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.

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)

There’s been a lot of interest online today about a 1969 Public Service Advert – ‘VD is for everybody’, which shows a range of people who could have a sexually transmitted infection. You can see it here:

Having been flagged up on Boing Boing debate has centred on whether the advert was counter productive and seemed to endorse STIs, or whether it was highlighting how anyone could be at risk from infections – even ‘nice’ people like you (as the song goes).

What’s interesting about this advert is it’s not unique in public health messaging around STIs. In fact the ‘you can’t tell by looking’ theme has run across sex advice campaigns for years. For example this 1948 US advert for the US Navy shows you can’t be sure who has an STI (while rehearsing the women-blaming angle that can often subtly or not so subtly underpin campaigns of this kind – see also the ad at the start of this post!).

It’s also found in this UK public information advert by the Department of Health’s ‘Condom Essential Wear’ campaign.

@mngreenall has found a couple of international examples such as this Nigerian campaign featuring Femi Kuti

And this more sinister advert from Kenya’s Ministry of Health

While South African HIV prevention organisation LoveLife have a fascinating overview of their media/behaviour change campaigns. A similar global archive of different sexual health campaigns (some commercial, some governmental) can be found at the wonderful Sex Smart Films.

The plan within all of this kind of messaging is to challenge the stereotype that STIs can only affect certain people and that anyone could potentially get or share an STI. They also flag up how many STIs can be symptomless so you may not always know you have one. The former two adverts focus on telling people about risk and where to get help, while the latter one focuses on risk and prevention (condom use). That may say more about changing cultural values in media to allow prevention messages to be shared. Often symptom and treatment messages are easier to talk about in health media, although even then barriers can exist over how frank an advert can be.

Debates continue on how best to share STI messaging in public health campaigns. Humour, blame, shame, fear or reassurance can (and have) all been used to try and get the public to be more aware about their sexual wellbeing. Critics often claim hosting any campaign that talks about STIs frankly could ‘glamourise’ them or make it seem they’re ‘acceptable’, or only appeal to the ‘worried well’. While defendents of public sexual health campaigns argue adverts can destigmatise STIs, alert people to the risk of having an infection, encourage getting tested, and make it clear they are commonplace but that doesn’t mean they’re problem free and shouldn’t be tackled.

Practical barriers can also impact on sexual health media – politicians may be anxious about endorsing widespread public health campaigns on this issue. Charities and NGOs may run campaigns but often from particular positions (meaning some messaging can fit the blame/shame angle more than others). Television companies can also be skittish about what advertising they’ll allow and ad agencies may be keen to create something that’s shocking or visually striking but may not be particularly helpful or accurate.

Unfortunately in a lot of cases adverts are not run for any length of time, nor is their impact evaluated. Indeed for many governments, charities or organisations the belief that an advertising campaign has reached the public is seen as the end of an intervention. The aim of adverts like this are usually to raise awareness AND change behaviour, but follow up to see if any impact has been made in either category is not always carried out. Meaning it is often difficult to be sure what, if any, impact such campaigns have had. (A good review on mediated public health campaigns can be found here which explores this issue in more depth).

The ‘you can’t tell by looking’ advertising message is not unique to 1969. Indeed it was being used long before this date and continues to be used globally in sexual health information programmes. Seeing what messages have been used in the past allows us to consider whether they may still work in the future, what other approaches you could try instead, and most importantly to ensure any public health campaign starts with a built in evaluation plan to assess impact.

It’s great people have been thinking critically about public health messaging on STIs, so while people are eager to talk about it why not think about why kinds of campaigns you would like to see – and share examples of good and bad messaging you find online.

Update: Thanks to all of you who’ve been sending me examples of media campaigns for sexual health, I’ll add more as I get them – and any evaluations of activity also welcome!

Fans of the movie Anchorman will no doubt be familiar with the men’s fragrance ‘Sex Panther’. If you hadn’t heard of it before, here’s your introduction…

The fantastic line ‘they’ve done studies you know. 60% of the time it works every time’ has become a well known catchphrase. But I think it deserves far wider use and so I’ve appropriated it to highlight dubious sex research claims.

Last week a Dallas TV station didn’t disappoint with an amazing Sex Panther statistic of their own, claiming ’80% of women have an enlarged labia’. You can see the coverage of the story here.

Even with my dubious maths skills this doesn’t make sense. Because if such a large majority of women report large labia then presumably this becomes ‘the norm’ rather than ‘a problem’.

Using a standard Sex Panther approach we’re told nothing about the origins of this statistic. Merely an assumption that science has shown us 80% of women have larger labia. So we don’t know how many women were studied to make up this figure, who they were, when they were studied, or whether they actually considered themselves to have a problem. We don’t know who did the research, or whether it was even published. We’re given no clue about how ‘enlarged’ labia must be before they become unwieldy. The statistic becomes even more ludicrous if we’re assuming ‘enlarged’ to mean ‘larger than average’. In which case we seem to be being told that 80% of women have larger than average labia.

And that’s before we get on to the problem of the programme makers not being able to differentiate between the vagina and labia.

Of course the piece is really only an advertorial for a “misses only makeover” and sadly amidst the coy references from the anchorwomen we see absolutely no investigative journalism to assess whether cosmetic surgery for well women is needed or to interrogate the concept of ‘enlarged labia’ and who is problematising our vulva shapes and sizes.

Had any research been undertaken the journalists may have learned there is no clear evidence for the effectiveness of cosmetic genital surgery in well women, but there is a growing trend within the cosmetic surgery industry to pathologise the female body as a means to creating a wider market in ‘enhancement’.

Although uncritical media reporting on genital surgery is not unusual there is fortunately an antidote.

THE NEW VIEW CAMPAIGN announces its THIRD Conference, to be held at the University of Nevada, Las Vegas, on Sunday, September 26, 2010.

FRAMING THE VULVA: GENITAL COSMETIC SURGERY AND GENITAL DIVERSITY

While the vulva surgeons are holding a conference on the Las Vegas strip, the New View, in collaboration with the UNLV Women’s Studies Department and Petals, will hold a counter-conference to examine the
personal and political complexities of the new female genital cosmetic surgeries.

Our one-day event will include a morning plenary session on the emerging issues in genital scholarship, activism, and art, and an afternoon of experiential and discussion workshops for participants to share strategies and build connections. The event will conclude with an evening reception, photography and craft exhibition, and film showing at the Erotic Heritage Museum.

Areas covered will include:
• Cosmetogynecology and the new genital perfectability industries
• The rhetoric vs. the realities of Western genital surgeries vs. “FGM”
• Collaborative models of activism
• The revival of “cunt art” in craft, film, photography and painting
• Sex education and feminist-owned sex shops
• The latest body modification trends, from Vajazzling to Vatooing
• Disease-mongering, marketing, and body surveillance
• Critical health studies perspectives on cosmetic genital surgery

Confirmed plenary speakers include:
• Virginia Braun, University of Auckland, New Zealand
• Leonore Tiefer, NYU Medical School, NYC
• Vanessa Schick, Indiana University, Bloomington
• Lynn Comella, UNLV, Las Vegas

Full registration, hotel, and contact information here.

Please share information widely and if you’re a health worker, activist, therapist or sex educator do try and support the event if you can – either by attending the conference or donating to the New View Campaign. Journalists may particularly want to attend to learn more about celebrating women’s bodies and accurate reporting on the growing trend for medicalisation.

In the meantime go on – love your labia! Or love someone else’s. And if a journalist tells you there’s something wrong with your genitals without explaining the science behind their statements be assured they’re simply selling you Sex Panther Statistics.

Tonight the UK will see the first television advert for abortion services. Shown at 10.10pm on Channel 4 the advert for Marie Stopes will highlight for viewers where to get help and advice about pregnancy. The advert has already been opposed by charity Life and will not be shown in Northern Ireland (where termination of pregnancy is illegal).

Despite following a public consultation about advertising condoms and termination services on television, some quarters of the media have responded to this advert as though it was automatically going to entice all young women to have abortions – even if they weren’t pregnant! Before the advert had even been made available some journalists were expressing outrage that such messaging could be shared, and were referring to the campaign as ‘the abortion advert’ (rather than an advert for an advice service). Although there was also balanced coverage elsewhere.

One key question that the advert has raised is why do we need to promote services offering termination on television? A common theme in discussing this case has been that those who want a termination would know how to get one so why should there be a television advert talking about this issue?

Unfortunately we know there are many myths about termination of pregnancy which include what terminations actually involve, how you go about getting one, when you can seek a termination, do you have to pay, and what happens afterwards (you can find answers to these questions here courtesy of Living Well/NHS and Patient UK).

We have to remember not everyone has access to the internet and signposting to reproductive health services is generally poor. So it is not always obvious what services are out there or how you might access them.

Some people agreed the advert should be shown, but felt it ought to be screened earlier in the evening so as to reach a younger audience. While I agree with this there is the stereotype we need to challenge that the only people who have/need terminations are teenagers and young adults. Terminations are sought by women of all childbearing ages and for a variety of reasons and with a variety of outcomes. This is why we need clear signposting as it may be older women, young women, unmarried or single women assume such services are not open to them.

We know through research women often make up their mind about having a termination before seeing a doctor but do benefit from prompt referral to termination or maternity care services (depending on the choice they make). But we do also know that women worry about making the move to discuss their options (having or not having a baby) for fear of being judged or concerns over confidentiality. Making it clear there is a service out there who can offer advice and support can be a step towards reassuring women and their partners.

Another issue raised was that having an advert on television ‘trivialised’ the topic of termination or made it into entertainment. This is obviously reliant on how the advert was presented, but generally having information about reproductive health made available on prime time television is beneficial because it is targeting an audience who may otherwise miss the information. Our problem remains if we decide some issues cannot be mentioned in public information adverts on television or in the cinema, where are we able to share them? And if we decide to only have information accessible online or in pamphlets at the GP surgery how many people will we be excluding?

In discussing the proposed advert the media rehearsed several of the stereotypes we’ve grown used to in relation to termination. That it’s only young girls who have unplanned pregnancies, that terminations are only for unplanned/unexpected pregnancies, that everyone who experiences a termination suffers regret (or should feel shame), and that most terminations are carried out at a very late stage. Having such views expressed but not challenged remains a problem – and causes distress for many people with either experience of termination or general problems with fertility. It is unfortunate in the run up to screening the advert there were not more opportunities taken to challenge such myths or provide accurate information.

Having advertising that helps people find advice services for termination of pregnancy is important – particularly since all evidence suggests an early intervention (if one is going to take place) is preferable. While I welcome the advert for Marie Stopes International I would prefer to see a far greater effort made to improve the general signposting to our reproductive health services, the funding for such services and more information about what is available. In particular highlighting contraception choices and getting access to family planning services is vital to women and men and equally as important as having adverts showing where to get advice in the case of considering whether or not to continue with a pregnancy.

Hopefully having this advert screened will pave the way for more opportunities to highlight reproductive and sexual health services and for us to lobby for better sex education and family planning care within our communities.

Here is the advert, see what you think…

Further help can be found at

Family Planning Association has advice and information about what to do if you are pregnant
I’m not sorry is for women who have had positive abortion experiences to share their stories
Health Talk Online (DIPEX) focuses on the feelings and reactions people have when ending a pregnancy over a fetal abnormality

One thing that has marked this election is the growing focus on science issues. This has partly been down to the interest of some politicians in the subject, and mostly due to the activism of a number of scientists (natural and social), science journalists and bloggers.

The focus of these discussions has been around tackling key issues around science (funding, support, listening to expertise etc). And while it is really important these topics are being debated, I’d invite a step back to think a little bit more about the way politicians understand and use ‘evidence’ from science and healthcare in practice. Otherwise we may miss opportunities to work with politicians and inform political thinking – and in turn help the public on key issues around health, education, innovation and technology.

In order to explore some of these core issues I’d like to reflect on my experiences of working with the Department of Health (DH) on their sexual health campaigns, where I had the chance to see where there are major barriers to using, applying and understanding good approaches to sound science. Which results in misleading information and a lot of money wasted.

I began volunteering on the DH campaigns in 2001 and between then and 2008 I increased the work I was doing, eventually becoming both a consultant and spokesperson on the public sexual health campaigns RUThinking, Playing Safely, Want Respect? Use A Condom (see also their great ad campaign), and Condom Essential Wear. Most of which have now been updated for Sex and Young People and Sex, worth talking about (where I currently volunteer for NHS Choices answering questions on psychosexual health topics).

This work involved identifying core evidence to underpin key messaging and liaising with civil servants, ministers and PR companies to ensure accurate, accessible and engaging messages were shared at a variety of different audiences in diverse formats (print, online and broadcast media as well as live events like music festivals).

I came to this work through my background as an academic who teaches healthcare practitioners and policymakers internationally how to access, critically appraise and understand evidence. And through my research which has focused on the sex and relationships health topics of education, service improvement of reproductive health, and addressing psychosexual problems, with a particular interest in media and public health campaigning. All of which I apply via advice giving through educational events, practitioner training and the media.

I was honoured to be part of the campaigning work and believe there were a number of key areas where major achievements were made around getting sex talked about within the media, and particularly with young people. There were some great examples of innovative practice and in the activities I was involved in we ensured work was ethical, based on sound evidence, while still being engaging.

However, during the seven years of working on the campaigns I noticed a number of core problems. I don’t know if these are repeated within other government departments, but it would be worth investigating whether the issues outlined below are happening elsewhere. My hunch is they’re not unique to health.

It was for that reason I asked the Guardian’s Science Test of politicians (by Martin Robbins) to clarify how political parties intended to oversee and manage public health campaigns and associated PR companies.

Here are the key areas I noticed problems around the application and interpretation of research and evidence:

Bidding for contracts
The majority of public engagement activity run by the government (and via political parties) is organised through PR companies. That in itself is not problematic, PR companies are experts in ensuring messages reach the right people in a timely fashion. What is problematic is for health, education and other campaigns there seems to be frequent bidding process orchestrated by different government departments. Meaning several months on any contract will be spent preparing to bid to renew it (in competition with other PR companies). And until any bids have been renewed no new activity can take place. Which restricts the amount of work you can do to reach the public.

There is also the difficulty posed when a PR company is replaced. Where the company who has held the contract has built up their own contacts, messages, experience in delivering information and goodwill among the media. Because they are a commercial organisation this information remains with them if they lose the contract. Meaning the incoming agency has to begin from scratch building up these contacts, there is no organisational memory, and a lot of time lost in repeating activities. It also means experience built up on campaigns can be lost.

Uncertainty of messaging
During the time I worked on the DH campaigns there were periods where ministers were unsure about the direction in which they intended to go. That was not because they were engaged in a systematic review of the evidence which might help them decide, but because they were anxious about media and public responses to their messages. Particularly relating to sensitive issues like contraception, teenage pregnancy and STIs. It took three years to move the more fragmented ‘sex lottery’ campaign of 2003 into the national media run ‘Condom Essential Wear’ launched in 2006. [This was the first widespread government-backed public media campaign on STIs since the HIV/AIDS one of the 1980s]. Fear over how the press/public will respond led to haphazard delivery of messaging, also hampered by a limited budget.

It has also led more recently to overlooking evidence of good practice – which is about easier access to services, accessibility of testing and treatment, combined with prevention messaging. Instead the government has opted far more towards promoting testing, and has moved away from their 2006 approach which suggested prevention based messaging/normalising condom use. This appears to be based around cost decisions and attempts to deal with rising STI rates. While it is right that we alter messages depending on new information from research and evaluation, it is problematic if politicians and civil servants do not understand this process, or ignore it in favour of activity that is based around anticipated public opposition or healthcare spending cuts. And equally worrying given it muddles the public and healthcare staff around what they should be doing.

Reinventing the wheel
In the past decade our public sexual health campaigns have begun with the Sex Lottery, which became Playing Safely, which morphed into Condom Essential Wear and is currently Sex, worth talking about. And that’s just the campaign aimed at young adults. Teen campaigns for sexual health, general health and pregnancy have also morphed in similar ways. This has included new websites, logos, branding and core messaging for each iteration of the campaign. And within each development an additional range of agencies working on digital, creative, and marketing tasks. While material written for the web has been reused for some of these campaigns, in many cases new content has had to be created although again not always based on core evidence. It results in confusion to the public who are presented with different names, brands, and websites to find. Individual NHS trusts paying for their own sexual health websites that replicate content found on government ones wastes additional money. All of which results in a lot of activity, a lot of money spent, but no real sense of outcomes – the impact such campaigns have had. Sadly the focus of evaluation is often reduced simply to mentions within the media or visits to the campaign websites. Again indicating a lack of awareness of how to fully assess activity undertaken.

Flashy, gimmicky, but has it worked?
One aspect of the public sexual health campaigns has been a focus on getting young people involved. That has included viral videos, myspace pages, interviews with celebrities and texting services. More recently England’s Sexual Health Quiz was launched. Critics have questioned why this uses a kids vs parents approach (given evidence indicates competitive based education in this area is rarely successful). Other concerns have been expressed about the accuracy of the questions (particularly relating to cancer) and whether knowing how much water a condom holds really tells you anything about your ‘knowledge’ of sex and relationships, or your sexual health needs.

All of these activities are clearly costly, and most of them are focused online, which excludes large numbers of the population. We also have no idea how much they have cost, or what impact they have had. When asked, the Department of Health’s response to me was the latest quiz encourages ‘friendly conversation’ between parents and teens and provides right and wrong information. They had no information about whether this approach had been successfully piloted or was working to increase communication between parents and young people.

We have no idea whether, post election, the current quiz will still exist, or whether the data will be used to inform public health campaigning in the future.

Activity that doesn’t make the headlines
While we may be concerned over the quality of public engagement activity, there is the additional problem of campaigns that are paid for, but fail to reach the public or make much impact. For example one survey called ‘pulling pants’ was carried out for the DH by Tickbox which was to identify whether people chose ‘lucky pant’s to go out in. The survey indicated people spent time thinking about what underwear to wear – and clearly did have special undies they wore in the hope of pulling. But they did not put the same focus on taking condoms with them. This was a playful message, but actually quite important if you think about intentions to have sex. However, despite the survey being designed, run, data collected and the PR and polling company paid, it never made it to the media as ministers and civil servants were worried about the underlying messages. While I have a copy of the data, I do not have the costs for this particular project, but it would be equivalent to a standard public survey of 1000 participants spread across the UK.

Another activity that did make the headlines, but not in any great way, was the Alesha Dixon photospread run in 2008. It produced a series of gorgeous photos, but hardly any media outlets picked up on it (if memory serves only a couple of online editions of tabloid papers ran it). Which again represents a lot of money spent for very little return. [This is not a criticism of Ms Dixon who showed a genuine commitment to a campaign on a topic very few celebrities will be associated with]

It is not unusual within mainstream research or any public engagement activity for ideas to change, for messages to occasionally fail, or for problems to arise. But in relation to the cost of these campaigns – particularly when front line services are being cut – this is a worry. Not least when you add it to the fees for the more online activities, surveys run and time lost while rebidding for contracts.

Part of the problem of messaging being ineffective is the timing of them – Valentine’s Day, for example, is such a busy period to get any media pickup. But it’s also not a particularly good time to run public sexual health messaging – a better time would be around Christmas/New Year when people are more likely to have unprotected sex.

Policy/public health education and the role of the PR Company
By far the biggest problem around evidence-based approaches to public messaging is related to PR companies. In 2008 the Telegraph reported the government were spending approximately £1million per week on polls and focus groups and it may be the figure is far higher if you factor in consultations, and other public facing activity such as websites run by different government departments.

This issue has not really been fully explored and I think a canny journalists might be able to identify a far larger spend than already suggested.

These surveys and focus groups are not run to identify people’s key problems or needs, nor to improve services or our wellbeing. Instead they are run to collect information that will be used to inform media activity. Because nowadays most journalists won’t cover stories unless they can pin them to a survey or similar.

This wastes time and money on a number of levels. It firstly overlooks existing evidence on health, education or business that may well be useful to help us understand or deal with an issue. Peer reviewed research is rarely consulted or used to underpin such activity. Instead we see a number of leading questions used to get answers that in turn will generate headlines and discussions points for radio. Which can work if you have a spokesperson allied to a campaign that can translate that information into accurate and contemporary advice. But this is sadly not often the case given the use of PR companies of spokespeople who may not be the best qualified within an area to interpret and share information.

Research to inform public health is led by PR companies, not academics/practitioners
Over the years there has been a shift within public health campaigns where instead of being informed by key academics/practitioners about current evidence of best practice there is now the approach that the PR Company comes up with the idea for an activity as well as being responsible for promoting it.

A key example, and one that led me to resign from supporting the Department of Health’s sexual and reproductive campaign, came from the new PR agency they appointed. They had heard about some research covered in the Daily Mail where researchers counted the number of mentions of alcohol in the media. They suggested the same approach be used, but focusing on condoms.

Their recommendation was for someone (an academic) to observe the media over an unspecified period, and from that they could indicate how little condoms were mentioned in the media, and flag this up as a problem. They also incorrectly claimed no similar research had ever been conducted on this before (because they had not found any in searches they had undertaken).

Civil servants at the Department of Health seemed impressed with this idea. My opposition to it ran as follows. Such an activity if carried out correctly is very time consuming and costly. It would require very clear parameters around what media would be studied over what period. Given that we already know condoms are not mentioned much within mainstream media there is probably little point in doing such an in depth activity. But given we also know that integrating safer sex messages into mainstream media works see here and here and here and here, perhaps using that knowledge might allow us to bypass the research and focus instead on working directly with journalists – particularly in television where often plot lines in soap operas can be requested to focus on core issues (e.g. sexuality, bullying, teenage pregnancy). My advice was ignored.

On 20 February the Department of Health announced they had commissioned research that looked at media coverage of condoms in a report called ‘Mis Selling Sex’. The report still has not been publicly launched, and there is no clear information on who did the analysis, how it was conducted, and how much the activity cost. Moreover, there is no clear information on how the findings would be implemented outside of talking to television companies, which, as we already have seen, could have been done without having to do a full-scale study.

It is sadly a common problem within health research where people repeat studies, but in the case of a government department being advised they did not need to do this research – and could have used their money elsewhere – it is worrying such advice was ignored. If we do not see particular changes within mainstream media, this work will have been wasted. And even if we do see such messages in media they need to be sustained and supported.

What did I learn from my time in the field?
It would be wrong of me to imply those working on various government health campaigns are not doing their best or lack good intentions. My experience of working with ministers, civil servants and the PR companies behind the campaigns suggested a lot of well meaning people. There were also a few practitioners like me who volunteered our time and skills to inform campaigns and improve sexual health.

However, high staff turnover, fear of the response of the Daily Mail, a reliance on ‘desk based’ research and the focus towards ‘policy based evidence making’ rather than ‘evidence based policy making’ meant many good ideas were blocked, and weaker activities green lit.

Given sexual and reproductive health services are so underfunded, and yet given our equally worrying rising STI rates, it is vital any activity we undertake is cost effective, appropriate, built on evidence and evaluated. And that it directs people to the services they need. Spending money on campaigns that do not achieve this means people won’t go for help and while services continue to struggle with lack of funding.

I wonder how much better we may have done if money simply had been spent on improving services, and telling people where they could find them?

As mentioned I cannot speak for the rest of the activities run in different government departments but it is my belief that money and time has been wasted elsewhere. It is also my belief that politicians and civil servants will continue to struggle after the election because they are not supported by the public or by scientists/practitioners to use evidence to inform policies and services.

While we debate science and how important it is, we need to be aware of the real life problems encountered on the ground that means very often poor practice is allowed to continue because nobody is adequately checking what is being done, and few practitioners volunteer to ensure good services can be offered.

Please, while you’re campaigning for science, think about offering your services and scrutiny to ensure we can stop wasting time and money in the name of government backed health research and education.

Over the past few weeks I’ve been hearing about GMTV’s LK Today show’s forthcoming ‘sex week’, a series of morning programmes aimed at a mainly female audience to be run in the week before Valentines day.

It’s been an invaluable opportunity to observe how ‘sex’ is understood and constructed by programme makers, and how television journalists interact with sex educators, researchers and health practitioners. And ultimately what is chosen to count as content or ‘evidence’ for a programme.

It begins with a survey …
During the introduction to hearing about the forthcoming series I was told the programmes were going to be pinned around a ‘sex survey’. This is a predictable approach used by TV companies to create content and drive publicity. Fine if said surveys were well designed, reliable or valid, but usually they aren’t. Unsurprisingly the planned version of the GMTV sex survey wasn’t very good, but interestingly the programme makers were willing to accept feedback even if the final version wasn’t all that accurate.

The problem with using surveys to underpin programmes is they’re usually thrown together without much reflection by staff with no knowledge of survey design or much of an awareness of sex. Meaning results are either misleading or reinforce stereotypes. There is no real sense that researchers/practitioners like myself and others already know about such materials and can easily translate it into television-ready formats which we’re happy to offer if we’re approached during the planning phase of programme making.

TV sex programmes are led by two things – a ‘news’ agenda and the opinions of the producer – and it’s hard to argue with either
We all know that the media, less like education or research, is closely directed by a news agenda. The creation of GMTV’s ‘sex week’ was no exception, so during preparations for the programme it seemed production staff were keen to find sex addicts and those who’d been cheated on, presumably to fit stories tagged around celebrity sex addicts and cheaters currently in the headlines.

This does two things. It fits sex into a fairly narrow framework, but also restricts discussions towards gossip rather than actual evidence. Now undoubtedly with celebrity sex scandals there will be public interest and opinion. But this won’t help inform relationships unless we can move away from the celebrity angle and focus on the issues at hand. Even then we’d need the ability to do so accurately. So in the case of ‘sex addiction’ we’d need to take a completely different stance than that offered by a standard production angle – that sex addiction is real, here’s a celebrity example, and here’s a ‘real life’ case study to further illustrate the problem. Instead we’d need to look at how sex addiction isn’t really the problem made out by the media, who is promoting the ‘sex addiction’ agenda, and what people really need to worry about in relation to relationships – and how to solve relationship problems without medicalising behaviour.

In phone conversations I had with staff working on ‘sex week’ I was asked if I could help them find a sex addict, someone who was celibate, someone who had an STI, and recommend other experts who could join in panel discussions about sex and relationships. While I was happy to recommend a number of colleagues who I rate (and know would do a great job in talking confidently about sex and relationships to the viewers) obviously I couldn’t recommend case studies (it’s unethical to refer someone you meet in education/research to journalists).

It is unclear exactly what will feature within ‘sex week’ but if it follows the format being worked on over the past few weeks ‘sex’ will be problematised. This can be seen in the way GMTV framed sex in their introduction to their sex survey: “Valentine’s Day is upon us, but are you fed up with your sex life? Is your partner inattentive and unadventurous? Or was the last sexual compulsion you experienced many, many moons ago? Maybe you’re lucky enough to enjoy a passionate relationship with your partner. Whatever you’re getting up to between the sheets, share your sex stories and thoughts with us in our sex survey”. Through to focusing on people who do it too much (addicts) or with the wrong people (cheaters) or those who aren’t doing it enough (celibates).

Sex programmes on television will consistently fail to reach their potential if…
- The focus of any programming is defined and limited by top down approaches where producers set agendas and instruct junior staff to find experts, ‘statistics’ and case studies to support the beliefs and values of the producer. In the case of GMTVs sex week the staff I talked to were charming but were seeking answers to questions set by their producer (who of course didn’t bother speaking directly to any experts). As a result you’ve a constant interrupted dialogue where a producer sets an agenda, a junior has to find someone who’ll support this, and anyone who has a different view will be ignored. No programme will work if you’ve got junior staff negotiating with numerous key players but no authority to green light their inclusion and pressure from an editor to find tame contributors.

- Where ‘news’ (aka ‘gossip’) underpins all stories. Particularly when directly pinned on celebrity cases (with the emphasis on speculating about the celeb not wider issues). Ethically it is inappropriate for practitioners to judge celebrities or any case study and pinning stories so closely to celebrity cases will make it difficult for any ethical practitioner to contribute.

- Where poorly designed surveys are conducted as part of a programme but don’t inform it due to quality issues (or because the survey is conducted to generate publicity not content).

- Where searches for scientific evidence to inform a programme are only carried out on google and ‘evidence’ is understood in terms of some statistics to help stack up a story. A particular problem when staff are pressed for time, don’t understand evidence, and probably aren’t aware that there is a wider body of extensive information about sex they could be drawing on.

- When experts are used to inform content but where staff struggle to identify who is adequately qualified to contribute.

- Journalists (and particularly senior production staff) lack basic sex education so are unable to understand core critical issues about sex. Meaning the ‘sex week’ staff were unaware of any critical discussions of ‘sex addiction’ – they assumed it was real and accepted as a medical condition until told otherwise, and even then continued to work with it as a key contemporary sex issue. There was also the problem of staff accepting ideas that should seem nonsensical – for example one researcher called me asking if I could confirm whether celibacy was harmful to your health since one expert they’d talked to told them if you don’t have sex it could cause physical harm. As with many media encounters a large part of my discussions with staff for ‘sex week’ was about basic sex education (ie how sex won’t get rid of wrinkles or how not having sex won’t harm your body, and that celibacy and asexuality are not the same thing). No reputable sex educator will object to providing this service, but it demonstrates how programmes can’t be made accurately if staff are working from a position of ignorance and misinformation to begin with.

All of which raises serious ethical and practical dilemmas for anyone thinking about being involved in TV sex programmes
Reputable sex educators are always happy to give time to create accurate sex coverage for television. Sadly the approach taken by many production teams often creates barriers for those wanting to be involved. There is the general assumption that you will be willing to provide background information for free, very often to also contribute your time to the show/series for nothing, and the appearance on television is a privilege so you must unquestioningly fit in with the show’s agenda.

Given that many ‘sexperts’ working within the media do so as a means to advertise their products and services they’ll obviously say whatever’s asked for to get their time on television. However, genuine experts won’t be motivated in the same way. We will want to share accurate, sex positive information in an engaging way, not repeat what the producer wants to hear. For many of us schedules need reorganising if we’re going to be on TV (for ‘sex week’ we were asked to set aside two days for filming). That means patients, clients, colleagues and students timetables will also need restructuring. This is only worth it if you’re actually going to be able to share sex positive information.

Once you become aware there’s a show in development you want it to be as accurate as possible – regardless of whether you appear on the final edit. However, that in turn raises issues of how much you should be involved given you can provide lots of time and effort for nothing, have no record of your contribution, and ultimately not see any of your efforts inform the programming. (Which is sadly the case with ‘sex week’ where contributors including myself who’d been booked to appear were told at the last minute we weren’t needed as they’d be sticking with their resident TV doc and sexpert).

Because of these issues the end result of most TV sex shows currently means sex is always constructed in particular ways – usually limited, negative, problem-based with judgemental case studies pinned on celebrities. Expertise may well have been consulted, but may well not be understood or applied. And contributors may not end up on any programming leading to time being wasted and a lot of lost opportunities and bad feeling created.

Very often journalists complain they can’t put together decent programmes because they are up against limits of time or resources. Yet this case study and countless others like it indicate that’s just not true. There’s stacks of evidence, loads of qualified people who can talk about it in engaging ways, and a lot to be said that’s currently not talked about. The key problem is producers make specific decisions to frame sex and ‘sexpertise’ in particular ways. Meaning you get poor to average sex coverage when you could have had GREAT sex.

The tracking of GMTV’s sex week from programme outline to broadcast allows us to think about how sex programmes are constructed for mainstream prime time audiences. You’ve had the background from me, but you can explore this further by watching the programmes (run on ITV1 every morning this week from 9am GMT)

What will they discuss? Consider what they may have talked about and reflect on how much of the programme is linked to their sex survey (the results of which can be found here). You can also question what other evidence is used to underpin programme (and where might that have come from) and what other evidence could have been used. How much of ‘sex week’ will frame sex in a language of hormones, evolution, body language, and gender stereotypes (and how much of that coverage seems accurate or understood). You may want to reflect on who is and isn’t included in discussions (for example in terms of ability, age, ethnicity or sexuality) and how much of the series will be pinned around product placement (lingerie, sex toys etc). Finally you may want to consider how much of the series provides actionable information people can put into practice (rather than instructions on what we should be doing sexually).

As a sex educator my wish is always that quality sex information is provided to the public, so if GMTV manage to do this during ‘sex week’ then this is good news. My anxiety is the programmes won’t be as good as they could be (for reasons set out above) and this is common to most television shows about sex/relationships.

The questions remain about how we address this problem? Practitioners are keen to get involved and share good information but are restricted by many practical and financial barriers set up by television companies. Television companies are keen to continue to include sex content but are unwilling to improve content, particularly because they need to talk about sex but fear losing advertising revenue or viewing figures.

Perhaps the key to the puzzle is not to be found with journalists or practitioners, but lies with the public who can demand better programming (presuming they’re aware what’s currently on offer is inadequate). After all, no matter how eager or well meaning us practitioners can be, or how much evidence we can share, this is never going to be possible unless producers have a reason to provide it. If viewers want this – or if viewers will switch off if it’s not provided – then maybe our sex programming will get better.

Yesterday I wrote about the case of UK morning television show GMTV who’d got into hot water after hosting a biased survey about breastfeeding that had upset mums a lot. It resulted in the programme being publicly criticised for their actions.

I mentioned how I’d been approached by GMTV about a planned series on sex, which they wanted to base on a sex survey. I agreed in principle to take part, with the proviso I had some input to the survey. They sent me their draft questions and I gave feedback. I’ve not heard anything back from them (not even an acknowledgement they received my message), but looking at their sex survey (which is now live on their site) it seems they have listened to the feedback I provided.

Their original list of questions wasn’t too bad, although as with any survey they required reflection and change. For example they planned to ask ‘do you have a partner?’, but this is often misleading and folk who are either dating or married assume it doesn’t apply to them. So a better term (which I recommended) is ‘are you in a relationship?’ They also wanted to find out ‘is your sex life good’ which I suggested they change as ‘good’ is a difficult concept to measure (my standards for ‘good’ may be much more stringent than yours). Instead I recommended ‘how satisfied are you with your relationship?’ (and added asking about partner satisfaction was equally important). I recommended they drop questions that are difficult to reliably measure through a survey (like ‘how often do you think about sex?’) along with questions relating to ‘meeting a stranger online for sex’ (which seemed at odds with the rest of the questions and judgemental).

Based on their suggestions my rewrite looked something like this – aimed to be very basic and to get some general data that could be compared with existing studies and used as a talking point for their programme.

- Demographics: age, gender, location (I usually don’t start a survey like this as demographics are quite threatening, but given the rest of the questions were sensitive this wasn’t a bad place to begin).
- Are you in a relationship? If yes, how long have you been together?
- Are you happy with your sex life?
- Is sex important to your relationship?
- What things help you enjoy sex? (I suggested this might remain open ended or give multiple choices such as communication, willingness to explore new things, time to spend together, trusting each other)
- What are the main barriers to enjoying sex? (worries about body image, confidence issues, lack of partner support, relationship problems, health problems, fertility worries, tiredness, lack of privacy/kids in
the way, sleeping in separate beds)
- Do you have any questions about sex you would like us to answer? (open ended)

Looking at their live survey it seems many of these pointers have been taken on board. These include:

6. Are you happy with your sex life? Yes/No
7. Do you think your partner is happy with your sex life? Yes/No
8. Is sex important to your relationship? Yes/No

9. What would help you enjoy sex more?
Good communication
Willingness to explore new things
Spending time together
Trusting each other
I’m happy with our sex life

11. What prevents you having more sex?
Kids
Tiredness
Poor body image
Health problems
Partner’s sexual difficulties
Relationship problems
Sleeping in separate beds
I’m happy with how often we have sex

12. What things enhance sex for you?
Time together
Good communication
Confidence
Help around the house / childcare

13. Do you still find your partner attractive? Yes/No

If I were doing this study myself I’d have more space to talk about positive things that enhance sex and I’d combine questions 9 and 12. I’d allow more scope for participants to share what does/doesn’t work for them and I’d focus on relationships and intimacy as much as sex. However, the inclusion of factors that get in the way of desire which are very practical for most women (lack of time/privacy due to kids being around, body image etc) is important and will allow for a good discussion for the programme.

However, there are still major problems with the survey and the first one you spot on the welcome page which says “Valentine’s Day is upon us, but are you fed up with your sex life? Is your partner inattentive and unadventurous? Or was the last sexual compulsion you experienced many, many moons ago? Maybe you’re lucky enough to enjoy a passionate relationship with your partner. Whatever you’re getting up to between the sheets, share your sex stories and thoughts with us in our sex survey”.

Yes, it’s in media speak, but there are problems here around the aim of the study – is it about Valentine’s day or sex? It’s leading from the outset with the first statement asking whether people are fed up, or if their partner is inattentive or unadventurous, or sex is something that’s not happened for years. It’s hideously sex negative and likely to invite people who’re either having problems with their sex lives or want to prove they’re super sexual. It’s very bad practice to begin a sex survey with statements like this and no clear aims, but it’s another example of how little attention people give to even basic things like the way you begin your survey and invite participation. Sadly, this opening to the survey suggests it is likely to be as problematic and biased as the previously flawed one on breastfeeding.

At the close of the survey there are suddenly several questions about porn and paying for sex, which don’t really fit with the rest of the questions asked:

14. Do you use pornography? Yes/No
15. Does your partner use pornography? Yes/No
16. Would you ever pay for sex? Yes/No
This question is optional.

These are flawed questions because it’s unclear what does ‘use’ pornography mean? ‘Use’ as in something to turn you on during sex, or before sex with a partner? ‘Use’ to give you ideas for sex? ‘Use’ for masturbation on your own?

Not only do these questions not measure porn ‘use’ (because of a lack of explanation in the questions) but they also don’t tell us useful information like whether women are happy or not about porn or their partner looking at it. It’s almost as though this was tagged on at the end because porn might come up as part of the planned series on sex so there had to be some data on it. Because there wasn’t any thought about this (or using existing survey questions on porn, which again there are loads of) these are just wasted questions.

The buying sex one is also not clear in terms of why it’s being asked (on a reputable survey you’d always ask why you want someone to tell you something). Making the question optional is good, but it’s still not going to tell us anything more than whether people think they might consider buying sex, not whether they have and what their attitudes to paying for sex are. Because this question is placed above asking people for their name and a daytime contact number it makes the porn/paying for sex questions even more threatening – and less likely to be answered.

It’s a shame the introduction to the questionnaire and closing questions are so flawed as the questions in between aren’t too bad. You can easily see, however, that by not taking care throughout the research process, that you can unduly influence and potentially scupper an otherwise good piece of work.

As mentioned in yesterday’s blog, for many journalists (and for most people who’re novice survey designers) it’s common to think if you throw down a few questions on the back of an envelope your survey is good to go. I think from looking over this current survey that there’s an additional problem I often encounter when teaching survey design. Which is folk grasp they need feedback, but assume if they get a little bit then that’s the green light to run with a piece of work.

In fact, to make a good survey (and this applies whatever it is for) you need to find out whether other surveys already exist on the topic you’re interested in. Use or adapt them for your own study. Get feedback on them from colleagues. Amend the questionnaire accordingly. Pilot on a representative subsample. Amend as needed. Then proceed with your work.

This can be more time consuming than bunging down a few questions, but if you liaise with an expert it shouldn’t take long. And it means what you do produce is reliable and useful and far less likely to risk criticism or non completion.

I’m glad to see GMTV appear to have taken feedback on board, although sad to see that by not fully understanding how surveys work that errors in their existing sex survey means it’s not very reliable. Of course they will be able to use it to inform discussions, but the outcomes they get may not be all that representative and thus conversations may be skewed and not deliver what viewers really need.

After writing yesterday several journalists emailed me and asked what my tips were for them to create good surveys for use in features or programmes. I’d recommend following the steps for good survey design outlined above and also:
- get experts to help (they can tap into questionnaires quicker than you can)
- don’t be afraid to use existing measures
- don’t base programmes/features on a survey you’ve designed without going through steps outlined above (if you don’t have time commission someone to do this for you)
- may be better to use the findings from another survey as a talking point
- don’t make the mistake of seeing a survey as quick and easy
- if you get help and feedback then have a dialogue about it (don’t assume feedback equals a green light to proceed unless specifically stated)

People like myself should be willing to work more closely with journalists to improve practice around surveys – which might include training on how surveys work or survey design/analysis, or assistance with writing and disseminating surveys. I see it as a duty of care to make existing measures more accessible and to help journalists put together good quality surveys.

However, there is a problem around offering such a service. Who pays for it? Is it something journalists will expect for free? Is it part of wider public engagement duties we ought to be providing? If so do our institutions cover that cost or the media outlet we’re working with? What do we do if our advice isn’t heeded? How much time should we give to such ventures? And how do we measure ‘success’?

For example I managed to get some questions changed from the original GMTV list. Or so it seems. I’ve had no further contact with them to confirm this (I can only go by what they originally sent, what I suggested, and seeing my suggested changed questions now appear on their website). So you could judge that a success. However, responding took time and you have to ask yourself is it worth providing such feedback if you’ve no guarantee the overall quality of a survey would be good (or represent the standards you’d expect in your usual practice). Is it worth doing if you get no feedback whatsoever? Or with no guarantees you’d be able to appear on television (or in print) to talk about the survey?

I’d really be interested to hear from journalists or health/social scientists/practitioners about this topic so please email me your thoughts.

Journalists – I’d love to know if you are interested in getting training on using/understanding surveys, or feedback on creating individual surveys well as the need arises. What kind of support (if any) are you bothered about?

Researchers/practitioners – I’m keen to hear what your experiences in dealing with the media around research have been. Do you think we should do more to encourage collaborative working or training? If not, why not? If so, how might this relationship be encouraged to avoid exploitation and overcome poor practice?

And to everyone reading, is it right to expose bad research in the way I’ve done in yesterday or today’s blog? Or best to keep discussions about research private?

I’ll feed back any comments in a future blog.

Recently a UK morning television show hosted an online poll about breastfeeding. Not a problem you might think. Breastfeeding is an important and topical issue and one that often creates anxiety for mothers. So finding out what women’s experiences are of breastfeeding is important.

However, if you are going to do this you also need to ask questions in a fair and unambiguous way. That’s just basic good survey design. If you ask questions in a leading, biased or confused way you’ll either find people won’t respond to you, or those who do won’t be representative so any resulting data is meaningless.

Unfortunately it seems GMTV hadn’t gone to the ‘survey 101’ class and posted a poll that included questions like:

“Do you think breasts should not be displayed in public for any reason?”
“Do you think women should use discretion when breastfeeding?”
“Do you think it’s a woman’s right to breastfeed in public?”

It also apparently asked whether it was “wrong” to breastfeed a child over 12 months.

These questions are a problem because they’re leading and negative. If you wanted to find out women’s views and experiences of breastfeeding (good and bad) you could ask them about where they feed, or whether they’ve encountered support or barriers when feeding at home or in public. You might ask them who gave them advice about breastfeeding and whether that was helpful (and if not why not), and focus on key issues like family/partner support.

You’d want to be sure anything you asked delivered a clear answer. For example for the question ‘is it wrong to breastfeed a child aged over 12 months’ someone might answer yes but meaning they felt it was wrong to feed an older child in public, but were not averse to the child being fed at home. Or they might answer yes to the question not believing it’s ‘wrong’ to feed a child over 12 months in public, just that they would feel uncomfortable doing so. Or their understanding of ‘wrong’ related to exclusively breastfeeding a 12 month old (although they might be fine with occasional feeds to a little one). With vaguely worded yet judgemental questions you can never be sure what someone’s responding to.

That’s not to say you can’t ask provocative questions, but you would do it in a way that was clear that was your aim. So you could say ‘some people believe the time to stop breast feeding is when baby is 12 months old?’ and ask people to agree or disagree with that statement. It is suggesting there’s a cut off time for feeding, but not that feeding or not over a particular age band is right or wrong.

Indeed good quality surveys are characterised by the fact that they can ask sensitive questions but in a way that does not suggest blame or moralising. Good social research is about finding out about peoples views, not imposing views on them or making them feel their beliefs are faulty.

Usually it’s just geeky social science types like me who get in a flap when dubious surveys hit the media, but on this occasion members of the website Mumsnet also noticed what was going on. As you can see from the linked thread members of the site were upset about the wording of the questions which they felt devalued breastfeeding and mothers who chose to do it. The discussion also alleged the reason for the dubiously worded survey was down to the show being sponsored by Nestle who manufacture baby milk.

Interestingly this story then hit the headlines (albeit more with a focus on the perceived anti breastfeeding angle rather than the duff survey design). However this is an important step forward in campaigning around shoddy surveys used within media as if the public notice and speak up against biased surveys we may be able to challenge more of their widespread use.

It’s clearly difficult to show a link between the dodgy GMTV survey and the show’s advertisers (Nestle claim they had no influence on the survey). So leaving aside the possibility that the advertisers played some role, why else might this situation have arisen?

Within media it’s very common to use surveys. These can be used as promotional tools to plug a magazine or television show, or to create content or a peg to hang a story on.

While there is huge amounts of data that exists that could inform stories (more on this shortly) most journalists assume to make their story/programme ‘unique’ they have to create a brand new survey to inform later content. Which might be an article using data/quotes gleaned from a survey, or a discussion based radio or television show based around your survey results.

My hunch is this was simply the case of a journalist writing down a few questions and getting their producer to approve them. Possibly sharing them with colleagues in the office but certainly not reflecting on them, sharing ideas about the question tone, or piloting in any way.

Generally journalists aren’t aware of the amount of work that needs to go into designing, delivering and analysing a survey, so a back of the envelope sketch of a few questions is enough to run with.

It’s a classic example of poor journalistic practice as not only are the surveys created usually slipshod and meaningless, they’re also unethical since they may well upset participants (as in this case) or mislead the public on key health/social issues.

Moreover it’s bad practice because it shows no research has been done. For pretty much any topic on health or social issues there will be a body of research investigating that. Studies that can be found if you search using Scholar or PubMed. In the case of breastfeeding not only are there countless surveys on attitudes towards breastfeeding, experiences of breastfeeding, feeding duration, partner support, impact on relationships, there are even journals specifically dedicated to lactation. So it’s not exactly an area where you couldn’t quickly find numerous existing and well designed surveys that could inform a programme. As an example here’s what comes up when you put in the very basic searches attitudes towards breastfeeding and breastfeeding experiences.

Sadly many journalists appear unaware these resources exist, or unsure how to search and find information. When I speak to journalists about such resources they often tell me they couldn’t use any pre-existing surveys because they have to design a ‘new’ one in order for it to be fresh for their programming. There is no sense that the very purpose of existing published research is to inform and underpin education and practice.

This is worrying in terms of practice, but also depressing since evidence is published in order to inform public understanding and practice. It is remiss not to make use of such information that could still provide a talking point/background for a story or programme, but would ensure what was discussed was accurate and based on the experiences of a wide range of people.

My guess is that GMTV hosted a sloppy survey for reasons set out above. However there is really no excuse for this practice to continue. They have had a very public warning that such activities are unacceptable.

More than that, I was contacted by GMTV last week who are planning a forthcoming series of programmes. They asked if I might be involved and told me they were basing the whole event around a survey. I explained I’d be delighted to be involved but I’d need to see the survey first. I was told the survey was based on a few questions they’d written down but they did agree to send me them and in turn I gave detailed feedback on how to reword the questions and add more meaningful ones.

To date I’ve heard nothing back so I can either assume they’re busy firefighting the breastfeeding debacle, never got my emails, or my approach to trying to ensure their survey was correct was not welcome and they’ve found another expert (perhaps one who doesn’t ask difficult questions about surveys). Experience tells me it’ll be the latter, but I’m happy to be proved wrong.

If I do hear anything I will let you know. Given this barrage of complaint against the programme and an offer from at least one experienced social scientist to help improve their survey design one might assume GMTV would be keen to get it right in future.

Let’s see what happens. And in the meantime let’s continue to name, shame and campaign each time we spot a shoddy survey.