Last week saw the publication of a paper Multi-person Sex among a Sample of Adolescent Female Urban Health Clinic Patients in the Journal of Urban Health (sadly not open access). This tackled the issue of young people having Multiple Sexual Partners (MSPs) and in particular raised concerns over coercive sexual practices.

Predictably the media reported on this story with scary headlines like:
Teen girls who engage in group sex are often coerced, study says – NY Daily
Group sex is the latest ‘trend’ for teenage girls, disturbing report reveals – Daily Mail (The research excited upset the Mail so much they ran coverage of it twice)
Teens as young as 14 engaging in group sex, study finds – ABC News
‘Sexting’ is related to teen group sex trend, says study – New Jersey News Room (the study doesn’t say this at all, in fact recent research suggests the phenomena of teen ‘sexting’ is over exaggerated).

While we sadly are used to the mainstream media sensationalising sex research (particularly on young people), other sex blogs and medical news outlets covering this study have been equally remiss at reading the original research and critiquing it. Which is depressing.

So let’s do the job the mainstream media should have done. Let’s critically appraise the research and see if we do need to worry about MSPs and young people.

First, a quick disclaimer. Researching young people’s sexual experiences is important. Such work should focus on their needs, report faithfully any adverse issues they may be at risk from, and take their mental and physical wellbeing seriously. Research on teens should always involve young people at all levels and avoid being a top-down process where adults define teenagers’ experiences. In critiquing this research I am not suggesting young people are not experiencing problems within their relationships. I am also not saying the researchers were anything other than well intentioned.

Strengths of the research
The paper’s plus points are that it tackles a topical issue. While group sex among young people is (as this paper acknowledges) pretty unusual, it is something that has gained media interest over the past few years. So trying to collect any data about this phenomenon is important to reassure and also to direct sex education and public health programmes. The researchers seem to have developed the study over time, basing the survey they used on a series of in-depth qualitative interviews. The paper does acknowledge early on that multiple sexual partner experiences may be consensual and non consensual (more on this in a bit).

Sampling and sample size
Participants were recruited from a youth sexual health clinic. This is not unreasonable at all. It’s an excellent place to find out about young people’s sexual health. But it does mean those going there may be in need of help or support so might not be representative of teens generally.

The authors acknowledge this but I suspect that fact will pass a lot of journalists by when they report this. Media focus, I imagine, will be on all teens, rather than a subset of teens.

The paper tells us researchers were aware of 1224 female clients at the youth clinics, with 747 identified suitable for the study. Why the other clients attending the clinic weren’t suitable for the study is not explained. That, I think, is a problem. Information about participants who were unsuitable for the study, or who refused to participate (and why) should have been clarified just to help us interpret this data. I’m surprised reviewers didn’t ask for it to be included in the demographics table as is standard practice. Of the 747 clients identified, 495 (65%) agreed to take part. A 65% response rate on a sensitive topic is not a problem, but it does reduce the number of people responding further, which in turn affects how representative the sample is.

It is not declared whether the participants were Cis or Trans Women. This would have been helpful to disclose.

Table 1 in the paper provides details of 328 participants. I’m unsure if these were the final sample that was used in the study/analysis. Regardless of all this we learn right at the end of the paper only 24 of those who completed the survey had had a Multiple Sexual Partner experience. And of those, their analysis indicates, 35% said the experience was consensual.

Does this represent a major new trend in youth behaviour?
No. The paper reports of the patients attending the youth clinic very few of them had experienced non consensual group sex. It does not mean we should not be very concerned about these young people or others like them. But it does mean journalists covering this story should put this into context. The study is not showing a major trend in teen girls being forced to have group sex. It is saying non consensual group sexual activity among teens does not seem to happen often, but when it does it is highly distressing and increases the risk of psychological and physical ill health.

My worry is the media coverage of this will not read the original paper and will suggest there is an outbreak of teen sex parties happening regularly, that young girls are forced to participate in. The study did not find this and nor has it identified a major public health problem. But I doubt that will be made clear. This in turn will worry parents, mislead teachers and healthcare professionals, and probably lead to slut shaming of young women (as this kind of coverage invariably does). All the while ignoring the role of boys at best, or presenting them as gang rapists at worst. None of which is directly helpful to the needs of young people.

Problems with phrasing and terminology
The paper seems to use terms like ‘sex parties’, ‘multiple sexual partners’ and ‘gang rape’ interchangeably in places. This is confusing for the reader but I imagine also for participants in the study. This is recognised as a limitation later in the paper where the authors talk about participants who’ve experienced gang rape not necessarily seeing what they experienced as a multiple sexual partner act.

The focus of the study appears to be on heterosexual teens, although this is not really clarified.

The age range of 14-20 is important as this is a wide age range in terms of young people. While some 14 year olds may be mature and some 20 year olds immature, in general the needs and experiences of those who are in the younger age group in this study will be very different from older participants. Any of these participants could be exploited, abuse has no age barrier. However, older teens/young adults may well be better able to consensually engage in sexual behaviours younger teens cannot. This was not explored in enough detail in this paper.

The main drawback with the study, to me, is the question used to identify if participants had engaged in Multiple Partner Sex. It asked:
“Have you ever had sex (vaginal, oral, or anal) with more than one person at the same time or with more than one person at the same place? (This might be called group sex, a threesome, an orgy, or pulling a train).”
The paper doesn’t clearly explain how participants were invited to answer this question, although does suggest it was via a yes/no response (or similar). Imagine I said ‘yes’ to this question. What am I saying ‘yes’ to? That I had vaginal, oral or anal sex? The wording of this question means there’s no way of differentiating between participants who had all of these experiences and those who had one of them.

There is also no way of identifying how often participants had engaged in these various activities and whether they experienced them positively or negatively. It could be completely possible for a participant to have experienced oral sex positively but vaginal sex negatively (or vice versa). But the question phrasing does not allow for this to be explored. It also doesn’t allow participants to indicate if they were giving or receiving these sexual activities (or both).

Once you get past this confusion participants are still being asked about these sexual activities AND whether they’ve done them with more than one person. How do you answer if you’ve engaged in said activities but with only one person? The question doesn’t allow for this.

Participants could also easily be confused by a question that doesn’t make clear if the mention of ‘sex’ here refers to penetrative sex (and if so is it via a penis, finger or sex toy) or oral sex. That is important as we know from sex research unless you are very specific about what you’re asking about you’ve no real idea what participants are reporting.

The question is also confusing a group sex act (i.e. having sex with more than one person at a time) with multiple partner sex over a period of time (i.e. sleeping with more than one person in a day, evening etc). In fact this becomes more confusing as these behaviours are asked as if they’re the same thing but with no time period specified. Most of us who’ve had more than one partner could easily answer ‘yes’ to the question, assuming you have been intimate with different partners on different occasions in your home.

Deconstructing this question may seem like nit picking but in fact is very important when we are designing surveys. Unless our questions are meticulously phrased we have no real idea what participants are responding to. This in turn makes a difference to the conclusions and recommendations we can make.

Elsewhere in the paper the researchers conflate group sex and an orgy (which usually involves several people) with a threesome. They also don’t clarify who might be participating in these activities. The assumption seems to be that it’s a girl and all boys. But it could well be all girls or a mix of girls and boys.

Does ‘pornography’ and ‘sexually explicit’ mean the same thing?
Participants were also asked
“Many people come into contact with pornographic, x rated, or other sexually explicit material. How many times in the past 30 days have you viewed pornographic, x rated, or other sexually explicit material?”

This is an interesting but again problematic question. What do the researchers mean by ‘pornographic’ or ‘sexually explicit material’? Are they the same thing? Are they including explicit mainstream media such as music videos or magazine articles talking about sexual positions? That could be considered sexually explicit but not necessarily pornographic. Is this a particularly accessible question to ask a young person? Asking how often they’ve viewed such material also isn’t clear. Do they mean how often someone has watched pornography/sexually explicit material and masturbated? Simply seen it in passing? Or perhaps laughed at it with friends (as is very common among teens)? Was it watched alone or with a partner? What did it feature?

This information IS important because the researchers did find an association with multiple sexual partners and reported porn use, but it isn’t clear what relationship the young women in the study really had with porn. In order to better educate women about issues around porn we need to know more about what they are watching and how they feel about it. It is worth noting if participants said anything other than ‘no times’ they classed this as having viewed porn. So that means someone might have seen porn once in passing and be categorised in the same way as someone who viewed porn regularly and was aroused by it and someone who was forced to watch porn occasionally but against their will.

Another question asked
“Has anyone ever insisted (without using force or threats) that you do sexual things they saw in pornographic or x-rated magazines, websites, or movies when you did not want to?”

This is not an unreasonable question, but it is not necessarily something that’s easy for a teen woman to answer. For example they may well have been coerced to do something they did not want to do, but unless they asked the person coercing them if they had seen this in porn they would not necessarily know for sure this was the case. They may have a good instinct they were being asked to perform something inspired by pornography, but they wouldn’t know for sure – and would not be in any position to ask if they felt threatened.

Given the age of participants it may be someone did coerce them to do something they didn’t like but had not got the idea for this from porn. They may have got the idea from a sex tips feature in mainstream magazines like Cosmopolitan or Men’s Health, or from their peers, or from a TV show. Much of the mainstream media talks about anal sex, threesomes, oral sex etc so this could have just as easily informed the coercive behaviour.

I would have liked to see more focus on the nature of the coercive behaviour, why participants felt this was linked to porn, and if it wasn’t linked to porn where they felt the driving force behind the coercion came from. I say this not to dispute porn may play a part, but to identify exactly what is driving coercive behaviour as if it’s features in mainstream magazines or peer pressure we need to tackle this just as urgently as any perceived threat from porn.

The focus here seems to present young women’s relationship with porn as something that is done to them by young men. Young men are presented as the consumers of porn and use it to get ideas to coerce young women into doing things they don’t want. This does not explore where young women may like or dislike porn, or young men having a critical view of porn. It does not include young people who have little or no exposure to porn. It presents young women as passive, as victims. And as heterosexual. This is often taken up by the media who use debates on sexualisation or pornification to demonise or ignore young men and victimise and slut shame young women. In both cases we find it becomes a situation where adults (either academics, medics or journalists) speak for young people.

Multiple Sexual Partners – a problem in itself?
In their reporting of the results the authors say:
“While there may be a subset of girls who initiate or make self-actualized decisions about MPS participation during adolescence, it is important to consider whether social norms that encourage hypersexuality may contribute to expectations about sexual activity that make it very challenging for adolescents to resist engaging in MPS, even though they would not perceive their MPS participation as nonconsensual. The strong association between exposure to pornography, having been forced to do things that their sex partner saw in pornography, and MPS suggests that pornography may have influenced directly the sexual experiences of the girls in this sample, as has been found elsewhere. Importantly, even if participation in MPS is voluntary for some adolescents, it is crucial to know how this early experience shapes their sexual behavior trajectory and affects their lifetime risk for negative sexual, reproductive, and other health risk behaviors”.

This statement concerned me for three reasons. Firstly it suggests a kind of false consciousness idea that no young woman could ever really consent to a MSP experience. This is disingenuous to the participants in this study who stated they had willingly enjoyed a MSP. I suspect it betrays more of the researchers own values about MSPs.

Secondly it implies that even if a young woman does consent to a MSP this will be because pornography has informed her choice. Yet we know from the way they asked about porn they don’t really have strong enough data to make this conclusion. It would have been interesting to explore if mainstream media might have influenced their choice as well, but not to have decided for participants that they didn’t really know their own minds.

Thirdly there is the implication that having a MSP as a young person will inevitably lead to problems in future relationships. That seems like a leap beyond the data and also I suspect unfair to those who consensually, as adults, explore non monogamous relationships. Moreover we know many people who never have MSPs as young people (or adults) have problems in their relationships as adults. So to make this claim really requires more than a small sample of 24 participants who were asked some confusing questions. The researchers do say this ought to be followed up in future research and I don’t disagree there, but I hope they would be less judgemental and aware of sexual diversity in doing so.

Where are the experiences of young men?
There is no focus on young men in this paper and I think any study that is tackling coercion in heterosexual youth (as this paper appears to be doing) really needs to also study young men. The assumption is they are coercing young women, but are young men also feeling coerced in relationships? Is the pressure of masculinity leading to risky sexual behaviours or are they acting respectfully with their partners? Are the experiences of young gay or bi men different from their heterosexual peers? How do young men feel about being portrayed as sexually coercive? Are there issues around communication and consent we need to focus on with young men and women – and how should we be addressing this issue?

I worry media coverage will report this as though young men have been included or present young men as predators, when again the number of participants reporting negative experiences from forced group sex or pornography was low.

Should this paper have been published?
I critically appraised this paper, but does not mean I think it should be ignored. Had I been asked to review it for publication I would have asked for major revisions (based on the comments above). I find many Public Health studies on youth sexual behaviour (and sexual behaviour in adults) are well intentioned but often problematic due to heteronormative approaches. In this case this can be seen with the focus on heterosexual activity and underlying subtext that group sexual activity is never truly consensual and non monogamous relationships are not presented positively. This can alienate or pathologize many people inadvertently, while trying to help another group of people. A better awareness of thinking around diverse sexualities would help ensure generalisations about group sex among consenting adults are not pathologised while trying to tackle gang rape of teens.

I hope coverage of this will be responsible but fear it will not. I suspect it will be further used to demonise young people and worry the public. In turn ignoring the fact most young people are not engaging in group sex or coercive behaviour. In fact that most aren’t having sex at all. They may well have questions and worries about sex, but these may not be addressed while we focus on more sensational topics.

Creating a moral panic in which we shout a lot about the behaviour of young people but do very little to actually help them. And in cases where research is poor or ambiguous it may direct our efforts to help young people in the wrong direction.

You may remember earlier in the year Channel 4 ran a new series called The Joy of Teen Sex (JOTS). Series 2 is currently in production. Practitioners and educators were anxious about JOTS while it was being made. When the series aired we continued to be very worried about the core messages shared, the way sex and relationships were presented, and how messages of heteronormativity, commercialised and aspirational views of sex were normalised. We were not alone. Parents and young people also were troubled by the ideas shared in JOTS. This prompted a group of professionals working in education and healthcare to write to the Channel expressing our concerns.

Channel 4 responded, and the remainder of this post shares this and our reply, along with some additional updates about problems with sex/relationships programming at the Channel.

Channel 4′s response (25 February 2011)

“I am writing in response to your letter to Channel 4 of 8 February regarding The Joy of Teen Sex. As the head of Channel 4′s features department which commissioned the series I have been asked to respond on David Abraham’s behalf.

Channel 4 values feedback from viewers and experts and we have considered your letter carefully. I think it is important to confirm, before discussing any of your points, that we share your overarching belief of the importance of young people having access to open and honest information on sex and relationships.

It was in light of the Government’s 2007 Review of Sex and Relationships Education in Schools that we developed a slate of sex education programmes that would address the systematic issues raised in the Review, in particular the paucity of and poor quality of sex education in schools; the importance of complimentary information being provided in and out of school; and that sex and relationship education should be inclusive and meet the needs of all young people. Television is a powerful medium through which we can provide information in a way that is educative authoritative and entertaining, and which can draw-in significant audiences, both watching on their own or with friends and families. Channel 4 has a particular resonance with younger people who see us as a friend and youthful presence, and characteristics that make us uniquely able to bring effective sex education to the screen.

Over the last few years we have provided a range of sex education programmes and online resources – each seeking to reflect different aspects of sex and relationship education. The Joy of Teen Sex formed part of that mix, alongside programmes such as The Sex Education Show, KNTV Sex or Underage and Having Sex. We are proud of our track record in this area – both in terms of a frankness and relevance that young people rarely have access to – and crucially the impact that the programmes have had.

After last year’s Sex Education Show: Am I Normal, Channel 4 commissioned a public value case study, on the impact of the programme among teenagers. The research found that overall the show did a great job for teenagers:
- 78% of 14-19 year olds agreed it told them things that they would be too embarrassed to ask about
- 70% said they learnt things they didn’t know before
- 60% said that the programme made them feel more confident about themselves
- 62% of those who watched ep2 or 4 said they had changed their attitudes towards disabled people having sex
- 76% prefer learning about sex on TV than at school

Although we do not yet have comparative data for The Joy of Teen Sex, we have had some anecdotal evidence that the programme has had a positive impact on young people. Dr Rachael Jones has reported a marked upswing in attendances at sexual health clinics and that often The Joy of Teen Sex has been cited as a motivator for attendance.

In addition, the Sexperience website, which has sat alongside both the Sex Education Show and Joy of Teen Sex strands, has been immensly popular (attracting up to 5,000 user comments/questions a week), providing a forum for discussion and advice sharing. That the programmes and website have had a positive effect on young people seeking sexual healthcare advice or changing behaviour is evidenced by their being referenced or included in various NHS booklets and websites as well as their use in secondary schools.

In response to your particular points of concern about The Joy of Teen Sex, I would first like to reassure you that the programme was commissioned with the intention of providing accessible, relevant, entertaining and empowering information about sex and relationships to young people. Its purpose was to inform and educate by offering a platform to discuss any problems, questions or anxieties they might have. The programme was aimed at teenagers over the age of 16 (and their parents) and deliberately sought to be up-front and honest and to reflect the issues that young people wanted to discuss. Throughout the course of the series we sought to represent a wide variety of young people from different cultural backgrounds; heterosexual, homosexual and bisexual contributors featured alongside single people and those in steady relationships; sexually active young people as well as those considering their first sexual experience.

The series deliberately did not shy away from the fact that many 16-and-overs are sexually active and want to lead fulfilling as well as healthy sex lives. In tone and content it was also not an attempt to replicate The Sex Education Show – which is more focused on adolescents and the care to be taken before sex becomes part of a young person’s life – but was aimed at at the issues confronted by youngsters already having sex or being pressured by their peers to do so.

In putting together the programme we worked with a number of experts in the sex education field, both on and off screen. This included Peter Greenhouse, Consultant in Sexual Health at Bristol Sexual Health Centre, who also worked on The Sex Education Show and the highly regarded Dr Rachael Jones of the West London Centre for Sexual Health, who featured in the series providing medical and contraceptive medical advice. The background of other contributors – including Ruth Corden, Billie JD Porter and Joanne Wierzbickia – was made clear as was their role in the series to add to the mix of viewpoints and expertise, rather than to provide medical advice. We believe that it is critical to the success of these programmes that they are supported by credible medical experts who are available to advise us on medical matters and vouchsafe the reliability and authenticity of any advice proffered either during the programmes themselves or through the supporting website. While we will not always agree with our medical experts on presentational matters or issues relating to the narrative conventions used in television, we will heed any advice we have sought from them on any specific medical matters.

Given Channel 4′s ongoing committment to provide content that deals with young people sex and relationships, we have been planning to hold a roundtable discussion about television and sex education in the next few months to bring together people involved in providing sex education in the health and education spheres and people involved in making TV content. We very much hope you will be able to attend the event, and that it will provide a forum for your concerns to be addressed more fully by a range of experts.

We will be in touch in due course about the event. In the meantime I hope this reply provides some reassurance about the intentions behind this programme and across our sex education output, and the positive impact that the series has had during and since broadcast.

Yours Sincerely

Sue Murphy
Head of Features”

Our reply
26 June 2011

Dear Sue Murphy
Cc: David Abraham, Andrew Jackson, Katy Boyd, Liam Humphreys, Kate Teckman, Dominique Walker

Thank you for your letter of 25 February 2011. We are glad to hear of Channel 4’s ongoing commitment to improving the quality of broadcasting and that you share our ‘overarching belief of the importance of young people having open and honest information about sex and relationships’.

Our previous letter outlined a lack of underpinning of Channel 4’s programming with strong evidence and critical thinking and we are concerned that your response does not fully engage with the issues we outlined. It appears to be justifying problematic programming rather than reflecting on areas where content needs to be improved.

As stated in our initial letter we agree television is a powerful medium to share sex/relationships information, something supported by the wider literature on media and education. You are right to state you have the trust of young people, placing you in a strong position to share sex information with them. However, our concerns over how you have been going about this – and will do so in the future – remain. It is because you have a position of authority and trust among viewers it is vital to ensure messages shared are accurate, informative and entertaining. We would invite you to revisit our first letter and consider many of the areas we identified as currently not being adequately addressed. As ever, our offer to help you improve upon the quality of your programmes remains.

You cite within your reply a ‘public value case study’ but you do not include full details of who this was run by, how it was conducted, on whom, or how representative of the public/viewing audience these participants were. While the figures from this ‘case study’ seem striking the outcomes are not completely clear. Respondents stated they learned things they did not know, but this is only positive if the things they learned were accurate – learning something you did not know that is also misleading is not the same as learning something that is accurate and explained in such a manner as to give you the life skills to ensure confident behaviour in sex and relationships. Claims that teens prefer learning about sex/relationships from TV rather than school are not particularly helpful given most teens will prefer learning anything on TV rather than school and is disingenuous to the many creative and thoughtful sex/relationships programmes already offered within UK schools.

Your claim from anecdotal evidence that Joy of Teen Sex had a ‘positive impact on young people’ is not particularly helpful. Those of us working in clinical settings can equally supply our own anecdotes that following Joy of Teen Sex screening we did not notice an increase in clinic attendance. Those of us working in pastoral/advice-giving settings have had to counter fears and anxieties raised by the programme, with young people requiring reassurance over misinformation shared. In particular the coverage of anal sex, STIs, lack of sexual desire and contraception shown on Joy of Teen Sex made young people we have contact with feel afraid of sexual and reproductive health services, or that they were abnormal for not identifying with the sex tips featured on the programme.

You state ‘we sought to represent a wide diversity of people from different cultural backgrounds; heterosexual, homosexual, and bisexual contributors featured’. Again we would draw you back to our previous letter that highlights how many of your messages within the Sex Education Show and Joy of Teen Sex were heteronormative and misleading over LGBT issues. Simply having some guests who may be LGBT or mentioning homosexuality is not helpful if your wider programming focus is through a heteronormative lens. By that we mean presenting diverse sexualities as ‘different’, problematic or unusual; or seeing heterosexual, monogamous and sexually active relationships as ‘normal’. Given the Channel’s stated focus on diversity we would also expect to see programming that made explicit how many young people are not sexually active until over 16 and that many enjoy relationships based on delaying/actively consenting to a committed intimate relationship when they are older. We disagree that you have included a wide diversity of cultural backgrounds and would welcome the opportunity to discuss with you what an inclusive and sensitive programming schedule that is culturally diverse could look like.

We note you spoke with experts to inform the series but we would again refer you back to our first letter. This clearly indicates many of us were also approached to inform the Joy of Teen Sex, shared our expertise – and our concerns – but were ignored. We are hoping a learning outcome for you from the feedback we have given in this letter and our previous one makes it clear that you need to listen to a wide range of practitioners – not just those who are agreeing with your programme remit. Indeed if experienced professionals are all telling you there are problems with your programmes and consistently offering to ensure you are both accurate and entertaining, you should listen to them. We would also remind you many of the counter signatories on our first letter and this one have extensive media experience delivering sex/relationships advice in print and broadcast media. Some of us have even been consultants and contributors on programmes such as The Sex Education Show or other sex programmes for your Channel. Or have spoken at Channel 4 events on education/health.

We remain concerned over the way the contributors finally selected in the series of the Joy of Teen Sex were portrayed, including some of the messages they were providing. We do not feel their qualifications were completely transparent – for example one appeared to be a qualified Social Worker but her status was later amended, while another had experience in sex toy sales but not necessarily the more complex and nuanced area of sex education/care. Equally concerning is the lack of young people’s voices and experience which could have been a feature of the series but was not included. In empowering sex/relationships education and healthcare the voices of young people as peer to peer advisors and consultants are central. We hope future programming acknowledges this.

We welcome your comments and are looking forward to your proposed round table discussion about your programming. We hope you will use our first letter and this response to inform some of the conversations at that meeting. We note Channel 4 have recently entered into a Memorandum of Understanding with Trans Media Watch which will ensure ‘accuracy, dignity and respect’ in its portrayal of transgender people. We hope a similar commitment to sex and relationships broadcasting could also be developed.

As ever we remain committed to supporting young people, sex and relationships information and media opportunities to deliver this.

Yours Sincerely
Petra Boynton PhD, Social Psychologist and Sex Researcher, University College London
Dr Stuart Flanagan, Genito Urinary Physician
Justin Hancock, Bish Training, trainer and consultant
Lisa Hallgarten, Director, Education For Choice
Wendy Savage MBBCh FRCOG MSc (Public Health) Hon DSc
Marge Berer, Editor, Reproductive Health Matters
Romance Academy – a nation-wide, holistic, relationships and sex education initiative
Dr. Meg Barker, Sex therapist and social psychologist, The Open University
Alice Hoyle, Sex and Relationship Education Advisory Teacher
Alison Terry, Second year student, Applied Community and Youth Work Studies, University of Manchester
K. Barratt, Second year student, Applied Community and Youth Work Studies, University of Manchester
Becca Thompson, BSc MA COT
Steven Norris, Student Teacher
Clare Bale, RGN, BA (Hons),MPH, PhD Candidate, University of Sheffield
Dr. Lesley Hoggart, Principal Research Fellow, School of Health and Social Care University of Greenwich
Matthew Greenall, advisor on international HIV & sexual health programmes
David McQueen, International Speaker and Youth Advocate
Janet Horrocks, Healthy Schools Project Officer
Joelle Brady, MSc, Researcher
Kendelle Bond, MD of Zest Consultancy, Public Health Consultant
Dr Jayne Kavanagh, Medical Ethics and Law Unit Lead, UCL Medical School and Associate Specialist in Sexual and Reproductive Health, Camden Provider Services
David Evans, Researcher and Chief Executive SRE Project
Peter Bone, Chair of the Advisory Council, PSHE Association

Further Issues
Comparing our first letter with Channel 4′s reply and our response makes it transparent how there are problems with the Channel’s approach to sex/relationships programming and despite their claims about delivering quality broadcast materials this has not been achieved. Indeed where core problems have been pointed out, I would argue the Channel has sidestepped discussing or dealing with them. I feel the Channel has not adequately considered the problems with their past and current broadcasting on sex and relationships. As we speak The Sex Researchers – a series that promised to promote accurate and empowering information on past and current sexology is being aired. Only it is misrepresenting sex research (and researchers), again rehearsing narrow views of sex, gender and sexuality. Making out quirky lab based studies on desire and attraction (heterosexual obviously) are representative of mainstream sexology. The sex research community, including the Kinsey Institute, who helped put the programme together are very upset about how our time has been wasted in putting together something that seems to ridicule our work – and mislead the public on sex/relationships information.

Since JOTS aired we’ve also seen another series of The Sex Education Show broadcast. This series focused on sexualisation. When researching this issue the programme makers asked how they might ‘test’ sexualisation. They were referred to the Buckingham (et al) report on commercialised goods which is an excellent critical discussion of the area and provides a template of how to investigate the concepts of sexualisation and commercialisation. Rather than using this template, and while going against information from experts solicited for the series, the Sex Education Show went looking for examples of sexualised goods then made a fuss in stores about their sales. This is despite other evidence from reviews like the Buckingham one which indicates such products are not that usual and are interpreted very differently by parents and young people, but the concern over them from parents is often tied up in anxieties about girl blaming. Indeed the discussion of boys are largely absent, while the subtext of class and racial prejudice (about the ‘type of girls’ who wear such clothing) is problematic.

When acting as a consultant on Series 2 of The Sex Education Show I suggested Sexualisation could have been a topic to cover (from a critical perspective) since it tied in with the APA report on this issue that had just been launched. This was ignored with a focus given instead to limiting access to internet porn. When it comes to sex Channel 4 and related production companies seem to want to focus instead on topical issues that are both televisual and capture a public anxiety over a popular concern – rather than looking at and using evidence in a critical way.

Indeed if you look at how discussions pan out on the Channel’s Facebook page for Stop Pimping Our Kids (the campaign part of the last series of The Sex Education Show) it seems any in depth critical reflection is avoided or only included under duress (for example, witness how they position critical blogs discussing sexualisation research by myself and Dr Brooke Magnanti). Channel 4 now has a campaign for one current series (The Sex Education Show) which calls for restrictions on sexualised media. But other series the Channel has recently created – such as JOTS or The Sex Researchers seem to be promoting sexualised media (particularly for a youth market). In fact you could argue these plus Series 1 of The Sex Education Show with its focus on pubic hair removal, burlesque classes and new lingerie to boost sexual desire (in a show aimed at teens) comes under the Stop Pimping Our Kids campaign to crack down on sexualisation.

We are currently left with a situation where Channel 4 as a broadcaster focuses on a lot of sex/relationships content in various guises (entertainment, advice and education). These seemingly fall within part (or all) of it’s Public Service Broadcasting remit. Consistent, public and vocal calls for programmes to be improved – by the public and professionals – have been ignored. Programmes have been made during the past year which fail to have learned from the input from experts and feedback from professionals about content, accuracy and tone. We have an ongoing situation where programmes are being made by the Channel that contradict each other (and even contradict themselves), while offers of help to sort this muddle out are generally overlooked.

I hope the meeting the Channel are hosting in the coming weeks will be productive and the Channel will listen and really apply the core messages being shared. Otherwise we will continue to have a situation where both Channel 4 and production companies it commissions to make sex/relationships programmes will be viewed with mistrust and suspicion. We cannot currently trust Channel 4 to make quality sex and relationships programmes. And that is a situation entirely maintained by the Channel in the face of ongoing offers of support.

How sad.

Today sees the launch of the Bailey Review of the Commercialisation and Sexualisation of Childhood. A copy of the report and appendices available here. Background to this review here, with terms of reference here. More information can be found via their Facebook page and these videos.

[If you are interested in evaluating the review – particularly if you’re a journalist on a deadline - you may want to skip to the end of this post and focus on the section ‘Questions you should be asking about the Bailey Review’].

What is ‘sexualisation’?
Over the past few years ‘sexualisation’ has gone from a phrase that nobody had heard of (and nobody was particularly bothered by) to a buzzword beloved by the media and politicians. It has led to several separate reviews being commissioned in a number of Western countries, including those undertaken since 2008 in the UK alone (here’s a review of these preceding reports and tools to evaluate them).

As the term has become part of popular discourse a related problem has emerged where it is used a lot in media, politics, healthcare etc as though it’s an agreed upon and simple concept, and yet it is anything but . Something that becomes more obvious if you read through these critical essays reflecting on the term and the issues it raises courtesy of the Onscenity Network.

Background to this review
The Bailey Review follows in the steps of numerous other investigations and reports on youth/wellbeing. These have been framed within various contexts including: education/development (Byron), violence against women and girls (Papadopoulos), or commercialisation (Buckingham et al). All of these share the common focus of looking at potential areas of ‘harm’ and offering solutions to protect young people. They have differed in their focus with some looking at the impact of the internet, others addressing wider media formats (such as music videos), or commercially available sexual products (e.g. padded bras) aimed at children.

The assumption underpinning these reports, as well as the Bailey Review, is that sexualisation/commercialisation is a major issue affecting children and teens. However, with the exception of the review by Buckingham et al for the Scottish Government these evaluations have not interrogated the concept of sexualisation, nor focused on wider issues that might be facing young people. These may include: poverty, housing, nutrition, road safety, ‘failing’ schools, problems within health/social care that impact on young people, lack of parental support, limited provision of afterschool clubs, or inadequate availability of affordable childcare (to name a few).

Which leaves us with a consistently unanswered question: ‘is ‘sexualisation’ the main problem facing young people/parents?’ And does it warrant all these investigations?

What was Bailey Review tasked with?
The review was designed to address areas of parental concern with a focus on four key issues:
• whether and to what extent sexualised imagery now forms a universal background or ‘wallpaper’ to children’s lives;
• whether some products are inappropriate for children, and others in dubious taste: parents are anxious about what is appropriate;
• whether businesses sometimes treat children too much as consumers and forget that they are children too, with particular concerns about the kinds of marketing techniques associated with digital media;
• how parents can tell advertisers, broadcasters and retailers about the things they are unhappy about and how they can make an effective complaint.

The review was open to consultation and you can read a number of submissions to this process here. Some of these are more reflective and nuanced than others.

Concerns and Criticisms about the Bailey Review
Criticising sexualisation does not mean dismissing young people’s rights or ignoring abuse, exploitation or our changing mediated culture. It does mean thinking critically about the simplistic (and often moralistic) views of sexualisation used by politicians and the media – and how these can actually detract from the rights and needs of children and teens, while frightening and disempowering parents.

From the outset there have been numerous concerns expressed over this particular review and previous ones. These include:
- The number of recent preceding reports on the issue of sexualisation from various Western countries that (presuming sexualisation is a major issue) could have informed current policy and practice – but didn‘t.

- The varied quality of previous reviews. The Buckingham/Scottish Parliament report was innovative and thorough. While the Papadopoulos/Home Office report was problematic see here and here) based on limited and cherry picked data that failed to differentiate between academic research and PR campaigns and lacked rigour in reporting on findings (for example on focus groups used).

- Reg Bailey is the Chief Executive of the Christian organisation the Mother’s Union (MU) (although the MU have distanced themselves from directly being involved with the review). Some have questioned whether a transparent and independent review could be hosted by an individual with links to a faith based, conservative organisation. Not least because at the same time Bailey took on the review for the government the MU launched their Bye Buy Childhood campaign.

- Differing political approaches have led to a haphazard interpretation of ‘evaluation’ so the Scottish Report permitted academics to interrogate and investigate the idea of ‘sexualisation’ while the Australian and UK Home Office reports seemed to follow a remit of identifying a politician-identified problem then looking for evidence to support it (while ignoring any evidence to the contrary).

- With the Bailey Review, as with other recent sexualisation reviews academic concerns over simplistic, moralistic approaches/ignoring evidence/critical thinking have been largely ignored. Indeed many practitioners working in this area who want to inform debates on sexualisation/commercialisation and have concerns about the rights and needs of young people have struggled to have their voices heard.

- While purportedly about young people most of the investigations have not particularly included young people. Where they have been invited to contribute it has been within a very limited and top down framework where adults have set agendas and asked young people to respond to them.

- The reviews have mostly reinforced the theme of girl’s as victims/boys as oppressors (and a built in assumption all teens grow up to be heterosexual). Along with judgements around class (it’s usually working class girls who are seen as ‘the problem’ in this area); and race (black music/artists are frequently used to illustrate declining moral standards in music lyrics/videos).

- Critics have argued the preoccupation with sexualisation favours white, middle class parents (usually mothers) whose children are not generally facing particular hardships. It is easy for these parents to be worried about sexualisation because other concerns over family finances, nutrition, housing, safety within their community or their child’s educational needs are not so pressing. Indeed it can be argued that parents who are worried about sexualisation often engage in this debate in ways that judge or look down on other people and their children.

Has the media sexed up ‘sexualisation’?
When the American Psychological Association launched their review on this area in 2008 it was virtually impossible to get media coverage of it and generally it was seen as a sideline issue. However with the launch of the Home Office review in the UK the media has begun to see this as far more of a topical area. It’s become an ironic that the media, while taking a stand *against* sexualised/commercialised culture also use this topic to sell copy/generates viewing figures.

For example Mumsnet has been running their ‘Let girls be girls’ campaign, Psychologies magazine ‘Put porn in its place’ (ironically based on a survey of under 16s where parents weren’t told their kids were being asked about porn), and The Sex Education Show’s ‘Stop pimping our kids’. All may be well intentioned, but ignore much of the current evidence about young people’s lives. Worryingly when journalists want to cover the topic of ‘sexualisation’ they don’t go to academics or practitioners, they turn to these media outlets who often are not sharing a particularly nuanced or accurate perspective, but are getting a plug for their website/magazine/TV show every time they are asked to share their views. Put simply you may genuinely care about children, but you can currently also boost your audience if you talk about sexualisation.

We’re in a current situation where successive governments commission different reviews into sexualisation while various media outlets and charities host their own campaigns on the issue. Which again brings us back to the question: ‘is ‘sexualisation’ the main problem facing young people/parents?’ And given all these overlapping reviews and campaigns why aren’t we seeing any major outcomes from them?

Questions you should be asking about the Bailey Review
Before you ask these questions you may want to read up on previous reviews and utilise the free tools provided to evaluate them
- why the need for yet another review given the glut of them in recent years?
- how much all these reviews have cost so far?
- how much impact have the preceding reviews had? All had lengthy recommendations yet have any been implemented and if so have they ‘worked’?
- how have the various reviews differed from/added to/learned from each other?
- do the outcomes of the Bailey Review adequately match the four key issues (see above) it was initially tasked to evaluate?
- what methods has the Bailey Review used to gain an insight into what’s going on and how transparent is that information? (for example they’ve done a survey but is it any good? Who were the participants, how were they selected, what were they asked, why run this rather than using existing evidence?)
- how have young people been involved in the Bailey Review?
- how realistic are the recommendations from the Bailey Review, and what impact do they foresee them having on the wellbeing of children, teens and parents?
- how easy might the recommendations be to operationalise? (For example if there are to be restrictions on music videos will this be based on the lyrics, visual images or both – and who will decide what constitutes appropriate/inappropriate content?)
- how much will the recommendations from the Bailey Review cost to implement?
- are there any particular groups of children/parents who’ll be enabled or disadvantaged by the findings in the Bailey Review (i.e. is it skewed towards reassuring the middle classes?)
- is there a potential conflict of interest in Reg Bailey leading this review given his links to the Mothers Union and their own anti sexualisation campaign
- how has the Bailey Review approached questioning parents? Have people been presented from the outset with the view that sexualisation exists and is a problem or have parents and other organisations been allowed to talk about other worries they may have around their child’s wellbeing?
- how representative are the individuals and organisations responding to the Bailey Review? Do there seem to be any groups whose voices are heard or silenced?

And finally, let’s return to that most important question ‘is ‘sexualisation’ the main problem facing young people/parents?’

Join in the debate
The Bailey Review’s already being discussed on twitter on the hashtag #baileyreview. Once you’ve read the report you may want to share your thoughts on it there, or via your own blog. If you’ve any specific questions or comments about the review you can also put them to @educationgovuk (start with your question then include @educationgovuk so all your followers can see your question, RT their replies, and use #baileyreview on anything about this topic).

Update 07/06/11

Since the Bailey Review was released yesterday there’s been a lot of interesting discussion about the report, mostly on blogs rather than in the mainstream media. Here’s a lineup of some of the most interesting writing I’ve found on this topic (I’ll try to keep this updated with a range of issues represented):

Heresy_Corner (Nelson Jones) has a thorough and thoughtful reaction to the review with Children Being Children

Dr Brooke Magnanti (who did a grand job live tweeting responses to the data in the Bailey Review yesterday) gives her First Look at the review.

The fantastic Meg Barker tackles the issue of gender and sexualisation in Sexualisation and Gender stereotyping? One response to the Bailey review Similar issues are raised by Steve Greer who picks up on the ‘not said’ aspects of the review, particularly in relation to gender over at Queer Theory Reader. Quiet Riot Girl also discusses the masculinity issues, male objectification and the men’s media market which the Bailey Review overlooked in Nice Tits, Love! while Dan Avenell illustrates how the Bailey Review problematises lad’s mags while ignoring the mainstream older women’s magazine market over at The Bockingford Kid.

Over at the Ministry of Truth a somewhat different view is taken, looking at the ‘evidence’ making behind the Bailey review (probably also winning the best title of a post on this topic prize at the same time) Won’t You Fuck Off, Reg Bailey Additional concerns on the quality of the report (and how accessible it is) are raised by Think Base, while Jennie Kermode invites us to think about the core terms and assumptions underpinning the Bailey Review.

The Guardian’s CiF had a (predictable) ‘debate’ feature with different takes on the review. The first part from Holly Dustin might be somewhat more plausible if it didn’t rehearse the dreadful (and completely false) ‘statistic’ ’63% of girls want to be glamour models’. (From a PR survey that allegedly was never really completed: more criticisms of this statistic/survey here and here). Jane Fae Ozimek (whose writing style I covet) really gets to the heart of the problems with the review. Read both takes in Sexualisation and the Bailey Review.

Also at the Guardian their head of Media and Technology Dan Sabbagh writes probably one of the best accounts of this review from a mediated perspective (which makes you wonder why more media/tech expertise wasn’t included within the Bailey Review and preceding ones). His reflections can be found at ‘Sexualised Children’ -Is it always the media’s fault?. Mark Lawson also tackles media issues, this time picking up on how the Bailey Review appears out of touch with new media and youth access and how realistic a fixed watershed is within this context.

Richard Godwin in the Standard focuses around anxieties about childhood adults have in The problem is we’re scared of our children that ends with a quote which ought to focus all our reading and research on this issue ‘Childhood is generally what adults make it’. Meanwhile Libby Brooks returns to the wider concern about whether the Bailey Review addresses the most important issue facing young people, focusing on child poverty as a more pressing problem to tackle.

As you can see most of these posts have focused on the content, evidence and messaging around the Bailey Review. A different but equally interesting perspective from Caroline Farrow, who takes apart the review from a faith based perspective. Reflecting on issues of history, censorship and parenting. Here’s her post on The Bailey Review.

A lot of the discussions of the Bailey Review were rightly serious in tone, so it was good to have some light relief in the form of Andy Toots hilarious post Yippee-ki-yay,Mrs Dorries (which simultaneously also highlights the right wing media’s hypocrisy over the whole ‘sexualisation’ debate).

Update 10/06/2011
There are a number of academic conferences and events coming up between now and the end of the year
that will tackle issues of sexualisation and commercialisation. These include:

Girls, Sexuality and Sexualisation: Beyond Spectacle and Sensationalism. 30 June 2011. Cardiff

BSA Regional Seminar. Sexualisation: A cause for concern? 5 July 2011. Sheffield

BSSN 5th Annual Conference: Hard Science? Sex, Science and Technology. 15 September 2011. Brighton.

Sexualisation of Culture Conference. University of London. 1-2 December 2011. London.

Equally interestingly Westminster Media Forum have scheduled a Keynote Seminar on 18 October 2011 entitled Protecting children from commercial and other adult pressures: next steps for policy and business practice. A draft timetable is available here and a booking form here. The event’s not cheap (I don’t know why WMF always have such inaccessible pricing), but if you can afford to attend I would strongly recommend going and raising the many issues that have now been outlined relating to both the Bailey Review, preceding reports, and wider issues about evidence making, policy and practice.

Meanwhile MP Sarah Teather, Minister of State for Children and Families is asking for feedback on the Bailey Review. If you have any particular comments or questions please submit them here.

Update 13/06/11
The background literature review commissioned to inform the Bailey Review by Professor Ann Phoenix is now available. I’ve a lot of time for Ann and most people who’ve read her review have been impressed with how thorough it is. There is also this DfE Review by Ann and colleagues looking at how different countries attempt to regulate commercialisation/sexualisation. It is certainly worth reading this document and comparing it with the claims made by the Bailey Review. Critics have noted these reports were not made as accessible as the Bailey Review, and the literature review was not made public by the Department for Education until several days after the Bailey Review was released.

Brooke Magnanti returns to the Bailey Review, this time focusing on terminology and definition.

Suzanne Moore focuses on the issues about capitalism and poverty that the Bailey Review fails to address.

Charlie Brooker is typically cynical but right on the money with his take on gender, media and sexualisation.

Polling company YouGov have run their own research on sexualisation to tie in with the Bailey Review. Check the survey questions asked, there are some major problems with them – can you spot them?

Meanwhile the prize for the most offensive cashing in on the Bailey Review comes courtesy of The People who went undercover to film girls attending a ‘Pole Dancing Class for 3 Year Olds’, only to share images and film of said girls in their class as an example of ‘sexualisation’. This was later picked up by the Mail who also gloated over the photographs of said girls. Both stories ooze class judgement and girl blaming, suggesting an epidemic of pole dance classes for children across the UK (when in fact a possible 8 girls may have been involved in the classes reported on by the People). The comments on the People story are, fortunately, for the most part sensible. Our take home message? ‘Sexualisation’ is very bad. But filming little girls without their knowledge or consent and presenting them in sexually provocative photos in a national newspaper is seemingly fine.

Over the past few weeks parents, practitioners, young people and journalists have been concerned about the Channel 4 series ‘The Joy of Teen Sex’. This has led to a number of us deciding to complain to the Channel and recommend a way forward to ensure future programming is improved.

Below is a copy of our letter, sent to the Chief Executive (David Abraham) and Commissioning Editors yesterday. Myself and others will be reproducing this letter on our blogs and you are welcome to share it on forums, your own blog or for teaching/discussion purposes. If you have been worried by the series and believe Channel 4 should address the current poor standards in sex and relationships broadcasting you may also want to contact the Channel yourself.

Dear David Abraham

Cc: Sue Murphy, Andrew Jackson, Katy Boyd, Liam Humphreys, Kate Teckman, Dominique Walker

We are a group of professionals who are pro-sex education and accessible sexual and reproductive healthcare. We believe in accurate and open discussions about relationships and sex, and feel television can be an effective and powerful medium for sex education programmes that are entertaining as well as informative.

For the past decade Channel 4 has been making programmes addressing sex and relationships issues for teens and adults including: The Sex Inspectors (2004), Orgasmatron/Body Shock (2005), The Dark Side of Modern Love (2005), Am I A Sex Addict (2007), The Sex Education Show (2008-present), and most recently The Joy of Teen Sex. This clearly demonstrates a commitment on behalf of the Channel which we feel is important given how little coverage these topics receive.

While these programmes may have attracted high viewing figures, they have been criticised by therapists, healthcare providers, and educators for portraying inaccurate or outdated and misleading representations of sex education, healthcare, clinical treatments and therapies.

Many of us have been approached to participate on these programmes, or publicise them to our colleagues/clients. We have repeatedly shared our worries about the direction programmes appear to be taking, although have had little success in having those concerns heard.

The recent series The Joy of Teen Sex has been even more problematic than previous similar shows, raising complaint and concern from sexual and reproductive healthcare staff, sex educators, youth workers, sex researchers, parents and young people. In particular they have been worried by:

- the range of topics covered, which may not be representative of the needs/questions teens may have

- some of the skills and qualifications of the professionals used in the programme

- the advice given to programme participants which left little room for exploration, choice, and the right to refuse sexual activity that doesn’t appeal to them

- misleading and/or factually incorrect information, and frequently used unreliable statistics to back up points made. For example the inaccurate claim made at the start of each programme that the average teen has had three sexual partners by the time they reach 16. In fact reputable research finds most teens have not had intercourse before they are 16.(1).

- little attention paid to communication, confidence, respect, romance, affection, closeness

- an overemphasis on sexual techniques and products

- offering options that may not be realistic for viewers, particularly younger teens or those on a low income

- valuing the ‘televisual’ over more relevant issues to young people – e.g. exploring vajazzling

- consistent muddling of key terms (e.g. vagina used when vulva is meant), or using outdated terms such as ‘hymen’

- inaccurate representation of what sex education is like, what sexual health services deliver, and how sex education and healthcare professionals should act. For example a medic making a client cry by showing her graphic images of STIs; telling young women to expect bleeding as part of losing virginity; or not making clear the difference between normal vaginal discharge and an STI

- mixed messages from programme makers in their casting calls to young people/parents, and what professionals being consulted for the series were told it would offer (see Appendices 1 and 2)

- an overall tone that encouraged teen blaming, slut shaming and homophobia, while perpetuating messages of hegemonic masculinities and narrow sexual norms

- not listening to numerous professional concerns during the development stage

- no awareness of, or respect for, cultural diversity

- producers of the show using twitter to promote the programme while simultaneously dismissing professional and parent complaints of the series, referring to anyone who questioned the series as ‘haters’ (see also Appendix 3)

We are concerned the Commissioners and Channel Four have not shown due diligence over this series. It seems to be fitting a pattern of programme development where viewing figures are prioritised over empowerment but where programmes are still marketed as ‘educational’. It does not appear to fit with the Channel’s Public Service Remit or Corporate Responsibility.

We are worried misinformation about sexual and reproductive healthcare and education has been grossly misrepresented, leading to parents feeling anxious, young people’s right to accurate information not being delivered, and professional advice being ignored at all stages of programme development.

The right of young people to comprehensive sex and relationships education is still contested in this country. Many individuals and organizations oppose sex education on the grounds it will sexualise their children, claim it will not give accurate information, or will encourage sexual activity rather than encouraging thoughtful decision-making about relationships. For this reason it is vital that any programme claiming to provide education about sex and sexuality does not provide fuel for these arguments. Sadly we have seen reactions to The Joy of Teen Sex in public discussions and on places like twitter that indicate the programme is already being used as evidence of the ‘failings’ of sex education.

As a result we fear this style of programme making could lead to young people and adults not getting the sexual and relationships advice they need; making the job of healthcare providers, therapists, educators, parents and youth workers more difficult; and causing distress to young people and parents. We have been overwhelmed with emails from anxious teens and parents who support sex education, but are concerned about the messages of teenagers, sex, relationships and sexuality portrayed in this series.

Channel 4 clearly intends to continue making programmes about sex and relationships. We are hoping as Channel Directors you will wish these future broadcasts to be accurate, entertaining and empowering. To ensure this happens we are calling on Channel 4 to establish an advisory group made up of sexual and reproductive health practitioners, sex educators, youth workers, parents and young people to oversee the development of future programming and ensure that it is entertaining, accurate and empowering. This idea is endorsed by Brook, the young people’s sexual health service. All of the signatories below are happy to help you with this endeavor, and are now expecting you to listen to our concerns, and promise quality sex and relationships broadcasting in the future. We look forward to hearing your response soon.

Signed
Petra Boynton PhD, Social Psychologist and Sex Researcher, University College London
Dr Stuart Flanagan, Genito Urinary Physician
Justin Hancock, Bish Training, trainer and consultant
Lisa Hallgarten, Director, Education For Choice
Wendy Savage MBBCh FRCOG MSc (Public Health) Hon DSc
Marge Berer, Editor, Reproductive Health Matters
Romance Academy – a nation-wide, holistic, relationships and sex education initiative
Dr. Meg Barker, Sex therapist and social psychologist, The Open University
Chris Ashford, Principal Lecturer in Law, University of Sunderland
Alice Hoyle, Sex and Relationship Education Advisory Teacher
Alison Terry, Second year student, Applied Community and Youth Work Studies, University of Manchester
K. Barratt, Second year student, Applied Community and Youth Work Studies, University of Manchester
Becca Thompson, BSc MA COT
Steven Norris, Student Teacher
Clare Bale, RGN, BA (Hons),MPH, PhD Candidate, University of Sheffield
Dr. Lesley Hoggart, Principal Research Fellow, School of Health and Social Care University of Greenwich
Matthew Greenall, advisor on international HIV & sexual health programmes
David McQueen, International Speaker and Youth Advocate
Janet Horrocks, Healthy Schools Project Officer
Joelle Brady, MSc, Researcher
Kendelle Bond, MD of Zest Consultantancy, Public Health Consultant
Dr Jayne Kavanagh, Medical Ethics and Law Unit Lead, UCL Medical School and Associate Specialist in Sexual and Reproductive Health, Camden Provider Services
David Evans, Researcher and Chief Executive SRE Project
Peter Bone, Chair of the Advisory Council, PSHE Association

(1) Wellings, K, Nanchahal, K, Macdowall, W, McManus, S, Erens, B, Mercer, CH, Johnson, AM, Copas, AJ, Korovessis, C, Fenton, KA, Field, J Sexual behaviour in Britain: early heterosexual experience. Lancet, 2001: 358; 1843-1850

APPENDIX ONE
Example email correspondence from researchers on The Joy of Teen Sex, to professionals:
“We are in the early stages of shaping our series and are keen to talk to industry professionals, so we can get it right. I understand your concerns and I can reassure you that our aim is to make a thought-provoking and positive series that will look at relationships, emotions and identity as well as “the act of sex”.”The Joy of Teen Sex will not be gratuitous, voyeuristic or salacious. Our aim, working alongside dedicated professionals, is to provide a platform for teenagers and parents to discuss the emotional, physical and psychological pressures young people face when they are seeking to forge loving relationships.”

APPENDIX TWO

Example of casting call information to recruit participants to the programme (reproduced and discussed in this previous blog post about The Joy of Teen Sex).

APPENDIX THREE
Metro Newspaper’s account of Twitter remarks from one of the producers on The Joy of Teen Sex, made during and after episodes were aired. (These have since been removed from twitter by said producer).

Update
Our letter has been reported in The Guardian and Channel 4 have since sent the newspaper this response (reprinted below). For the record the Channel have not as yet been in touch with any of the signatories of the letter and have not even acknowledged receipt of our letter. We await their promised correspondence.

Channel 4 has been committed to programming that addresses the lack and inadequacy of sex education in schools for many years through programmes such as the Sex Education Show and The Joy of Teen Sex. We are proud of our programming in this field as well and their ability to bring large audiences to the often difficult issues they have addressed. We have a hugely successful Sexperience website which has consistently been a leader in the field and has seen millions log on for further advice or information after watching the programmes. Anecdotally we also know from healthcare professionals that viewers have sought medical advice and treatment as a result of watching the programme.

While the programme makers of The Joy of Teen Sex consulted with a number of sexual healthcare professionals to ensure the information provided was accurate and appropriate, we realise that this type of programming will not always appeal to everyone. However, Channel 4 is always willing to listen to the concerns of viewers and interested parties following its broadcasts and we will correspond with the authors of the letter directly about their concerns.

A few thoughts on this response (from me, rather than on behalf of everyone who signed our letter). Given the major problems with The Joy of Teen Sex, it seems more than disingenuous for them to claim the series has been addressing the lack of and inadequacy of sex education. The point of our letter is to highlight how the misinformation in Channel 4′s programming is misleading regarding sex education, and may in fact be causing more work for parents and practitioners while giving ammunition to the anti sex education lobby. There are plenty of ways to support sex education but causing concern to young people, educators and parents is not the way to do it. Nor is creating programmes which feature mainly 18′s and over (not representative of ‘teens’). Or making programmes for teens that are screened after 10pm, and are blocked to under 18s when they’re archived on 4oD. The Channel can’t even claim they’ve not been told about the problems around delivering SRE and how media can inform this – they’ve asked me to speak at their education events twice to specifically tackle this issue (see here and here).

Anecdotes are fine, but how many healthcare professionals have said people have sought advice? Presumably if this is being reported to the Channel they’ll have some record of it? Why are these professionals listened to, but those of us who are raising concerns (based on what we’re seeing in practice) are not?

The Channel mention they consulted with ‘a number of sexual healthcare professionals to ensure the information was accurate and appropriate’. How many professionals and who were they? Six people/organisations signing our letter were directly approached to appear on the Joy of Teen Sex when it was in development. We all shared our concerns about the programme idea at the time but were unable to participate because the producers would not alter their focus. So that’s several professionals we directly know about who gave extensive feedback who were ignored. It would be useful to know who the healthcare professionals who were ultimately used by the Channel, because if they were responsible for signing off the inaccurate statistics and misleading examples of practice screened week on week there are, sadly, questions to ask about their competence.

It is not enough to say our complaint about this series and other programming is just a matter of taste. It is a matter of accuracy and broadcasting ethics. Our reason for writing to the Channel is not to have a grumble about a few things we just don’t like the tone of. It’s a serious catalogue of consistent problematic practice.

The Channel states how it ‘is always willing to listen’. Presumably that includes all the parents and practitioners who have also contacted the Channel separately from our group letter? People who are still waiting for any reply? Channel 4 has not, so far, indicated they are listening. They need to respond to us directly for us to know this is happening. And to continue a dialogue that shows they are taking on board feedback. Not fobbing people off with vague PR speak.

I will keep you posted on any further correspondence from the Channel who I hope decide to revisit our letter and realise we are offering them an opportunity to ensure they provide accurate, entertaining and empowering sex programmes in the future. It would be supremely arrogant of them to continue to decide they know better than young people, parents, practitioners – in other words, their audience.

Last summer myself and several other sex educators, therapists and reproductive healthcare staff were approached by researchers from Betty TV working on a new programme commissioned by Channel 4 called ‘The Joy of Teen Sex’. The show was described as a cross between the established (and popular) Embarrassing Teenage Bodies and The Sex Education Show. The Joy of Teen Sex would be set in a mock clinic where young people who had sex and relationships questions could get advice. The TV company was looking for people to appear as experts on the series (who’d play the role of ‘clinic staff’), and/or to refer them young people for possible inclusion.

After friends and family the media is often one of our main sources of sex information (acting as a ‘super peer’ – who doesn’t always have the right answers). Young people particularly appreciate sex and relationships advice from broadcast and online media. Providing sex information via the mainstream media is not new and has been well received by young people, parents, educators and healthcare staff (a classic example can be found here, see also here).

I am very much in favour of using the media to share information on sex and relationships (and other health topics). But I had reservations from the outset about this particular series. All of which I shared with the researchers at the time, and I’ll repeat now.

The series was billed as being a ‘youth’ programme. Although that doesn’t necessarily mean young people were actively involved in its creation. The title ‘The Joy of Teen Sex’ sounded like something by an adult trying to impress the kids rather than generated by a youth audience.

As I heard more about the planned content of the series it seemed profoundly out of touch with the title. The title implied an attempt at celebrating sex, while the calls for participants suggested it was mostly negative and problematising sex (more on this later). The proposed content did not match the kind of things I’ve noted young people are worried about (through my research and work over the past decade as an agony aunt; and from listening to parents, sex educators and healthcare staff).

Given both Embarrassing Teenage Bodies and The Sex Education Show had received some criticism for their approach to sex-related topics , I was concerned that merging them for a new format without learning from the feedback for existing programmes was not good practice. When I shared these worries with the researcher from Betty TV they did not appear interested.

Setting up a ‘pretend clinic’ was also perhaps unhelpful as it may give an inaccurate impression to young people of what sexual health services are like. If the mock clinic appears off-putting to an audience it may also discourage them from attending a sexual or reproductive health clinic in real life (for more ideas on what a ‘real’ GU clinic is like click here).

The ‘clinic’ setting also framed sex and relationships issues within a health or medical format. Which may be appropriate for tackling the treatment of STIs or contraception, but given this programme was also being presented as providing advice about relationships was a medical tone the best to use? After all, do you head to your GP when you want tips to spice things up sexually? Given the wider concerns about medicalisation and sex, presenting young people with the idea sex and relationships are a primarily medical issue (as opposed to social or cultural) is unhelpful.

Those worries, however, were insignificant compared to my anxiety when I received the advert the company wanted me to pass on to young people, which read:

SO YOU THINK YOU KNOW IT ALL WHEN IT COMES TO SEX?

(The above advert was also posted here with other casting calls can be found here and here)

Let’s unpack this advert.

First of all the programme starts with a challenge – asking if young people know it all. None of us ‘know it all’ when it comes to sex. Such an approach runs counter to working with young people on sensitive issues, where the aim is usually to create a safe space where people can ask questions or debate issues with confidence, rather than feeling judged, silenced or challenged.

‘Sex’ is not transparently defined. Discussions with the TV researchers making the programme indicated they understood ‘sex’ as penis in vagina intercourse (or anal sex in the case of young gay men). This is an extremely limited view of ‘sex’, the meaning of which has been explored in depth here.

Yet ‘sex’ and relationships are constructed in a particular way by this advert. For young people the advert focuses on ‘sex’ as whether or not they know much about infections, problematising porn, ‘losing’ virginity, and young women’s orgasmic difficulties. That leaves out a whole range of other issues young people may wish to talk about while reinforcing many gender and sexual behaviour stereotypes.

When it gets to the parent section of the advert it becomes even more judgemental. Here we see ‘sex’ categorised with more mentions of porn, a brief nod to sexuality, value judgements about ‘sleeping around’, and the setting up of girls as victims, boys as predators. There is nothing positive for parents. Only a list of potentially scary issues a parent might get in touch with. Indeed sex is stated as ‘the biggest worry for parents’.

Is that true? Are parents not also worried about their child’s future? Their academic progress? Their friendship groups? Risk of violent crime? Their health and wellbeing? Financial worries? Some parents may well be anxious about their child’s sexual development, but I’m confident most parents will have additional, and equally pressing, concerns. Realistically if sex really is your prime concern as a parent is television the best place to get support? Particularly if your worries are linked to the motional or physical safety of your child. This is not to say parents should not want advice, just that framing conversations with young people about relationships in purely negative ways is unhelpful.

The advert does indicate what the aim of the series might be. Rather than an opportunity to empower parents or listen to young people, it seems to be designed for the viewer to judge the wayward teen or hapless parent. Previous programmes and wider media coverage about young people’s sexual behaviour have been criticised for creating a format which slut shames young women, makes young men appear to be perverts, presents a heteronormative tone (while pretending to be right on about sexuality), and generally suggests sex is a scary issue – for both young people and their parents. It harks back to an old fashioned view (explored in depth here) that if we had to deliver sex education we might as well make it as offputting as possible to dissuade young people from considering trying it. Aside from this being limited, it is also disempowering. And it shifts topics that young people may not necessarily be seeing as a negative, into a problem. Although in this case dressing it up as a ‘sex positive’ series.

The phrase that put me off supporting the programme most was ‘Sex is the most important thing in a teenager’s life’. It may surprise you, but I profoundly disagree. ‘Sex’ may be important to some teens some of the time, but not to all teens all the time. For many young people the most important thing in their lives may be their friends, their schooling, hobbies or sports, their pets, their faith, music or a whole slew of other stuff I’m probably to old and boring to know about.

Indeed when you talk to young people, often what they are interested in is being in a relationship, being close to someone (either in the short or long term). They may certainly have questions about ‘sex’, and have a range of feelings attached to it – curiosity, anxiety, and excitement. But they will also have other questions that go beyond the mechanics of intercourse.

The majority of young people (2/3 of the UK population) do not have ‘sex’ (at least defined as penis in vagina intercourse) until they are 16 or over (the UK’s age of consent). Many young people aged under 18 have not have sex or a relationship. Those having sex at a very young age tend to be more vulnerable due to numerous reasons (covered here) and are of particular concern to educators, healthcare staff and youth workers.

When you talk to people who deliver sex and relationships education via schools or youth groups, those who are working ethically and appropriately are not trying to convince young people sex is the most important thing in their lives. Indeed, they are usually stressing to young people the importance of having many interests, and encouraging them to delay sex. Alongside tackling wider problems or opportunities facing young people (like schooling, home issues etc). Critics of sex education often argue that talking about sex encourages early experimentation, which is not accurate. However, you can see why critics get worried when young people are being encouraged to view sex as the cornerstone of their entire lives, when for many it isn’t (at least not all the time).

From the calls for respondents the programme ‘teen’ has been defined as young people aged 16+ (or in some cases 18-20). Meaning the focus of the series is better described as being aimed at ‘young adults’.

Setting up a post watershed series (screened at 10pm) aimed at ‘teens’ but really meaning over 16s raises issues over what topics will be covered. Working with young people on sex and relationships issues reveals lots of diversity. You may find a nine year old asks a question that seems very ‘adult’ while a fourteen year old wants to know something that you’d expect a much younger child to be aware of. Part of the skill in working with young people (as it is with adults) is pitching what is discussed at their level, within their comfort zone. Not talking about issues they are not yet confident to understand, or that may be beyond their comprehension or are age inappropriate.

There is always a dilemma in education and advice giving about to provide information that does not patronise young people nor decide for them what they ‘ought’ to know. Young people have a right to sex and relationships education, but when television programmes muddled entertainment and advice (ignoring the latter for the sake of the former) this can mean young people either get information that is not useful, or are presented with concepts that may not be appropriate to their needs.

My worry with this programme is the topics selected for the series were chosen to attract an older audience, rather than truly deliver sex information to teens based on issues young people really want answers to.

It is important to stress I only had involvement at the early stages of development, when practitioners were being approached to be part of the series or find potential participants. I don’t know whether the focus of the programme has altered since, but reading pre-reviews of the series suggests concerns myself and others had with the series have not been resolved.

According to press coverage, in the first show we will meet a woman called Michelle whose 17-year-old daughter Rachel got pregnant last year, is sexually active, but ‘refuses’ to go on the pill. Already we can see the cards being stacked against the mother and the daughter. The danger of such programming is it becomes an opportunity for audiences to judge others who are not fitting particular expected roles. Worryingly there is often a class and race based subtext to this kind of media coverage where audiences are invited to judge chavvy youth or those from ethnic minorities or different faiths.

Other press discussions of what we can expect from the programme, from sex tips to ideas about techniques suggests the focus is a primarily adult one – but one that is also problematic. Adult sex advice (from the media and self help market) is preoccupied with positions and performance. Where ‘perfect’ sex is something to continually aspire to, is measured by how much you do it (not what you do), and where orgasms are something you ‘achieve’ not ‘experience’. It is a space where relationships are usually defined as monogamous (usually heterosexual but sometimes lesbian or gay sexuality is acknowledged). It is not a place where diverse sexualities are talked about in depth – or if any kink or alternative sexualities are focused on it is usually in a fairly sanitised or problematised way.

Sex for grownups (in the mainstream media and popular culture) excludes those who can’t fit into size 10 sexy lingerie, afford the latest sex toy, or whose bodies can’t mould themselves into 101 different positions. It is not a place for people with disabilities to have a voice, nor for those who are Trans, queer or asexual to speak out. If you are single you are allowed to be sexual so long as you can talk (albeit not very explicitly) about friends with benefits, or better still indicate you are trying your hardest to get into a relationship.

Many researchers, therapists and sex educators feel the stifling mainstream depictions of sex and lack of adventure and exploration – and absence of focus on communication – is a problem for adults who want to experience enjoyable sexual encounters or relationships. As a result, the aim of teaching young people to view sex and relationships in more diverse ways is to overcome many of the bad advice aimed at adults, or at least develop the critical thinking and life skills to see through the commercialised, pressurised and frequently unrealistic versions of sex currently on offer in mainstream popular culture.

It is therefore worrying the ‘The Joy of Teen Sex’, rather than tackling what ‘sex’ might be and how young people may look forward to experiencing it, may just serve up a predictable platter of Cosmo-esque sex tips. This is not what youth-focused sex and relationships education should be.

The media frequently distorts the teaching of sex and relationships. This can frighten parents and disempower teachers. Yet with programmes that provide unrealistic ideas about advice giving for young people this could easily give parents the wrong impression, suggesting as the norm activities that are not considered appropriate within school based or healthcare settings. It would be damaging if a programme that misrepresented both sex education and sexual health care contributed to a backlash against supporting parents, schools and healthcare providers from giving relationships information to young people.

Parents already worry about tackling sex and relationships issues with young people although they play a fundamental role in educating children. Media coverage that exaggerates the concerns of young people, presents an overly sexualised focus, or does not tackle the more mundane (and less ‘sexy’) questions young people may have can do two things. Firstly it can suggest to parents they need to be fearful for their child (and their potential sexual interests), and secondly imply the issues their child wants to know about are completely outside a parent’s ability to tackle. Neither are empowering for parents or young people. It is perhaps for this reason parents have already started speaking out about the programme.

What is not clear is why young people and parents wanted to participate in The Joy of Teen Sex. Were they seeking attention or fame? Or did they need advice? If it’s the latter it would be useful to know what led them to get this through a television programme rather than existing services – particularly if people had encountered barriers with existing education or healthcare on sex and relationships issues. Were people unaware of, or unable to access existing sources of free help and information? What about the participants in the programme? How representative are they of young people generally – and how many would-be participants for the show were not included? Why was that? It would be interesting to see journalists follow up on these questions, rather than just inviting us to gawp at and judge the participants in this series.

I have not seen the programme, so I my concerns could be completely misplaced. I will watch it and see if it manages to provide accurate and empowering information. I sincerely hope it does, but I am not confident this will happen. As a supporter of mediated sex advice it infuriates me programmes continue to be made where experts are ignored, where unethical practice is permitted, where young people are not involved, and where the end result does not educate but may well disempower parents, teachers and young people. It represents an endless stream of programming that wastes time, money and opportunities to share accurate advice people so desperately want.

I am always happy to support programmes that cover sex and relationships in an affirmative and diverse way, that move beyond ‘sex’ as intercourse, positions, techniques or infections to answer the questions young people really have in a sensitive way.

I did not feel The Joy of Teen Sex was offering this (although as already mentioned I am happy to be proved wrong). When I was asked to participate as a presenter and to refer young people to the researchers I refused. I felt the TV researchers were not listening to the feedback I shared on how they might make this programme more accurate and empowering, or my concerns about the wellbeing of young people and parents.

Equally worryingly the researchers warned me and other educators not to criticise or question them in public (i.e. on Twitter) or share our concerns about the series.

When a TV company commissioned to make a youth focused programme tells practitioners concerned about young people to keep silent, you really have to wonder who they are trying to benefit.

The Joy of Teen Sex is on Channel 4 tonight at 10pm (GMT)

*

Amidst stories about snow and the final of The Apprentice you may have noticed yesterday’s news claiming the government wants to persuade Internet Service Providers (ISPs) to block access to online pornography.
The Sun – Porn Block on PCs
The Daily Mail – Porn, keep out! Parents to be allowed to block computers from receiving sexual material (not only do the Mail confuse the opt out/opt in system, but also seem unaware parents can already restrict access to adult content online)
The Guardian – Broadband firms urged to block sex websites to protect children (as with much other media coverage the Guardian stacks its story up with a problematic survey from Psychologies magazine, more on this later)
The Telegraph – Internet Pornography Curb By The Government

Where did this story come from?
It originated from a question asked by MP for Devizes (Cornwall) Claire Perry in a House of Commons debate on Internet Pornography on 23 November (summary here). From this Ed Vaizey (Minister for Communication, Culture and the Creative Industries) suggested a meeting with the major UK ISPs to talk about a potential blocking of access to porn and a sign up system (so those wanting to access sexual materials online would have to opt in to gain access).

You can see from the debate linked above and media coverage the focus is presenting this proposal in terms of child protection, and as a mental health issue.

As yet no meeting has been set up and no ISPs agreed formally to any proposed blocks at source. Indeed from today’s news ISPs appear to be saying the proposal is ‘unworkable’.

This proposal is, however, likely to be politically popular – at least in some quarters. It taps into fears parents may have around sexualisation and risks to young people. It appeals to sex negative/conservative voters. It also removes responsibility from parents who may lack confidence or familiarity with the internet and be uncertain what young people might be seeing online or know how to address this. Like many discussions within the sexualisation debate (which this is falling under) it may seem intuitively a good move, yet there are numerous problems associated with this proposal.

Here are some of them

What is this proposal aiming to do?
Although the proposal is suggesting a block at source, it seems this is going to be difficult to provide in practice. It is also only focusing on online pornography, not addressing other areas of sexual content young people might be accessing, nor social networking sites where young people may also be having contact with others people (sometimes in a sexual way). This doesn’t mean these other sources should also be blocked – but it does raise the question why the government is only focusing on ‘online pornography’? What evidence is there that this poses the most significant risk to young people (compared with other media), and what evidence do we have that the best solution to tackling the problem is a block at source with an opt in approach?

Despite media coverage and political debate it is not clear what is proposed (aside from wanting to meet some ISPs), and certainly no clear explanation of why the focus should be on online pornography only or the extent to which this is a major child protection issue (greater than say, addressing poverty; housing; poorly performing schools; addressing the physical and sexual abuse of children; and improving the training funding and support for social services, schools and other youth services).

Defining ‘porn’
One of my plans during my PhD (which focused on evaluating research on pornography effects) was to create absolute definitions of ‘pornography’ and ‘erotica’ as distinct and measurable categories which could be used in research, legal and health settings. In practice I found it pretty difficult to achieve (and gave up trying).

When asked, participants would define porn as ‘dehumanising’, ‘degrading’, ‘exciting’, ‘base’ while ‘erotica’ was described as ‘arousing’, ‘mutual’, ‘equal’ or ‘tender’. In fact what people were really doing was suggesting the values they attributed to said terms. Erotica was viewed far more positively than porn.

However, when I presented the same participants with actual sexual images to talk about they couldn’t agree upon which were porn or erotica. Indeed some saw certain images as ‘erotica’ which others viewed as ‘pornographic’. Unpacking why they felt this was a fascinating part of my research, but indicated for me something that has plagued researchers and lawyers for years. Because sexual materials are usually linked to moral and/or political judgements you can end up in a situation described by Ellen Willis (1979) as “[i]n practice, attempts to sort out good erotica from bad porn inevitably come down to What turns me on is erotica; what turns you on is pornographic”

Before any blocks at source can be made there has to be some level of agreement of what ‘online porn’ is. Currently it isn’t clear what this is defined as and given the range of sexual material online it will be difficult to agree what should or should not be restricted. And who will make these decisions?

Moreover it is unclear where sex advice, art, and conversations about porn online will fall within this proposed restriction. Critics of the proposal are concerned over wider censorship issues that it raises.

What about parental control?
While in opposition the Conservative Party made much complaint about the so-called ‘nanny state’ they saw being endorsed by Labour. Frequently Conservative MPs used the mantra of ‘parent power’ to advocate not having to tackle sex education and sexual health care for young people. Ironically we now see the same party suggesting rather than parents deciding what their offspring can have access to or supervising access to the internet, this decision will be made for families by the state in collaboration with ISPs.

Parents are currently already able to limit access online. They are also able to limit what access young people have to sexual imagery from other media sources, and decide whether or not to allow a young person to play computer games or use social networking sites. Parents can also talk to young people about safety online, confidence and communication generally, and tackle wider topics around sex and relationships.

Sadly, however, many parents don’t do this. This may be down to embarrassment, time pressures, a lack of awareness of risk to young people, a lack of knowledge of about the internet, or a lack of involvement in parenting generally.

For many parents a block at source could seem appealing as it means they don’t have to set controls over what their children are accessing. They may also believe this absolves them of the task of controlling media access more generally, or having to talk about sex and relationships, or around issues of respect, assertiveness and communication.

Simply putting a block on porn access online would not prevent young people seeing imagery elsewhere. Nor would it mean they would no longer require parental support, supervision and advice.

Blocking more than ‘porn’?
One of the major concerns over this proposal is it would block more than porn. Anyone who has had the fun experience of working within organisations like the NHS (as I’ve had for many years) will recognise how intranet blocks can stop you accessing advice sites and even research papers tackling topics containing ‘naughty’ words like breasts or testicles, psychosexual problems or sex education.

A feature of blocking at source means it’s not just sexual imagery created for entertainment/arousal that is blocked, you may also find you cannot find self help, advice or educational materials.

This government proposal could mean the many young people who have questions about their gender or sexuality, are being abused or bullied, want to know about puberty, STIs, contraception or pregnancy, or have general ‘am I normal?’ worries will not be able to gain access to such information online. For many young people these questions are not always ones they can ask of teachers or parents. Parents or teachers don’t always give them the answers they need. It may be on more sensitive topics they can’t ask friends or even use internet cafes or libraries. The privacy of online advice may be the only place they can find answers. As not knowing about these issues can put young people at risk and cause mental distress it seems ironic a proposal based around safeguarding young people’s mental health could directly harm it.

Advice websites, online information forums, resources like Scarleteen that talk frankly about sex for young people could easily find themselves blocked within this proposal.

Under such a proposed scheme parents (and other adults) may also find they cannot find out information about ovarian cancer, psychosexual problems, smear tests, fertility, miscarriage, pregnancy advice, partner abuse or rape.

Young people (and adults) have a basic human right to information about their sexual lives, gender and sexuality (see here and here for two examples discussing this issue). These proposals bring up wider discussions not only around censorship, but also about open access to health information.

Do blocks and bans work?
Many adults may remember our recent history where pornography was largely illegal within the UK, or was heavily restricted in accessibility. Jokes abound about the only place to find porn – aside from under your parent’s bed – would be what you stumbled across during walks in the woods (or perhaps shared by a bigger boy at school). However this did not stop young people wanting to see, or seeking out, sexual materials.

It would be wrong to suggest availability, access and commercialisation around sexual imagery hasn’t altered. It does seem sexual imagery is more prevalent and easier to access than in the past – but not just in terms of ‘online pornography. Shifts within commercial markets have also meant more discussions about sex in the mainstream media, advertising, music and other entertainment industries – aimed at adults as well as young people.

This does not mean such materials should also be met with a blanket ban. Focusing on ways to talk about the messages shared within popular culture, from parents and peers are important. It seems peculiar this government seeks to block access to one form of sexual imagery but are less interested in addressing realistic and rights based sex and relationships education.

Generally blocking or banning one area doesn’t seem to work (research and wider issues discussed here) – people still find ways to access material, and given sexual media appears in more places than online porn it is unlikely just blocking one area will make much difference. Indeed we’re left uncertain what difference politicians expect as a result of such a block.

Moreover in discussions in this area we are not hearing about research that talks about the more complex and nuanced relationships young people have with the media (see here and here for examples). This proposal also seems to be assuming the majority of young people have some kind of private internet access at home, and this is their main source of viewing explicit material. However this may not be the case and does not guarantee young people won’t find sexual imagery in other sources. The proposal seems to be suggesting that online access to porn is causing specific harms and yet no clear evidence is being shared about what those harms may be.

It is not clear what this proposed block is for. Is it to protect young people? If so, from what? Finding out about sex? Seeing sexually violent images? Being exposed to adult content while they are still young? To prevent young people becoming sexually active? It seems to be working under an assumption that young people who see sexual images may be mentally harmed, or perhaps will become sexually active at a young age, or be coerced (or coerce others) into a sexual act they may not have previously considered. Yet within this no clear evidence is presented around whether this is being observed now and what impact this is having on young people long term.

The media’s lack of critical attention
Press coverage of this story has been largely uncritical. In that it has presented the proposals set out by the government without any real discussion of how workable they may be or the issues related to potential blocks that might put young people at risk. Moreover the media have not been particularly careful to focus on the wide range of evidence addressing media effects in this area (and particularly about young people’s use of online porn). Instead most media coverage have backed up their stories with the quote from a survey from Psychologies magazine that 1/3 of young people have seen online porn (when aged under 10).

This represents part of the problem with the media on this issue. Journalists appear to believe that online porn does cause harm to young people and therefore rather than thinking more critically about sexualised culture and youth, they accept studies that support their position.

The Psychologies survey is particularly flawed as it is presented as being representative of children across the UK, whereas it was actually only conducted in one London school.

I was concerned over the way this research was conducted on young people and when raising questions about it was sent various emails and was called by the editor about it. This included a copy of the survey questions and response rates.

From this correspondence it was difficult to identify whether parents did or didn’t know their children were completing an online survey about pornography. Questions asked were in placed muddled or confusing, and while some answers suggested young people had seen online porn, the majority of respondents had not (and nor were they in a sexual relationship). Indeed most respondents who had seen porn weren’t particularly troubled by it – seeing it as arousing or a joke. The limited sample, problematic questions, ambiguity over parental consent and young people’s ability to opt out of the research means this survey is not reliable. And yet it remains popular among both journalists and politicians as ‘proof’ of our ‘problem’ with online porn and young people in the UK.

It would be unfair to single out Psychologies magazine as they are not the only media outlet who has completed research in this area that could have been a lot more robust. Channel 4’s Sex Education Show also conducted a survey on porn as part of its second series (The Sex Education Show vs Pornography) which, despite being told that pornography was not the major issue affecting young people still made a show with this focus because the series was commissioned to have a campaigning focus similar to ‘Jamie’s School Dinners’ (as one producer informed me). Because many of the cases presented in the programme suggested accessing extreme porn was both easy and commonplace it persuaded many people this was a major campaign issue. Even people who might usually question evidence or ask to see research accepted the depiction of online porn within the programme as ‘the norm’.

Completing research on young people and sexual imagery is something that is important but has to be managed ethically, responsibly and carefully. At present while claims are made about the number of young people accessing sexual imagery and the impact this is having on them, in truth there is a lack of robust research in this area. This is mainly linked to a lack of funding to study the topic, and limits to what can be asked of young people by ethics committees.

We do have evidence around the impact of porn but not all of this is based on online porn and even when it is, is flawed by a lack of definitions about what ‘online porn’ is. Many studies are overly simplistic, lab based and feature undergraduate students. The experiences of sexualised media (not just online porn) on young people remains an under researched area and at this time it is difficult to make any firm conclusions about its impact.

Claims about how it is changing young people’s brains, behaviour and bodies sound frightening but often do not have much reliable data to back them up.

Unfortunately at present politicians continue to avoid engaging with evidence on a critical level and various lobby groups of different pro and anti porn (but largely anti porn) positions are making their views count more than independent research. As a result many claims are being made about online porn and its impact on young people but, if you try and source any evidence for said claims, it is difficult to find anything particularly reliable.

The media and politicians, rather than accepting a few flimsy studies that back up their beliefs, need to look more closely at what is happening to young people and hear from those conducting careful, respectful and ethical research in this area.

What happens now?
This is only a proposal. So at present no meeting has been set up and it may be no meeting may happen. Critics of the proposal are arguing it’s a play on the part of the conservative to faith based voters, in a similar move to actions taken in Australia (see here and here). And that it won’t go any further than a chat with ISPs (if that far). Others argue the proposal is based on well meaning, but ill informed, intentions that will continue to be focused upon as part of wider debates on sexualisation.

We have seen little critical discussion of the issue within the media outside of talking over whether the proposal is workable. Debates about the evidence in this area, the acceptance of limited studies to make policy, parallels with Australia, and the needs and rights of young people are largely absent in media coverage and in debates on blogs or twitter (which have tended to focus more on the censorship or tech angles).

Because this is a proposal there are things you can do about this issue. You can lobby your MP and ask them what their views are, and provide them with more balanced information about young people, their rights and ways in which we can empower them to negotiate a commercialised/sexualised culture. (Here’s a nice set of free resources to help them!)

We can all ask to see what evidence the government has that this specific proposal would make a demonstrable difference to the lives of young people, what that difference might be, and how it might be measured.

Critics who fear this is another form of censorship and regulation need their concerns addressing.

We need to be careful to continue discussions about young people’s rights and responsibilities without questioning of this current proposal (or ones like it) degenerating into accusations of promoting abuse or denying young people need support. (As previously experienced in debates on extreme porn).

Parents can lobby for greater responsibility and control and reject the idea of an opt in system. They can argue the existing system where parents can already block access and talk to their children about sex/relationships issues is adequate. This requires parents to step up to the plate and be more engaged in the parenting process and certainly educators, practitioners, healthcare providers, therapists and youth organisations can do more to support parents in this role.

Despite this debate being largely about them the opinions of young people are largely absent. It would be good to hear more from young people about what they think about online porn and related issues. We do not do enough to include young people’s voices, nor offer support or empowerment to them on this or other child protection issues and that is something we should rectify as these debates look set to continue.

We can focus on increasing access to relationships education both at home and school, support online services already offering independent and ethical advice to young people on sex/relationships, and ensure any education offered covers topics around delay, respect, communication, confidence and pleasure. Not just about biology, STIs, just saying no, and contraception.

We should question the government on this issue. Why are they considering this proposal? Why is it important to them? What do they think it will achieve? Who are they aiming to protect? And if they are interested in child protection what other areas such as child poverty (in particular) might they also be focusing on?

This proposal raises wider issues around health, education, access, and rights to information. So it is worth looking beyond what may be fairly empty government proposals or broader discussions on censorship and think about what this government’s understanding of young people’s rights may be – along with their awareness of ‘sexualisation’ and how to deal with it.

Certainly young people are living within a different culture where there is easier access to sexualised (and often commercialised) messages. These are not just within the domains of ‘internet porn’ but often in the pages of our daily papers, celebrity sex scandal stories, music, advertising and so on. It is important to talk about the information both young people and parents need, but deciding to begin this debate recommending a top down, censoring approach does not allow us to really explore what would help young people and where actual risks may be from.

Want to know more?
If you are interested in this issue a discussion is ongoing about it on twitter using the hashtag #ukpornban Meanwhile people like @quietriot_girl @auntysarah and @bishtraining have been actively engaged in debating this proposal on twitter. Bish has also written an excellent summary about the issues raised by the proposal here. If you see any other blogs or articles discussing this issue you think are helpful please email me (info@drpetra.co.uk) and I’ll add them to this post.

Other interesting writing on this topic from:

Pandora Blake who talks about some of the flaws in both the proposed scheme and the ‘research’ behind it. This is picked up by both @violetblue in ZDNet and @TomRoyal in ComputerActive who focus on the groups behind the proposal. Particularly the pressure group Media March. Tom’s post was written a year ago, but it seems Media March are still keen to persuade politicians to their cause. More on this organisation can be found at Liberal Conspiracy

Both Mashable and
Guardian Technology discuss whether the proposals even make any sense. (The piece by @tomscott says pretty much what I say above, just a lot more succinctly!)

@foxsoup writes at ThoughtSoup on the major limitations of The Psychologies survey (which journalists are continuing to treat as though it is a robust and leading piece of research in this area). While The Register takes a more pragmatic approach and discusses whether this proposal is really an issue and if it will ever lead to any action (they also talk about the reasons why this issue is being raised now).

In a more personal account Unaverage Girl focuses on how blocking porn could have killed her, reminding us of the wider issues about access to information for young people.

While on a lighter note @zoeimogen suggests we remember Cleanternet (a similar suggestion to this current proposal)

Meanwhile Claire Perry announced on twitter 100% of negative or abusive commentary about opt in system for internet porn is from the chaps. Women 100% positive (so far) Since then many women have taken the opportunity to tell her they disagree.

* Image used here comes from the amazing TV series ‘Father Ted’ where Fathers Ted and Dougal are required to protest against a ‘blasphemous film’ (the clip for which is here, wonderful).

As we already are sadly aware, the future of sex education in the UK remains unclear. Despite promises for sex education to be statutory and numerous consultations and reviews on the issue (including those by Ofsted, NICE and the Department of Education) we are still waiting to hear what is going to happen regarding sex education within schools.

Last week’s spending review indicated there will be cuts to many budgets affecting young people – not least around local government which often covers youth services and resources. Not just providing sex education but delivering activities and support for young people – and importantly giving them activities, goals and aspirations. Current cuts look set to discriminate against the poorest in society and in such times of economic austerity we can expect to see sex and relationships education fall off the radar. Indeed it may be deliberately ignored as might service provision for reproductive and GU services.

None of which is good news for young people, parents, teachers or health care providers.

Predictably within debates on the future of sex education it’s been young people’s voices that are largely absent. Last week saw the launch of a new campaign from the NCB’s Sex Education Forum encouraging young people to speak up for relationships education. Their Youth Advocacy campaign asks “Are you happy with the sex and relationships education (SRE) you have received? If not, it helps to know what you can do to make a difference in your local area. Read on to learn more about your rights, get top tips and resources, and find out about other young people like you who have made a difference”. Their website includes resources, films and materials to enable young people to campaign for better sex education. I’d encourage young people, teachers, parents, youth workers and other advocates to use these resources to push for quality relationships education in school, at home, and in other youth services.

Simply providing more sex education isn’t the answer (and seems unlikely to happen anyway). What we need is quality, evidence based and appropriately tailored programmes that focus on relationships, communication, confidence and respect – and are inclusive of young people, not imposed in a top down manner.

Housing, education, poverty and family support are also crucial. It doesn’t matter if we provide great relationships education if young people are not getting good overall education, lack hobbies and activities to enjoy, or are living in poor housing or on low incomes. While we focus on keeping relationships education as an important issue we cannot lose sight of these equally necessary factors that impact on young people’s lives – and that of their parents.

I’ll keep you updated on where things stand with sex/relationships education and will be creating resources for parents and teachers over the coming months (as it looks like we’ll be having to take more responsibility to tackle relationships education on budget and without national or local government support). In the meantime let’s look to young people to keep this issue in focus, and to campaign more widely for their rights to safe, happy and healthy childhoods.

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!

Over the past couple of years we’ve seen a particular preoccupation with Western media about underage sex. This has included the media frenzy over 13 year old ‘teenage dad’ Alfie Patten through to frequent media features on teenage pregnancy, abortions and parenthood, to more recent documentaries like Channel 4’s ‘Underage and Having Sex’ or ITV This Morning’s debate on the age of consent which I participated in.

These stories have generated a lot of public attention and added to the general anxiety about parenting, sex education, and wider social and moral issues. Most share the common theme of judging young people (and their families), particularly girls (who are more harshly viewed for having sex). Other subgroups of young people are also demonised (the poor, socially excluded or ethnic minorities).

As a result, discussions on the topic are difficult and usually framed in a moral context. Much of the debate hasn’t focused broadly on understanding early sexual debut, or to identify potential solutions to encourage young people to delay, or to identify what pleasurable and safe experiences young people might be exploring. Instead underage sex is mainly framed in the language of STIs, unplanned pregnancy or coerced sex. This often leads to discussions of sex and teenagers that centres around the age of consent – purely in chronological terms – which sex educators and researchers feel is not a very useful indicator of sexual behaviour.

What do we know about this issue?
Public concern over youth sexual behaviour is mirrored by the tone of a lot of the research within this area which tends to focus on early sexual debut with associated negative risk factors (such as STIs, abuse, unplanned pregnancy).

The literature uses a number of different ways to approach the issue from straightforward legal definitions of age of consent, although as you can see from this resource the legal age of consent for girls and boys, gay and straight varies internationally. Unsurprisingly countries with more repressive regimes, gender inequality and homophobic values tend to criminalise homosexual sex while fixing the age of consent for girls at a young age. Go figure who this benefits.

Other definitions refer to more ambiguous concepts such as ‘early sexual debut’ or ‘first sexual encounter’. Even within this what is defined as ‘underage sex’ varies depending on different research projects or educational interventions with some referring to sexual contact and petting which includes penis/vagina intercourse, while others present it as specifically about penis/vagina sex.

Critics have complained the focus of both research and education in this area has focused predominantly on problem based or sex negative consequences for heterosexual audiences. The specific issues of sexual debut for LGBT youth is frequently overlooked, while the experiences of certain BME groups is under researched or based around racial stereotypes.

Seeing underage sex purely in terms of penises in vaginas has been identified as unhelpful for a variety of reasons, most of which are summarised in this excellent discussion from Scarleteen. There is the assumption from many parents, practitioners and the media that if a young person has sex before the age of consent they continue to have regular penis/vagina sex from thereon in. This may be inaccurate as some young people may have ‘sex’ before the age of consent but not have it again until they are older. Linking of penis/vagina sex also tends to focus more negatively on young women – particularly around the idea of ‘losing’ virginity and ‘breaking’ of the hymen – an idea which current research disputes on medical grounds seeing it more as a cultural and religious construct rather than any real physical one-off event.

Why are we so anxious about this issue?
Clearly thinking about young people’s wellbeing is important, but it is often unclear in debates about underage sex what is the specific issue adults are most anxious about? Are they worried about pregnancy risk? Of a young person requiring a termination or having a child when young? Or a young person catching a sexually transmitted infection? Do they fear it may lead to promiscuity? Or are they seeing as an adult a situation that is exploitative but that a young person perhaps does not recognise as such (or maybe is aware of as abuse but is still subjected to)? All of these are reasonable fears and ones parents and teachers do raise. They also talk about fears of their child or children in their care getting a reputation (more so in the case of girls) or their being judged as an unfit parent or teacher if they are associated with a young person who has underage sex. As this issue is so often framed as a moral debate it makes it very difficult for us to articulate exactly what our specific anxieties are about underage sex.

Why do young people have sex before age of consent?
Reasons Young People have sex before the age of consent varies. It can include curiosity and experimentation to wanting to experience pleasure or feel close to a boy or girlfriend. It may be something they feel they need to get out of the way or believe everyone else is doing. Or it may be down to feeling coerced, being forced or just being bored. We generally focus on the more negative issues, particularly in relation to age gap relationships (or relationships that are unequal in other ways). Discussing more positive aspects of underage sex tend to be avoided for fear of encouraging sexual activity, seeming to endorse such practices, or the concern among adults that they are potentially abusive or attracted to children. This, accompanied by a media which is largely negative about teenagers having underage sex, makes it very difficult to have a clear conversation about this issue in a balanced way.

What are the risks to young people?
Clearly it would be remiss to present this discussion without looking at the specific problems linked to young people and underage sex. The well documented negative issues include:
STIs
Unplanned pregnancy
Young parenthood
Regret
Risks to reputation (particularly for girls and for LGBT youth)

However this is still very much focusing around penis/vagina (heterosexual) sex. Discussions with young people about kissing, cuddling, communicating desire via text or talking, and masturbation (alone or with a partner) tend to be a lot more positive. Where the focus is on penis/vagina sex under the age of consent there are subdivisions of problems – so unplanned sex with casual partners where condoms or other forms of contraception are not used are seen as inherently more risky than sexual activities which are part of a longer term relationship with a cared for person and where contraception is used.

Given the stigma associated with the first three issues it is understandable people want to prevent them, but sometimes in focusing on them so negatively there can be unforeseen outcomes. Not least those who do seek terminations or become young parents feeling judged negatively, or perpetuating the myth that any sexual encounter will result in either an infection or pregnancy. Such messages give young people false ideas about sex and make it less likely for them to use contraception (particularly condoms) which in turn has the additional effect of making it more likely they may get an infection or become pregnant. So clearly simply focusing on negative outcomes without putting them in any real context or providing advice about prevention is unhelpful.

Moreover it ignores that many young people are exploring sexual experiences with their peers that they enjoy but feel they cannot discuss for fear they are breaking the law, or feel anxious about as they are led to believe any sexual activity under the age of consent automatically is either abusive and/or has negative consequences.

Are particular young people at risk?
Evidence suggests there are particular groups of young people who are more likely to experience underage sex, although they may differ from the stereotypes we expect from the media. The kinds of things that would make it more likely you have sex underage include:
Lack of parental supervision and support*
Lots of pocket money, lots of free time
Lack of hobbies or after school activities
Reduced aspirations
Exclusion from school*
Socio-economic disadvantage
Low educational achievement*
Being from particular ethnic groups (e.g. in the UK African Caribbean boys and White girls are more likely to have sex before the age of consent)
A large age gap relationship*
Peer pressure/bullying
Low self esteem*
Lack of sex education from home or school
Being in looked after care
* also related to not using contraceptives or getting contraception advice/support

So the issue is not just about having sex before the age of consent, it’s related to how young a person is, how in control of the situation they felt, whether they consented to the encounter, whether they enjoyed it, and whether contraception was used (or the sex was planned). The context of the relationship also matters – in terms of whether it was with someone they felt affection for, how soon into a relationship they had sex, and when/how it ended. Many of these factors interact, so lots of free time + a lack of supervision + a lack of hobbies + few aspirations can work together to create situations where a young person might have sex before they felt ready. However other factors can produce contradictory results so while being disadvantaged economically may seem like a very big risk it tends to only be a real problem if accompanied by low educational achievement. So a young person from a poor background who is in a supportive home and being encouraged to achieve at school plus has aspirations and interests will be less likely to have sex underage than a young person who is from a poor background but also is excluded from or doing badly in education.

Prevention – do we need to make kids ‘just say no’?
Clearly situations which are abusive, coercive or unequal are a problem – particularly those that end in violence, unplanned pregnancy or STIs. Simply focusing on negative outcomes is not particularly helpful as already mentioned, and prevention is not likely to be effective if only couched in negative terms of focused specifically on penis/vagina sex. What would help young people is better sex education that focuses on relationships issues and addresses feelings, emotions, confidence, respect, assertiveness and communication skills. Education that focuses on relationships skills as a lifelong learning experience rather than one-off lessons or ‘big talks’ is vital. Delivery from parents and teachers is considered important, and peers are also very helpful. Shifting discussions from this issue from a moral debate to one about empowerment and wellbeing is vital – and our media could do a lot more to assist on that score. Finally reframing this as a youth wellbeing issue rather than a sex one is really important so we focus on aspirations, goals, interests and activities – supporting young people and making them feel valued and respected. Most importantly listening to young people is essential – and often a lot more reassuring than you might imagine.

‘Sexual Readiness’ – a more accurate measure than age of consent?
Research has indicated that a focus on chronological age within a legal framework does not adequately represent sexual maturity. ‘Readiness’ or ‘preparedness’ for sex may be equally important indicators for sexual debut. Meaning not all young people will be sexually mature at any given country specific age of consent. Some 16 year olds may well feel ready and interested in exploring a sexual relationship but not all will. And what constitutes a sexual relationship may vary among young people. Focusing on feeling prepared for a relationship, being able to negotiate with a partner, plan contraception use and be aware how to explore intimacy together is not something that can simply be expected to happen when a young person passes a particular age. Instead we should focus our attention on multiple factors that include physiological, psychological and biological maturity – and how young people feel about their experiences.

Because the focus of research and teaching practice in this area is negatively focused (often for well intentioned reasons) it means we know very little about what young people think about their sexual experiences. Given many fear they will be judged for admitting to underage sex often they tend to focus on (or be asked about) purely negative outcomes. Although controversial if we do not ask young people about a range of experiences they have encountered relating to sex, then we will not be best placed to offer them the in depth sex education they need. It also makes it difficult to differentiate between consenting and coerced experiences and makes it more difficult to safeguard young people most at risk from exploitation or abuse.

What’s the role of parents here?
Parents are often anxious to discuss sex and relationships issues with young people for fear of encouraging early sexual behaviour or being judged by other parents. It is important to talk about sex and relationships issues (see sources of advice below for more on how to do it). Focusing on the positive aspects of relationships a young person can expect to look forward to as they get older is more useful than simply warning about the bad things that may happen – infections, pregnancy etc. Threatening these are inevitable consequences of underage sex, or implying a young person will be criminalised for having sex underage may make it less likely your teenager will talk to you. Remember, a young person who has questions about sex is not necessarily having sex and may be looking for information or reassurance. If they are considering an intimate relationship then discussions with you can help identify who they are in a relationship with and any causes for concern you need to be aware of (age gaps, potential exploitation, issues of control and contraception). These are not always easy issues for parents to consider and you may find talking to other parents, to your child’s school or college or getting advice from your local outreach/health promotion services could be of use in such a situation.

Parents know their children well and are often excellently placed to put advice and education in context. You may be aware your child is interested in adult relationships and will want to prepare them for this and answer their questions while highlighting what positive and equal relationships are about. Or you may notice your child does not seem to be keen on discussing such topics and you may want to reassure them about relationships at a level appropriate to their maturity – not avoiding topics but ensuring they are covered in a way that best suits the needs of your child. Again, reflecting on the messages you are sharing with other parents or friends can be very useful to ensure you are pitching things at just the right level.

Certainly don’t leave any ‘sex talk’ until your child is over the age of consent for your country or state, they will need information well before this. And remember just because they’ve not asked you doesn’t mean they’re not picking up ideas about sex and relationships from other places (like the media and their peers). Talking about sex and relationships spans your child’s life – it doesn’t have to wait until their 16 and doesn’t stop once they pass this age.

Sources of advice/help
This previous post addresses what young people want in relation to sex education and includes evidence about what young people want to learn about positive relationships. It also links to other posts and resources containing advice on how to talk to young people about sex and relationships.
Hawes, Wellings and Stephenson’s excellent review ‘First Heterosexual Intercourse in the United Kingdom: A review of the literature’ (2010) Journal of Sex Research is essential reading for anyone wanting a systematic overview of the literature on this topic, which clearly outlines the different studies addressing sexual behaviour in young people.