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10.21 am

Ms Chris McCafferty (Calder Valley): I congratulate my hon. Friend the Member for Clydebank and Milngavie (Mr. Worthington) on securing this debate on a subject that is so close to my heart, and so important.

The first Cairo conference was a watershed for global population and development issues. Countries now accept that--as the hon. Member for Somerton and Frome (Mr. Heath) eloquently said--rapid population growth, high fertility and gender inequality hold back development and help perpetuate poverty. The conference recognised that the keys to smaller families and slower population growth are empowerment and free choice, not demographic targets. Most women, given the choice, will have fewer children than their mothers did. Choice means more access to reproductive health care, including family planning.

Today's world has the largest ever population of young people--about 1.1 billion, of whom 913 million live in the less-developed world. The problems that those young people face in sexual and reproductive health are huge. Every year, 15 million 15 to 19-year-olds give birth, and 13 million of those are in Asia, Africa and Latin America. We have heard that some 10 per cent. of the 45 million abortions taking place each year are to 15 to 19-year-olds, and nearly half those are unsafe. Every year, one in 20 teenagers will contract a sexually transmitted disease. Deep-rooted discrimination against the girl child at every level in some societies compounds the problems that surround reproductive and sexual health.

It was against that background that the all-party parliamentary group on population, development and reproductive health decided to look in more detail at the challenges that face young people in managing their sexual and reproductive lives, and to identify the actions that we, as parliamentarians, can take to help them to face those challenges successfully.

Our approach was to hold two hearings in May 1998, which I was privileged to chair, and our report, "Taking Young People Seriously", was launched in December. That documents the facts--sometimes brutal--of young people's lives in developed and developing countries.

The experience of our two hearings was memorable, and sometimes profoundly shocking. The evidence was presented by 12 NGOs working with young people in the developed and the developing world. As a result, we made six recommendations; I should like to say briefly why we made each one. However, I could ask all hon. Members to read the report for the rich variety of information and experience that it documents.

Our first recommendation was that Governments and other agencies should acknowledge that young people have sex and take a realistic and proactive approach to policy and public education, nationally and internationally, about young people and sexual and reproductive health.

I have outlined some statistics that our witnesses gave us, from which it is clear that young people are sexually active. The risks of death are two to four times greater for

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mothers under 20 than for mothers aged 20 or more. Ten per cent. of the 45 million abortions that take place every year are to girls aged between 15 and 19 years--and half those abortions are unsafe. When HIV and AIDS and other sexually transmitted diseases are put into that equation, the size of the challenge becomes obvious.

Our witnesses pointed out that adolescent sexual and reproductive health was seen as an unpopular issue. Dealing with adolescent sexuality presented a challenge for all NGOs working in the field. They felt that there was a need to move away from the negative approach of "limiting the damage" caused by teenage pregnancy to addressing teenagers' needs more positively.

Even in the United Kingdom there are many challenges. About 10 per cent. of girls start their periods unaware of periods, because no one has talked to them about the subject. A third to a half of young people under 16 are already having penetrative sex. The UK has the highest teenage pregnancy rate in western Europe--9.4 per 1,000--and an increasing rate of sexually transmitted diseases.

Mrs. Ann Winterton: The hon. Lady is painting a dismal--and recognisable--picture. We have free contraception, and abortions are available in the place of contraception in this country, yet rates of under-age sex, abortion and pregnancy are rising. Can she explain that? Secondly, does she believe that parents have a right and a responsibility for their under-age children, and that they should be aware when abortions are carried out on their children or contraception provided to those children?

Ms McCafferty: I believe that, if the hon. Lady is patient, she will find that the replies to her questions are in the responses that were made to the parliamentary hearings, and the group's recommendations. It is more a question of how things are done than of what is being done. I believe that, if the hon. Lady is patient, she will be able to take a different view.

Some developing countries are reluctant to recognise sexual activity in young people, and believe that to give young people information and services would be to impose a western model, which they see as promiscuous. As has been said, they associate the idea of sex education with the idea of increasing sexual activity for young people, and deny the existence of sexual activity among their own young people.

Our second recommendation was that Governments and other donors should give high priority to encouragingnew approaches to sexual and reproductive health programmes, especially those that involve young people in their design and implementation, and provide on-going sustainable funding for such initiatives.

It emerged clearly from what our witnesses said that, for services and projects to be successful, it was necessary to listen to what young people wanted, respond to those needs and involve young people in the implementation of projects--and that projects that did not do so were bound to fail. Interestingly, young people the whole world over want the same things. Research shows clearly that young people want confidential sex advice centres free of charge and without appointments. They do not like words such as "family planning" or "drop in". Young people in Ireland, Zambia and South Africa want exactly the same things. They want to be involved in the design and implementation of projects that involve their sexual and reproductive health.

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We heard of a variety of outreach projects in the United Kingdom, including youth panels. Particularly impressive is a programme in Zambia where young peer counsellors of a very young age are proud to wear tee-shirts proclaiming, "I am a peer counsellor". That is a good example of where the south can teach the north something about sexual and reproductive health and how to get through to young people and ensure a positive response. However, all these things are only drops in the ocean. They need replicating on a huge scale.

Another crucial fact to emerge from our hearings was the need for sustainable funding. It was clear to me and to the other members of the panel that for the foreseeable future sustainable funding will have to be from government and other official sources.

We had explicit evidence of how difficult it is to obtain financial support from private donors. Some manufacturers of products rely heavily on sexuality in youth for selling their products. Hon. Members will have heard the slogan "Everybody snogs in Joe Bloggs". However, Joe Bloggs is not interested in supporting young people's sexual health projects. This attitude seems to be shared by both Levi Strauss and Coca-Cola, both of which use sex as a method of selling their products. They appear to be unwilling to take responsibility for making that same sex safer for young people.

The perennial headache for NGOs is how to cope with success. New services rapidly attract clients, but the funding stays the same. Success for Belfast Brook meant that, in 12 months, it saw 5,000 young people. However, it was funded for only 3,500. If we are to take the need for young people's services seriously, that situation is clearly unacceptable. Governments and other official donors must take long-term responsibility for supporting services in the developed and developing world. That is the key message for the Department for International Development, the Department of Health and the European Commission.

Our third recommendation was that Governments and agencies should recognise the need for safe legal abortion as an integral part of sexual and reproductive health services for young people, and provide full, on-going funding for such services. The United Kingdom Government should, in particular, take measures to deal with the anomaly of the right to legal abortion services for the women of Northern Ireland.

The statistics have already been quoted and they speak for themselves. The need to pay attention to adolescent childbirth and unsafe abortion is a matter of life and death for young people in less-developed countries. In Zambia, a quarter of maternal deaths due to self-inflicted abortion are of girls under 19. The vulnerability of young women is forcefully illustrated by the rape statistics in South Africa, where one rape occurs every 50 seconds. In Northern Ireland, which is, of course, part of the UK, there is little sex education. There is a high rate of sexual abuse and both teenage pregnancies and abortion exist. Abortion is a sensitive issue, but it is essential to address it if progress is to be made in providing sexual and reproductive health services for young people.

Our fourth recommendation was that Governments and agencies should ensure that health professionals who work with young people are committed to and fully trained in confidentiality, that they understand its importance and understand also what it means in practice. It is clear that young people do not trust health professionals when they

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consult them about sexual and reproductive health matters. It is of paramount importance for success that a service is confidential. It is a real issue for young people. They do not trust grown-ups, and that applies across the board; they do not trust them at all.

A young person's right to confidentiality and to receive health information and services is recognised under the United Nations convention on the rights of the child, which has been ratified by all but two member countries. The convention lays a responsibility on health professionals to provide adolescents with information and services, even if that goes against the parents' wishes, provided that the child has developed the necessary capacity and maturity to understand the nature and consequences of the information and services to be provided. The Cairo and Beijing women's conferences criticised the failure of health professionals to observe and respect informed consent and confidentiality in respect of adolescent girls. It was clear that all the NGOs working with young people were aware of the importance of confidentiality. That needs to be translated into practice by ensuring that health professionals are equally committed.

Our fifth recommendation was that Governments and agencies should encourage and provide sustainable funding for the provision of support and information for parents to help to facilitate their communication with their children on sex and sexual relationships. Parents emerged as a neglected species. There was general recognition that they needed help to fulfil their roles and to know how to support their children's needs. There is evidence to show that young people want their parents to talk to them and be willing to talk about sex. However, it seemed that many parents found that difficult.

Our final recommendation was that Governments and agencies should take measures to make emergency contraception as widely available as possible for young people. The hon. Member for Richmond Park (Dr. Tonge) is a long-standing family planning doctor. She has called for emergency contraception to be made freely available to young people. Research demonstrates clearly how difficult it is for young people to obtain emergency contraception. Many do not even know who to approach or, as the hon. Member for Billericay (Mrs. Gorman) so starkly said, they are refused help when they seek it.

At 1.1 billion, this is history's largest generation of young people between the ages of 15 and 24, and their numbers are rapidly increasing in many countries. The reproductive behaviour of all these young people will determine our planet's future. It is critical that all societies address their education, employment and, especially, health needs. I hope that the Government will take a lead.

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