihood of cheating a partner – and implies this is always deliberately malevolent.

As this is such a sensitive issue it would be reassuring to know how participants were treated. Because neither OnePoll nor Bounty have made the process of this study transparent we have no idea how participants felt about being questioned over the circumstances of their conceptions. Could they have felt judged? Embarrassed? Humiliated? Were they left fearful a partner might discover they had not been clear about their motives in getting pregnant? Were some left feeling they were liars when previously they’d simply thought they’d misunderstood their cycle?

In social research you should always be careful not to cause harm or distress, to anticipate what harms you may cause in the questions you ask. On a potentially sensitive topic like this you would usually have many steps in place to ensure participants were supported and helped if the work raised any issues for them. We have no idea if women who took part in this survey were distressed by it (or the subsequent reporting).

It is important to stress that in all probability neither Bounty nor OnePoll considered the issues of domestic violence or relationship harm when putting this work together. I am not arguing here they deliberately aimed to distress women and their partners. However it does indicate the lack of consideration behind this work. Part of good survey work (and all social research) involves thoroughly considering and planning for all potential interpretations, outcomes and consequences of your work – good or bad. It is shocking that nobody at Bounty or OnePoll could apparently see what potential problems this work could create.

Given the poll is problematic on so many levels – and the public reaction to it so negative – you might have expected Bounty and OnePoll to take immediate and apologetic action.

Bounty’s response
Bounty initially shared the story on Twitter, however once they began to receive criticism for it they deleted this message later following it up with the statement “Apologies 2 any1 offended by our recent research story – this was meant as a bit of seasonal fun & is by no means a judgement of anyone”

While they were right to apologise, their reaction that this was ‘fun’ did not indicate a real understanding of WHY people were so offended by their publicity stunt. Nor did it seem sincere given they kept the poll information as a headline feature on their ‘entertainment’ page, despite requests to remove it.

OnePoll’s response
OnePoll’s reaction was as problematic as Bounty’s. If not more so. Rather than directly engaging with the issue or apologising (as Bounty attempted) they contacted me on Twitter saying Hi there – we are the agency who carried out this research, would love to have a chat with you, DM me your number? Thanks!

I suggested they email me a statement, which they duly did:
“As the agency which commissioned this research and distributed the resulting news story, I would like to respond. OnePoll polled 3,000 mothers on behalf of Bounty, looking into the subject of pregnancy. The stats emerged that a small percentage of women admitted to tricking their partner into getting pregnant. I’d like to say that the resulting story in no way glorifies or condones this, in fact Bounty support the very opposite in their quotes. As market research specialists and providers of national news, we would always present the stats, as they are, however controversial. I would like to apologise to anyone who was offended by this piece of research”.

Let’s look at this statement in more depth. The poll apparently was on the ‘subject of pregnancy’. Was this how it was presented to mothers? If so, how may they have felt if then asked to discuss if they had ‘tricked’ their partner into getting them pregnant? We don’t know the answer to this.

The press release and subsequent media coverage may not be seen as ‘glorifying’ misleading a partner, but it does make it seem like a major issue and the press release and subsequent coverage are highly judgemental to women as a result. The stats here (not presented by the company at this time) were arguably always going to be ‘controversial’ because the questions asked were framed in such a way as to create this outcome. As was the press release.

Rather than this being a case of a robust piece of carefully designed and sensitive research into fertility being accurately reported, what we see here is a deliberate strategy to create a shocking headline that will guarantee press coverage. Although it’s important to stress this is a standard approach in PR nowadays, so nothing particularly unique to or sinister about this particular poll.

I found the response from OnePoll odd. At a time when their work was being debated on Twitter they decided to email me a statement. I don’t know why. I responded:
“Thanks. I think you would be better of making these statements on Twitter and taking responsibility there. Ethically I think this was not a good approach and I hope given the criticism you’re noting from researchers, PR and other marketing companies – as well as from parents – that you will work to deliver more thoughtful work in the future.
Since you’re stating you think it’s important to put out the stats ‘however controversial’ you should also make these available via your site now so people can see the questions you asked, the way you recruited your participants and the data you collected.
Perhaps as Bounty have had the grace to apologise you may also want to make it clear it was not a serious piece of research rather than trying to make it look otherwise.
Many people were offended by the research and also your role in it. I think it best you try and repair that damage now on Twitter, on your website and through your future conduct”.

I followed this with a message on Twitter that I had been in discussion with OnePoll and advised them to apologise, justify the survey and make their data publicly accessible (as they claimed in the email is standard practice).

No response came to my email or to anyone’s messages on Twitter. At this time OnePoll have not apologised for nor justified this work on Twitter or their website. Nor have they made the data from this poll publicly available despite saying it was standard practice. They have, however, celebrated the news coverage of this story on their website.

If either Bounty or OnePoll genuinely were concerned over running this survey or the message it portrays their reaction would have been different. It suggests neither company are particularly concerned but simply want criticism to go away. Perhaps other people working in PR or communications could pick up on how this issue has been handled and what impact it could have on brand Bounty or the reputation of OnePoll.

What you can do?
Judging by responses on Twitter today, plenty of people have been upset by this survey and the actions of both OnePoll and Bounty. If you feel this has not been adequately dealt with you can take further action.

For Bounty you can write to their advertisers – all shown on their website asking them if they are comfortable placing their adverts with a parenting organisation who approve publicity stunts that present women as liars. And who then apparently ignore the distress caused to parents and the public. You may also want to do this more publicly engaging Bounty’s sponsors on Twitter, Facebook or other social networks where they may have a presence. If you belong to Bounty (or have purchased their products/services) you may consider whether you wish to continue this relationship.

OnePoll can be reported to the Market Research Society who oversee correct conduct and ethical practice in commercial social research. An outline of their professional standards can be found here, while details of how to make a complaint can be found here.

Everyone is accountable here, everyone signed this work off and approved it at all stages. From coming up with the idea, through to asking women about their experiences, through to writing the press release and subsequent submission to the media.

There were plenty of steps when SOMEONE could have noted there was a major problem and put a stop to this work. Nobody did. Everyone involved needs to take responsibility for this.

Commercial companies and market research ones need to learn they can’t misuse surveys to promote products, particularly if they could cause harm or mislead people. The same social networks they use to promote will be used to hold them accountable and expose poor practice. Creating commercial campaigns that could harm or distress cannot be explained away as ‘seasonal fun’. Here’s hoping both Bounty and OnePoll have the courage and decency to make amends for this sorry tale.

Today sees the launch of FPA’s Sexual Health Week 2010, with the focus of this year’s event aimed at the over 50s. Entitled ‘Middle Aged Spread’ it’s the first dedicated sexual health campaign aimed at this age group with the message for people in the 50+ bracket who are starting new relationships that they can get an STI “as easily as someone in their 20s”.

This may come as a surprise to those more used to associating sexual health problems with younger people. Indeed we’re only too aware of the prevalence of sexually transmitted infections in the under 25s - partly due to a lack of sex education and other negative factors, and partly due to better detection and treatment of infections.

However, we are also aware those in the over 50s are an important group to target as they may well have missed out on sex education in their youth, may not have been part of a generation who particularly worried about condoms and safer sex (although certainly were sexually active), and who may mistakenly believe they are not at risk from STIs because they’re older. And of course being older doesn’t stop it being difficult to ask a potential partner to use a condom – particularly if you’ve not had sex with a new partner for some time. For women who’ve not passed the menopause pregnancy is still an issue and guys can still get someone pregnant although this may not always be something that’s considered as much in the over 50s. Tessera blogs in more depth about reaching baby boomer’s sexual health needs here.

While this campaign is focused more towards condom use and older people, sexual health week also addresses wider issues around sexual wellbeing. Events will be run across the UK on managing your own sexual health, negotiating condom use (and carrying condoms), confidence in relationships, accessing sexual health services and when to seek help for an STI. If you’re hosting something let me know what you did and how it went and I’ll feature it on a future post. And if you’re a journalist do find out what’s going on across the UK and report on what’s going on – it’s a great opportunity to focus on empowerment and positive messages around managing our sexual wellbeing and relationships health. All of which is important given recent research findings suggesting while people are aware of STIs and the need for testing and treatment 1 in 3 remain too embarrassed to seek help.

Thinking about contraception is also a part of sexual health week, and there’s an exciting new tool designed for practitioners and the public to assess their contraception needs – and find the right contraceptive for them. My Contraception Tool is a project shared between the Family Planning Association and Brook, in collaboration with Maldaba Ltd, and the London School of Hygiene and Tropical Medicine.

Sexual Health Week isn’t just happening in schools, colleges and healthcare settings across the UK, it’s also part of online advice giving (see above). Which has had a boost in the past week by new research from Julia Bailey and colleagues from UCL who reviewed the evidence on interactive computer based interventions for sexual health promotion which suggests these can play an important role in sexual health promotion. This didn’t come as particularly surprising news to those of us engaged in sexual health advice giving online and across social media, although it is heartening to hear initiatives being reviewed in this way. Future research on this issue also needs to focus on how such interventions/initiatives are established, evaluated and sustained as there’s an ongoing problem of work being reinvented, a lack of coordinated approaches and a problem of initiatives being measured on audience figures rather than any other impact factor. This will certainly be a topic worth returning to in future sexual health promotional campaigns and research.

All too often sexual health campaigns tend to be depressing, overly medicalised or focused solely on infection control – little can be heard about pleasure, desire, communication or assertiveness. They’re also characterised by being serious and worthy. There’s no real fun to be had in the campaigning world of sexual health – and perhaps that explains why people don’t engage with campaigns or find it very difficult to cope if they are diagnosed with an infection.

So I was pleasantly surprised to see one initiative around trying to liven up sexual health education, from Science Matters. They’ve created a series of soft toy microbes which can be used to talk about sexual health. So far these have been used in school lessons, for training educators, and in projects with young offenders (who have to pick different infections out of a grab bag). I’m hoping to report more on the use of these little critters in youth and adult education. In the meantime you might want to celebrate sexual health week with
Chlamydia
Gonorrhoea
Hepatitis
Herpes
HIV
Kissing Disease
Syphilis
Or perhaps a little egg or some sperm?

And I’ll leave you with one of my favourite reminders about condom use (poss NSFW) – and remember sexual health isn’t just an issue for the over 50s, or for one week a year Sexual wellbeing is something for all of us to promote, as much as we can, and as often as we are able.

The Health Protection Agency has released its most recent figures on Sexually Transmitted Infections (STIs) (including HIV) today. This is based on data collected from GU clinics across the UK annually. You can read the main report here. Those who’re of the more thorough/geekier persuasion may also want to look at the data summaries of STIs (including breakdown by region, ethnicity and age) available at STI Epidemiology in England 2009 and Trends in STI diagnoses. I would recommend reading and critically appraising the HPA report and datasets if you are interested in this topic – particularly if you’re writing about it for the media, blogs or using it in health education/practice.

What are the main findings and recommendations of the HPA report?
* Numbers of new diagnoses of sexually transmitted infections (STIs) in the UK rose by 3% between 2008 and 2009, continuing the trend of the past decade.
* The impact of poor sexual health is greatest in young heterosexual adults and in men who have sex with men.
* There is considerable geographic variation in the distribution of STIs with highest rates seen in urban areas of higher deprivation, reflecting concentrations of the population who are at greatest risk.
* Some antibiotics may become less effective (or even ineffective) in treating STIs in the coming years.
* Increasing sexual behaviour risk may be contributing to the rise in STIs and will have done so in men who have sex with men, but much of the change will have been due to the increasing application of more sensitive tests throughout the past decade and to the more recent expansion of Chlamydia screening of young adults in community settings.
* Prevention efforts, such as greater STI screening coverage and easier access to sexual health services, should be sustained and continue to focus on groups at highest risk.
* Health promotion and education remain the cornerstones of STI and HIV prevention through improving public awareness of STIs and HIV and encouraging safer sexual behaviour such as consistent condom use and reductions in both the numbers and concurrency of sexual partnerships.

Why are UK STI rates rising?
Over the past five years there have been several initiatives to improve testing and treatment for STIs. This has included
- more rapid testing (particularly pee in a pot tests) and screening for STIs such as Chlamydia and Gonorrhea
- greater targeting of the under 25s to have said testing (via GPs, community pharmacies, and GU clinics)
- improved data collection on STI rates via individual services and the Genitourinary Medicine Clinic Activity Dataset
- a shift in focus in public health campaigns from STI prevention and normalising condom messaging towards testing/treatment focus
- attempts to make services more accessible to young people with initiatives such as ‘You’re Welcome’
- sexual health services have been modernising and restructuring, with standards of care established and sexual health networks being created to try and improve sexual and reproductive health services

It would be naïve to claim all of these changes are responsible for the identification of record levels of STIs, nor that all of them have been effective. But it is worth noting (and the HPA report acknowledges) that some of the increased detection of STIs will be down to higher levels of screening. So from that perspective the figures are more positive – it tells us we are identifying and treating people with STIs more than in the past.

Alongside these healthcare initiatives there are other, less positive reasons why STI rates are rising in the under 25s. These include:

Our lack of comprehensive, quality sex education
Sex education remains patchily delivered across the UK with some places doing excellently, others not so well or even teaching negative messages (more information here and here). Young people generally are afraid of unplanned pregnancy (and overestimate rates of unplanned pregnancy), but less aware of STIs. This is particularly the case if education focuses on teaching the names of STIs and showing gory symptoms, but doesn’t explain how you get and prevent STIs or talk about how many are symptomless.

Public Health Campaigns
While we have had government led public health campaigns aimed at the under 25s for the past twenty years these have been patchy, underfunded, and subject to numerous changes in messaging resulting in confusing ideas shared (my insider view of the problems with UK government backed sexual health campaigning can be found here). Despite the limitations of sexual health campaigns from the previous government it is worth noting the current coalition appears to be doing little in the way of public health campaigning for sexual health services.

Access to and funding of services
GU clinics have traditionally been referred to as the ‘Cinderella service’ – not as well funded nor respected as other areas of healthcare. Getting appointments also remains a problem with some services struggling to give appointments in 48 hours or less. In many places waiting times can be weeks rather than days. While demands on services continue to increase, along with the workload of staff rising massively, funding to match these demands is not forthcoming. Perhaps unsurprisingly some staff aren’t always sympathetic which can be off putting. Meanwhile despite underfunding, over expectation and cuts, it is generally staff who are blamed if services don’t hit targets.

Aside from getting seen within services is the wider problem of people knowing how to find them. Many clinics still struggle with promoting their services to the public, or being open at accessible times.

To see how it works in practice, try this experiment. Imagine you’re 16 (or thereabouts). You still live at home. You need to find where a sexual or reproductive health clinic is in your area. Your school hasn’t provided you with any advice, you can’t ask your parents and your friends aren’t much help. Without using the internet, how do you find a clinic locally? Look around your neighbourhood. Can you spot any posters or leaflets? Is there information at your pharmacy or GP practice or library? Are there any youth centres or clinics offering support – and if so when are they open? If you find services are there any that are open at times you could get to? (To make it more challenging imagine you were under confident, struggled with literacy or language, or perhaps had very strict parents who needed to know your whereabouts – this may further limit what you would be able to access).

Silo working
While there is plenty of research on sexual health services and initiatives to improve waiting times, accessibility, youth friendliness and treatment/testing options, alongside evaluations of what works within sex education, we sadly do not see much in the way of collaborative working. This is often referred to as ‘silo working’ where individual practices, organisations or individuals may well have great ideas but do not share them together. Alternatively work may be replicated (including mistakes) or opportunities for collaborative practice are missed. While services are overstretched, underfunded and pressurised it is difficult to find the time or enthusiasm to network.

Culture, attitudes and sexual climates
Norms and values relating to sexual behaviour have undoubtedly shifted over the past few decades. Pre and extra marital sex is no longer viewed as taboo by the majority of the UK population. Contraception to prevent pregnancy has enabled people to have sex for pleasure. Discussions about sex within popular culture have become more prevalent and some may argue more explicit, although this has not been matched with education to enable people to negotiate a culture that may well feel more sexualised to some. New technologies, the internet and shifts within publishing have allowed easier access to sexual imagery. These are not in themselves a problem but may become one if people do not have the life skills to interpret what they see and enjoy respectful relationships.

Our media undoubtedly plays a role here by covering sexual health stories with a mix of salacious scandal mongering and moral judgement. Every time sexual health data is released the media’s approach is to hysterically report a crisis and speculate on the reasons for it, but at no point to campaign for any initiatives to improve sexual health. The media COULD help by being supportive about sex education, campaigning for more funds to GU services, highlighting how to access services (for local news) or providing accurate sex advice to help people negotiate pleasurable safer sex.

Confusing/mixed messages on safer sex
STI rates can be reduced by condom use. Many young people do use condoms, but they may not consistently use condoms with partners over time. And they may also not get screened for STIs before using a non barrier method of contraception. The focus on testing and treatment without including prevention messages means some young people assume regular testing is sufficient to cope with STIs. Clinicians and sex educators often give mixed messages with some suggesting regular testing is mandatory, others advocating self management and using barrier methods of contraception is better. So people can be confused about what the right approach to managing their sexual health should be.

Confidence and communication
Evidence suggests young women in heterosexual relationships find it difficult to negotiate condom use, while young men will use condoms but won’t necessarily mention them unless a girl does (for more on condom negotiating styles and gender see, for example here). Varying sexual health initiatives have attempted to encourage girls to carry condoms and insist on their use or enable young men to do the same. Some have also focused on clearer communication and negotiation skills both about safer sex but also around discussing other intimate and pleasurable topics together. Studies on men who have sex with men indicate older men tend to be more aware of condom use but there is still variable use within relationships and condoms tend to be used more for anal sex than during other activities like oral sex or masturbation. Both straight and gay couples can assume condoms only need to go on just before a man is going to ejaculate so have penetrative vaginal or anal sex without a condom, putting one on before a guy comes.

‘Risk’ and ‘responsibility’
Negotiating safer sex is more difficult when alcohol is involved, and most people do not assume their partner is likely to have an STI. When you’re thinking about how much you fancy someone you’re not necessarily considering their sexual history. There can also be the view that STIs are things that happen to dirty, bad or promiscuous people – other people, not you. Sexual health messaging – particularly through education and public health campaigns often overemphasise morality discourses of ‘risk’ or ‘responsibility’. These tend to be ineffective as many young people do not consider being intimate as inherently risky or irresponsible. Such an approach also assumes older adults act in different (and more ‘appropriate’) ways than younger people, which is neither fair nor true. Within much sex education and healthcare lies the subtext that ‘good’ sexual behaviour is always being prepared, always having condoms to hand and always effectively negotiating their correct use, while sober. What may be great in theory often simply does not happen in real life.

How did the media (and public) respond to this story?
The media response to this story was interesting. Most coverage I saw repeated the HPA’s press release pretty much, some adding additional comment about why STI rates were so bad (most of them missing key areas as outlined above). While the coverage was perhaps not as hysterical as recent discussions on young people and contraception or abortion, there was still very much a subtext of blame and judgement among much coverage. Accompanied by a lot of handwringing about the state of our nation’s sexual health with relatively little discussion of what we might do to improve our wellbeing.

The overwhelming majority of coverage did not clarify that much of the increased prevalence in STIs was down to testing initiatives and treatment programmes. The focus suggested the STI rates were solely down to young people having multiple partners.

It seemed most journalists did not consult the HPA report nor particularly interrogate the data. Those called upon to comment were not generally selected from GU services or sexual health research. Instead it seemed anyone who’d ever written something about sex, sex therapists or generalists on the topic were asked to give their opinion about young people and their behaviour rather than appraise or expand upon the HPA data. Some of the comments made by sex experts on twitter, broadcast and print media clearly showed they had also not consulted the HPA report but still commented on its findings. It is very worrying when both a journalist and the person they ask to explain a report have not actually looked at said data.

Additional input from experts and the public shifted the debate towards a more blame-focused narrative generally blaming young people, or repeating memes such as:
- young women are all victims, they cannot make decisions for themselves
- young men are all predators, who are at the mercy of their overactive sex drives
- feminism has caused young women to act like men
- Sex and the City has taught young women to be promiscuous
- Young men are being blamed for STI rates
- Young women are being blamed for STI rates
- Young men’s needs are being ignored
- Young women’s needs are being ignored
- Young people are feckless, irresponsible and simply don’t care about STIs
- ALL young people undoubtedly know ALL about STIs and cannot claim otherwise
- Sex education/pornography/rap music etc is to blame for rising STI rates
- STIs were not a problem for previous generations
- Scaring young people about STIs will put them off having sex and combat this trend
- Young people who get STIs (particularly repeatedly) should be punished/refused access to healthcare
- STI rates are just as bad in the over 40s, if not worse than in the under 25s

While some of these are more extreme than others it does show how often this debate is further hampered by moral and opinion based discussions that have very little to do with the realities of why young people get STIs. Rather than exploring reasons and finding solutions we are encouraged instead to blame, shame and generally judge people who have STIs – not focus on wider causes or feasible solutions.

What can we do about our STI problem?
This is not a case of us having a problem but not knowing what to do about it. Our epidemiological data for STI rates is improving every year, sexual health services are modernising and new initiatives for testing/treatment are available, alongside prevention messages and strategies to promote safer sex. We know quality sex education increases safer sex and the likelihood of people being able to communicate their sexual needs assertively while reducing coercive behaviour. We know that training up teachers and health professionals to talk about sexual health issues with confidence – and to see these issues as important is necessary. We know young people are interested in such information. We know services would work better with more funds and resources, and if collaborative working was encouraged – and if the media supported rather than scuppered sexual health initiatives.

There is no mystery here. We have ample evidence to fix this. We are failing to do so because our debates on this issue focus on blaming young people and those with STIs and not focusing on the systemic problems that need to be fixed. This is not to say people are not responsible for their own sexual health, but with our current haphazard approach we also do not enable people to take control over their sexual wellbeing.

Data like this always tells a story – about people affected by STIs. But it perhaps masks the discomfort, anxiety, nuisance, distress or fear having an STI may cause. It misses what can happen to relationships, people’s self esteem, or future fertility.

It’s very easy to sit in judgement on those who have STIs. Assuming you don’t have one (are you sure?) or you would never have unprotected sex. It is very easy to believe we’re facing rising STIs purely because of feckless youth. But it completely misses the point. This is a major health crisis – and it affects us all.

Sources of help, advice and further resources
Sexual Health Helpline call 0800 567 123
NHS Choices on Sexual Health includes resources, advice materials and the facility to find your nearest sexual health/genito urinary clinic by postcode
Manchester Sexual Health Network has created the most comprehensive list of related links on GU/SRH I’ve found
NHS Evidence – Sexual Health Services links to resources, data and research on sexual health in the UK

Parents across the UK are understandably being made anxious by news reports today suggesting:

Rise in 11 year olds on the pill (Sunday Times)

One thousand girls on Pill at 11: Huge rise in contraceptive prescription for pre-teens without parents knowing (Daily Mail)

Huge rise in 11-year-olds on the pill (Telegraph)

The UK appears afflicted by ‘soaring’ numbers of sexually active girls, who lie to parents, enabled by GPs.

Is it accurate?

No.

Here’s why.

Where did the story come from?
These reports are based on figures from the General Practice Research Database (GPRD), indicating 1000 11-12 year olds annually are prescribed hormonal contraceptives (usually the pill or injection).

This was picked up by firstly the Sunday Times then spread to other newspapers, websites and broadcast media. As we’ll see journalists did not show due diligence in investigating the story.

Are 11 year old girls using hormonal contraceptives?
Yes. But despite the media hype there are many medical reasons why young girls might be prescribed hormonal contraceptives including:
- Heavy periods (resulting in excessive bleeding, vomiting, diarrhoea)
- Acne
- Endometriosis
- Polycystic Ovary Syndrome (PCOS)
- Irregular periods
- Amenorrhea (no periods due to extreme weight loss, anorexia, or side effects of radiation/chemotherapy)

Taking hormonal contraception is, for many girls, a means of ensuring they don’t miss school. It reduces symptoms that could be painful, distressing and single them out for bullying. When the pill is prescribed for medical reasons usually it is parents, in discussion with their daughters, who initiate contact the GP.

Of course hormonal contraception also prevents pregnancy. But being on the pill is not an indicator of having underage sex.

Approximately 26% of young girls have sex before the age of 16 Most are around 14-15. Fewer very young girls have sex and those who do are more likely to be coerced, regret the experience, struggle with access to healthcare and education, and lack family support. They are also far less likely to use any form of contraception. [More information on underage sex here]

What did the GPRD data say about different uses of hormonal contraception?
Unfortunately the data from the GPRD does not break down reasons for prescribing hormonal contraception to young women, so we cannot conclude precisely why they are using it. This hasn’t stopped media speculation it’s primarily for pregnancy prevention, wrongly suggesting all young girls on the pill are sexually active lolitas.

The media says teens don’t need parental consent to talk to a doctor. Is that true?
It is true practitioners do not have to tell parents if a young person consults with them (about any issue), guidance such as Gillick Competence and Fraser Guidelines (specifically for contraception). These set out the circumstances under which young people can get help without parental consent, and when parents or social services need to be involved. All of which happens with the awareness of a young person.

Generally practitioners want a parent or carer to be involved in supporting a young person. So providing health advice on any topic without a parent being involved tends to only happen in specific circumstances (explained in the links above). Before giving any advice practitioners are keen to establish the young person’s situation and find out what options they see themselves as having.

Aside from access to healthcare being a basic human right for any child or teen, there are sometimes very good reasons why a young person needs to talk about sensitive issues to their doctor. This may be when they live within a very strict home, or where their parents are absent or neglect them, or where they are subjected to abuse by their parents (or by others but are not protected by their parents).

So did the media make this story up?
Clearly ‘11 and 12 year old girls prescribed hormonal contraception with parents consent to prevent health problems’ doesn’t have the same salacious ring as ‘sexually active 11 year old girls’. The uncritical coverage does not refer to evidence based practice nor particularly includes reproductive health practitioners. Instead it relies heavily on the Christian Medical Association who have an anti sex education (and anti pre marital sex) agenda.

It wasn’t that the media lied about this story, certainly teens are using the pill for medical purposes and to prevent pregnancy. But this is not new. Doctors have been prescribing hormonal contraception to treat numerous complaints for decades. Just because it’s news to the media doesn’t mean it is not standard clinical practice.

Is sex education to blame?
Several news reports suggested the phenomena of young women using hormonal contraception was down to sex education – or would be made worse if sex education was implemented for young people. Indeed coverage on this was very confused on the actual or possible role of sex education in all this.

Currently sex education is not statutory across the UK and standards of delivery vary widely. Ofsted has recently produced a damning report on the state of UK sex education, while NICE is currently consulting on improving sex and relationships education in the UK. [More on what young people want from sex education here]

It seems much of the press coverage on the GPRD data is aimed at discrediting Ofsted and NICE’s suggestions that sex education be improved and appropriately tailored relationships education could begin with children aged 5.

Why was this coverage so poor?
There is an ongoing crusade by elements of the media to be anti young people, particularly young girls, and against all forms of sex education. And as we’ve already heard scandalous headlines about teenage nymphos sound a lot more exciting than a small subgroup of girls having the pill mainly for medical reasons.

However there are several other important reasons why the coverage was so bad.

Reproductive health is always framed as a two sided, moral debate
As you’ll see from the stories linked at the start of this post the media sets these stories up as moral debates where there are distinct baddies (doctors, trampy teens and anyone offering sex education) and goodies (Christian/Family groups, parents). The media focus is not to explore reasons why young women might use hormonal contraception, but to demonise young women generally and the medical profession alongside them.

Broadcast media tends to take this a step further inviting live debate between practitioners and moral authorities, and most of the calls I took from journalists today were seeking to pitch me into battle – cast in the unwinnable role of the ‘pro sex bogeywoman’ (as @badhedgehog observantly noted on Twitter).

Unsurprisingly this atmosphere does not allow clear information to be shared that might reassure parents or young people. Nor does it challenge poor media coverage, leaving the public still believing that loads of 11 year olds are a. on the pill and b. all promiscuous.

Many journalists have a poor understanding of reproductive health
Discussing this story with journalists provided a fascinating, if frustrating, insight into how many of them simply lack the basic sex education that would enable them to evaluate reproductive health data.

During the course of today I’ve spoken to 15 journalists, mostly working for radio and TV news stations, and 13 of which have been male.

Through these conversations I discovered none of the journalists knew hormonal contraception had medical uses. All of them assumed hormonal contraception was simply used to prevent pregnancy. And because of this assumption it hadn’t occurred to them to find out what else hormonal contraceptives might be used for.

They also were confused over what hormonal contraception was, in several cases not realising the pill was only one form. Most seemed to believe hormonal contraception just meant ‘the pill’. One journalist thought the injection couldn’t be a form of hormonal contraception because it wasn’t ‘a pill’, while another believed the contraceptive injection was ‘worse’ than the pill as it ‘lasted longer’ and made girls ‘more likely to have sex’.

Most of the journalists couldn’t work out why a young woman might opt for a hormonal contraceptive in injection form. They interpreted opting for an injection as easier for some than remembering to take a pill regularly as further evidence of fecklessness. This reinforced for them the stereotype of sexually lax behaviour they associated contraception use with.

Even those who accepted hormonal contraception could have additional uses still returned to the idea the main reason young people were using it was to have sex. Or believed if they were given hormonal contraception it would automatically lead to sex soon after. Or make girls more likely to act in loose ways.

Persuading them parents are mostly involved in decisions of hormonal contraception use with young girls proved pretty difficult. One journalist said ‘you’d go as far as saying a girl should go on the pill if she has heavy and painful period?’. Well, yes if that’s what she and her doctor agreed would help her. This particular journalist then asked me if I could come on air and say the first bit (parents should put their daughters on the pill) but not the second bit (explaining why they’d want to do this). Obviously I refused but you can see how even when presented with evidence to show a story is wrong journalists won’t move away from a particular angle.

Sadly while most journalists I spoke to did seem interested to learn about the medical reasons for using hormonal contraception and finding out more about it, once it became clear I wasn’t willing to participate in a ‘debate’ about whether young girls are sexually active or not, they were not interested in discussing things further. (It could be the journalists I spoke to aren’t representative of the media generally or were trying to make a particular debate point with their questioning, but my interpretation was most genuinely seemed ill informed about reproductive health)

Healthcare agencies, particularly in reproductive health, did not speak up
The whole case has highlighted for me the need for agencies promoting sexual and reproductive health to offer basic training for journalists. There is obviously a great need for many journalists to have information about how to understand clinical data, but also having an awareness of sexual and reproductive health to help them interpret this information.

Sadly the majority of organisations dealing with reproductive health (including NHS Choices, Nursing Times and the Department of Health) remained silent during the day – even when requested directly through twitter and email to get involved. This is sadly a common pattern where organisations miss key opportunities to deliver health information.

While this may be partly due to the way the media frames stories like this and practitioners don’t want to be cast as the bad guy, if enough people spoke out we could achieve so much.

As much as I have criticised the media here it is worth noting there were also many other responsible broadcasters and writers who did want to cover the story but they were struggling to find anyone to talk to them.

We cannot complain about poor media coverage if, as health practitioners and educators, we do not offer our services to ensure accurate information is shared.

How should the media have treated this story?
This really is a non story, but if the media had wanted to report it accurately they should have looked at the reasons why the contraceptive was prescribed, whether parents had consented to their daughter using hormonal contraception, and indicated proportionally how many young people were prescribed the pill for pregnancy prevention without parental consent. Indicating the numbers of 11-12 year olds on the pill as compared to the wider population in this age group would put this in perspective in terms of prevalence. And they should have written this in a way to highlight how to safeguard young people most at risk. Who we know mostly do not seek out medical help and are often also unable to get help within their families.

The take home message is?
Sadly bad science, scaremongering rhetoric and poor journalism makes it difficult for parents and young people to get accurate information. This may result in making young people more excluded from the health care they need.

Unfortunately if we do not challenge it we will continue to leave parents terrified and young people disempowered.

This piece appeared in a shorter form for The Times Science today as Too much too young: most 11-year-olds aren’t on the pill for sex

With grateful thanks to everyone on Twitter today who challenged this story, shared information about young people’s rights, and generally kept me going when I was getting fed up shouting about it!

Today sees the launch of Contraception Awareness Week where we’re invited to think about contraception choices to suit our reproductive health needs.

This year the theme of the week is focusing on unplanned pregnancies in the over 35 age group, something that’s common but often underreported – and unexpected when it happens to women.

More information about the campaign and evidence underpinning it can be found via the Family Planning Association where you can also find out information about contraception options – whatever your age.

What’s the difference between sexual, reproductive, psychosexual and relationship health?

Sexual health refers to dealing with either sexually transmitted infections, or physical or psychological sexual problems (also called sexual dysfunctions).

Reproductive health refers to your fertility – either advice on getting pregnant, information on contraception, supplying contraception (to prevent pregnancy), or helping you deal with an unplanned pregnancy.

Some clinics specialise in sexual health, sexual problems or reproductive health, other services will offer treatment or advice for any of these issues.

Psychosexual health services tackle deep-seated sexual problems that could be caused by psychological and/or physical factors.

Relationship counselling services help with problems ranging from sexual communication difficulties, to jealousy and coping with arguments or life after infidelity or divorce.

These services are dependent on your location – there may be more services available in certain countries/states. The politics or religion of different countries/states may affect service delivery or approach. Many clinics offer free support and advice, some private clinics do charge a fee, as do some doctors in certain countries – if you live outside the UK check your health care policies for more information.

Many sexual health services particularly those for sexually transmitted infections are often overwhelmed by patient demand. Part of the reason for this is that people pick the wrong service for their needs – so consult the list below to ensure you get the right help at the right time. And tell your friends so they get it right too!

Your Doctor (GP/Family Practitioner)
What can they offer?
• Advice about contraception and prescribe (and sometimes provide) contraceptives for you
• Advice on sexual problems (dysfunctions)
• Health checks relating to sexual problems (e.g. pain during/after sex, loss of erections)
• Information about menstruation, menopause, fertility (getting pregnant), pregnancy and abortion (termination), pregnancy testing
• Physical examinations of your genitals (including smear tests for women or testicular exams for men)
• Referrals to counsellors or other specialists in the case of sexually transmitted infections, sexual dysfunctions, previous or current sexual abuse, genital cancers
• Assessment and testing/treatment for STIs
• Advice about pregnancy/fertility, antenatal and postnatal support
• Advice and referrals for termination of pregnancy (in countries where abortion is legal)

Your doctor or practice nurse can perform external and internal genital checks, swabs and blood tests. They can test and treat you for STIs, or related infections. Depending on your location they may be able to provide you with condoms or refer you to a condom clinic. In many countries, GPs are the main providers of contraceptive services, so they’re not shy about talking about sex. Some people do feel embarrassed discussing sexual health with their doctor, particularly if they’ve known their doctor for a long while – or in cases where they may have an STI through an extra-marital affair or unprotected sex. If you would prefer to see someone you don’t know as well, you can either speak to a different doctor at the practice or go to a Genito Urinary Clinic for STIs or Family Planning/Reproductive Health Clinic for contraception/fertility advice (see below).

Useful links
NHS Choices has a dedicated section on sexual health
Patient.co.uk (links, resources and helpsheets on a variety of health issues)

Genito Urinary Clinic/Sexually Transmitted Infections Clinic
What can they offer?
• Tests and treatment for sexually transmitted infections.
• Advice about contraception (some clinics also prescribe contraceptives and provide condoms – at some clinics these are free).
• Information about safer sex.
• Advice on how to tell a partner you have an STI – some clinics will notify your partner(s) for you.

These clinics (also sometimes known as ‘sexual health clinics or centres’) will test and treat you for STIs, and provide safer sex advice and information. Some clinics work on an appointment basis, others on a ‘drop-in’ system, or a ‘first come, first served’ basis. Some have set times for teenagers, women or men to attend. You may want to telephone first to check appointment times and whether there’s a waiting list for treatment. You shouldn’t have to wait long to get an appointment, but in many countries where there is high demand for services the wait could be longer. You can get condoms from Genito Urinary Clinics.

Useful links
NHS Choices: Sex, worth talking about includes guides to sexually transmitted infections, including locate your nearest clinic and symptoms and signs of STIs
Planned parenthood’s guide to STIs (also available in Spanish)
Go ask alice! (your sexual health questions answered)
STIQ answers common questions about STIs, testing and treatment

Family Planning/Reproductive Health Clinic
What can they offer?
• They can advise you about contraception and give you contraceptives
• Information about how to get pregnant, or options if you have an unplanned pregnancy
• Pregnancy testing and referrals for termination of pregnancy (abortion) if you require it
• Smear tests for women

These clinics can perform smear tests (internal exams for women), and offer contraception and pregnancy advice. They can provide contraception such as birth control pills or injections, or condoms. If you want contraception only, then make an appointment at one of these clinics. If you think you have an STI, it’s better to see your GP or Genito Urinary Clinic.

Useful links
Family Planning Association guide to contraception, pregnancy and STIs
Brook sex advice for under 25s
Planned Parenthood advice on contraception, STIs and sexual and reproductive health – in English and Spanish
Marie Stopes global reproductive health advice source

Your Pharmacist
What can they offer?
• Home pregnancy testing kits (some pharmacies will do the tests for you)
• Over the counter treatments for cystitis, thrush, period pains (menstrual pains), folic acid (for those planning to get pregnant or during pregnancy and breastfeeding)
• Condoms and lubricant
• Give you contraceptives as prescribed by your doctor

In some countries, community pharmacists are taking a more active role in health care. For problems such as thrush or cystitis you can get confidential advice from your pharmacist. You can also get condoms, the morning after pill (emergency oral contraception), and lubricant from many pharmacies. In parts of the UK, US and Europe, you may also be able to be tested and treated for certain STIs by your pharmacist. If you think you have Chlamydia or Gonorrhoea, the pharmacist can provide you with a urine kit, which you return to them or post to a local laboratory. Results are returned in a few days and you’ll be given the all clear, provided with antibiotics by the pharmacist, or referred on to a Genito Urinary Clinic or your doctor if further tests or treatment are required. Not every pharmacy can offer this service, those that do will usually advertise testing with posters or leaflets. All pharmacies should be able to signpost you to your local Genito Urinary Clinic who will be able to help.

Psychosexual Therapy (Also known as sex therapy)
What can they offer?
• Identification and treatment of psychosexual problems (e.g. erectile dysfunction, loss of desire)
• Overcoming sexual problems due to past or present sexual abuse
• Dealing with sexual problems due to worries about sexuality
• Sexually compulsive behaviour
• Referrals to other healthcare services (e.g. urology, gyneacology) if needed

Many countries offer psychosexual advice and services. In some cases, they are free to patients with severe sexual problems, although have to be referred through a medical doctor, and can have a long waiting list. In countries where psychosexual services are free, patients can also book to see therapists privately. This cuts down the waiting time, and will cost money, but allows the client choices who they get therapy from (e.g. a religious person may prefer to have sex therapy from someone who understand and respects their religion; a lesbian or gay client may prefer a ‘pink shrink’). In other countries, psychosexual services are entirely private, and have to be paid for. These services may not be covered by medical insurance, check your policy. Some countries do not offer any services, or a limited number of therapists.

Useful resources
Overcoming sexual problems by Vicki Ford (Constable and Robinson)
Women who love sex: an inquiry into the expanding spirit of women’s erotic experiences by Gina Ogden (Womanspirit Press)
Our bodies ourselves: a new edition for a new era by Boston Women’s Health Book Collective (Touchstone Books)
Sexual health for men by Phillip Kell and Vanessa Griffiths (Class Publishing)
The new male sexuality by Bernie Zilbergeld (Bantam Doubleday)

Basrt (British Association for Sex and Relationship Therapy)
Sexual Dysfunction Association includes advice and support on male and female sexual problems
Women’s Health gynaecological and other women’s health advice
Male health information from the men’s health forum

The above organisations cater to gay or straight couples – however if you’d prefer to see a gay or lesbian-friendly counsellor you can contact:
Pink Therapy
Pace

Relationship Therapy/Counselling (also known as couples counselling)
What can they offer?
Counselling for individuals and couples for issues like…
• Communication skills
• Increasing sexual confidence
• Overcoming common sexual problems
• Dealing with jealousy
• Coping with infidelity
• Reducing arguments
• Planning for parenthood

Relationship therapy is offered in different forms in different countries. In most cases the service is paid for by the client – but is often means-tested, meaning those on a low income may pay less. Medical and psychosexual services can refer clients to relationship therapists, and clients can refer themselves. Many religious groups or other support networks offer relationship therapy – again this may be free or paid for and evidence underpinning advice may be patchy. Medical insurance may not cover costs for relationship therapy – check your policy. Some therapists will tackle domestic violence and reputable therapists will not see a couple together while one party is being violent. If domestic violence is a problem within your relationship you need to alert your therapist to this as soon as you can.

Useful resources
Overcoming relationship problems: a self-help guide using cognitive behavioural techniques by Michael Crowe (Constable and Robinson)
Loving yourself, loving another: the importance of self esteem for successful relationships by Julia Cole (Relate Guides)
Gay relationships: how to find them, how to improve them, how to make them last by Tina Tessina (Jeremy P Tarcher)
Relate
British Association of Counselling and Psychotherapy
Couple counselling Scotland
Relationships Australia
American association of sexuality educators, counsellors and therapists (AASECT)
BBC Relationships has a collection of resources and referrals addressing domestic violence

The above organisations cater to gay or straight couples – however if you’d prefer to see a gay or lesbian-friendly counsellor you can contact:
Pink Therapy
Pace

Hopefully you can work out from the list above what service suits your needs best. If in doubt call the service/clinic and ask if they can help you. If they can’t they should be able to explain a source of support.

Where to get advice about your sexual, reproductive or relationship health by Dr Petra Boynton is licensed under a Creative Commons Attribution-Noncommercial 3.0 Unported License

What made me start blogging?
Five years ago I sat down on a dark November evening and wrote my very first blog entry. It was a bit ranty. I’d been misquoted by a journalist and was anxious it would get me into hot water (again).

I didn’t have a game plan when I started blogging. My partner (who’s way more tech savvy than I am) thought it might be a good way of sharing ideas I was struggling to convey via the mainstream media (I was writing several advice columns in magazines at the time, as well as hosting a regular radio phone in for BBC Five Live).

I approached the blog as a form of therapy. I wanted to work with the media but was getting a lot of stick for it professionally (I’m an academic as well as a sex educator). Having a place to blog would allow me to correct any errors in reporting and disclose bad journalism. I even hoped it it might even let me bring evidence into sex/relationships reporting – and show it was possible to do so without things becoming worthy or dull.

One thing I felt sure of early on was this blog was something I enjoyed writing, but I wanted to be useful, and most importantly to deliver things about sex, relationships, science and journalism that readers wanted to know about. Which is why the blog has always been shaped by things you’ve asked for.

Readers make this blog (or “why don’t you have comments?”)
Last summer I asked regular readers to give me feedback on this blog and got some very helpful responses. It’s taken me a while to implement some of these, but I have now upgraded the blog to include the things you asked for – photos and images to liven things up, a better blogroll, summaries at the start of most entries so you can decide if you wish to read on. And categories. Something I didn’ think about five years ago and really wish I had. I’m now in the process of going back through all the 800+ posts and adding categories to them, which I hope will make this blog a lot more useful to you.

The one thing this blog doesn’t have is comments. I did start off having them, but encountered several problems. As I was offering advice within columns and websites elsewhere I hadn’t planned to also answer problems on this blog. However, not all readers understood this so I frequently found requests for advice on anything from infidelity to penis size included in discussions about blogs relating to research design or journalism ethics. This sometimes led to some readers mocking those asking for advice, which of course is completely unacceptable for me as an educator.

Moreover, I’ve always blogged openly – never behind a pseudonym. I work within the community on sex/relationships projects and educational activities (in the UK and internationally). This meant I was very accessible, and felt vulnerable when those whose comments were deleted or not posted, made very personal threats.

I found moderating the comments was time consuming and took me away from other educational activities which I felt were more worthwhile. So I decided to remove the comments option. When I’ve asked readers if they want them back the general response is ‘no’. That’s mostly from people who feel the blog’s a safe space to get information which they can use as they wish elsewhere.

Of course I strongly welcome respectful email feedback and am always happy to add information or correct errors within the blog. You’re always welcome to start discussions on other forums or your own blog about issues raised here. For now I’ve no plans to reinstate comments, but since I’m occasionally asked why I don’t have them I thought this was a good a time as any to clarify the issue.

Achievements so far
Having read back to 2004 I’m pretty pleased with this little blog. It’s nice to see it’s grown into a resource that people trust and enjoy reading.

The things I’m most proud to have written are activist blogs that highlight medicalisation, exploitation and abuse. These include the debates around female sexual dysfunction, questioning high street stores stocking ‘herbal’ erectile dysfunction drugs (not approved by the FDA), exposing the Advanced Medical Institute’s aggressive sales technique for men affected by premature ejaculation, or highlighting misleading media coverage of the availability of Viagra on the high street.

I initially planned to use the blog to set right bad sex coverage in the media (or occasions where I’d been misquoted). This has been a theme within the blog although I think it’s become more focused over time (although not necessarily less ranty than my very first post). I can’t say whether it’s made much difference to journalists, and I hope it’s not put people off working with the media. I’ve found it helpful to describe poor practice – not least because the general trend for ‘experts’ working with the media is to act grateful for any exposure, not publicly discuss poor experiences or document bad practice. Gems for me include an expose of GMTV sending a cab to my home at 6am on the off chance I might wake up and come to their studio. Or how a TV show wanted to discuss female sexual confidence without mentioning genitals or masturbation. Or some rather nasty experiences with snotty TV producers just after I’d had a baby. Not to mention the hilarious case of the science journalist who really took a dislike to me (and colleagues). Oh, and let’s not forget the journalist who wanted me to recommend them an ‘unethical psychologist’ .

Of course, the past five years have not been spent simply slagging off journalists. No. Sometimes I’ve also turned my gaze to bad science too. Where it’s been depressing to report on a carnival of studies which seem to set us back sexually. Studies complaining women orgasm too easily, or there’s a ‘clitorocentric conspiracy’ against the vagina, how sex with a partner is 400% better than any other kind of sex you might have, and you can tell whether a woman has vaginal orgasms by her walk.

Let’s not forget my other bugbears. The fake formula and shonky surveys and my goodness this blog’s a treasure chest for those. And if I’m not being irritated by that, then there’s always the problem of psychologists talking about celebrities, or the general ethical issues raised by Big Brother for me to moan about.

Of course, it’s not all been bad news. Anyone would think this blog is only about gripes and grumbles. I’ve always wanted to showcase a variety of sexual experiences within this blog and not just think about sex just for a Western audience. I’ll continue to discuss issues relating to sex and seniors; teenagers; disability; transsexuality; lesbian, gay and bi issues; open relationships; BDSM; sexual health; contraception; prostitution; pornography; reproductive health; pleasure; desire; asexuality; dating; psychosexual problems; showcasing great sex pioneers; talking about safer sex; and as many other topics as I can find for you to read about.

Where to next?
Unlike five years ago, I’m now thinking strategically about this blog – who it’s for, what it does, and seeking to find ways to assess any impact it may have. I’ve noticed over the years it sometimes deviates into areas that interest me, but may not appeal to all readers. So my aim is to ensure the focus of the blog remains around the core things you’re most interested in when you visit – sex, science, and media.

I’m currently involved in overhauling the site so in the new year I hope to have far more open access materials available for you – relationships and sex guides, information about sexual and reproductive health, more advice and links to sources of help, along with practical information for journalists, healthcare professionals, parents, teens and teachers.

I’ve been asked by many readers for more information about how to become an agony aunt/media sex educator, so I’ll be blogging about this – as well as how to write a sex blog – in the not too distant future.

I’ll also be making use of twitter soon, as sometimes I blog about issues people need to hear about fast (particularly developments in science/health), so hopefully that will make messages more accessible. I’ll let you know once I’ve sorted it.

Obviously I’d like to hear what you’d like to see. How would you like this blog to develop over the next year (or five!). Are there any particular things you’d like to see more/less of? Topics you want covered? People you’d like me to interview for the ‘quickies’ section of the blog? Campaigns you want covered? Let me know what your vision is for this blog.

So, happy fifth birthday blog. Big birthday kisses to those of you who’ve been with me from the beginning. For those of you who’ve only recently found this blog I hope you like it enough to stick around for the next half decade. I notice one of my favourite other blogs Mind Hacks has also celebrated it’s fifth birthday too, so congratulations to them.

Time to blow out the candles and make a wish. Of course, I can’t tell you what it is. You’ll have to come back in five years to find out if it’s come true.