Select Committee on Health Third Report

10  RELATIONSHIPS AND SEX EDUCATION

251. The Social Exclusion Unit's 1999 report on teenage pregnancy gave a resonant description of the mixed messages which besiege young people growing up today:

As one teenager put it to the Unit, it sometimes seems as if sex is compulsory but contraception is illegal. One part of the adult world bombards teenagers with sexually explicit messages and an implicit message that sexual activity is the norm. Another part, including many parents and most public institutions, is at best embarrassed and at worst silent, hoping that if sex isn't talked about, it won't happen. The net result is not less sex, but less protected sex.[222]

252. This is not merely conjecture - NATSAL shows that only 50% of young people used a condom the first time they had sex. As well as impacting upon rates of teenage pregnancy, less protected sex is also, as the statistics show, having a dramatic impact on sexually transmitted infections amongst young people. Given the obvious and specific need in this part of the population, we were surprised that although the Strategy does identify "young people, and particularly those leaving care" as a group in need of specific and targeted information, it makes no reference to sex and relationships education in schools[223], and does little to exploit the considerable progress in this area following the launch of the Teenage Pregnancy Strategy.

253. With the NATSAL showing that young people are becoming sexually active at an earlier age, it has never been more crucial to ensure that they are properly equipped with the information and skills they need to negotiate the highly sexualised adult world that confronts them, and schools should be an important part of this education. However, the practice of school-based sex education is far more complex than the well intentioned principle. How should sex education be delivered and by whom? At what age should it begin, and how should it be weighed against other pressing educational priorities? Most crucially, perhaps, what information, skills and messages need to be conveyed? Although there are few immediate solutions, the evidence we have taken from teachers, educationalists, and, most importantly of all, from young people, has identified serious shortcomings in this area.

What do young people know about sex and sexual health?

254. Dr Chris Ford, a North London GP with a special interest in sexual health, described her amazement at the lack of knowledge about sexual health displayed by young people, despite their being both sexually active and in contact with health services:

The number of young people I see who have never heard of chlamydia and who go to wherever and get contraception; they get the contraceptive pill but no information is given to them on how to stay sexually healthy and what problems they might get into.[224]

255. Research evidence supports this. In a survey conducted by the HEA, over a quarter of 4,000 14 to 15 year olds surveyed thought that the pill protected against STIs.[225]

256. Nor was young people's lack of knowledge limited to the relatively complex subject of sexually transmitted infections; it extended even to a lack of knowledge of the basic facts of life. Gemma Minty, a 16-year-old from Wigan and a member of the Wigan Borough-wide Youth Council, gave a telling example:

A few weeks ago, one of my friends told me that her little sister became involved in foreplay and, after that, she came running into her room crying her eyes out thinking that she was pregnant. To say that she was a 14-15 year old girl, it is pretty ridiculous that she did not know the basic facts around sex, foreplay and things like that.[226]

257. One in ten of the 13-16 year old girls taking part in a survey organised by the Health Promotion Research Trust had not had any information about periods prior to the onset of menstruation.[227]

Is relationships and sex education necessary or appropriate?

258. Some recent research has argued that providing young people with information about sex actually encourages early and potentially unsafe behaviour in children and young people who would not otherwise have considered it.[228] This idea has been seized upon enthusiastically by the UK tabloid media (although it seems not to have reduced the focus on sex prevalent elsewhere in their pages). In theory, an increased awareness of sex might serve to normalise the idea of sexual activity way before most young people would have engaged in it. According to OFSTED, there may already be inaccurate perceptions amongst young people about levels of sexuality, perpetuated by the fact that in much of the media directed towards young people, "the underlying, but inaccurate, message is sometimes seen to be that all young people are sexually active," despite the fact that only one third of young people in the UK have sex before they are 16.

259. While it did not go as far as blaming it for the current poor state of young people's sexual health, the Family Education Trust argued that sex education, however good, could only have an impact "at the margins". Robert Whelan, the Trust's Director, told us:

In the present debate about sexual health and teenage pregnancy much too much weight is being attached to what can be achieved by sex education ... it cannot begin to compare with the influence of the media, advertising, Internet, peer pressure ... I do not think there is a magic programme for sex education that we can devise that is going to solve the huge cultural problems we are facing, which are the sexualisation of the culture and the increasing pressure on young people to be sexually active at early ages.[229]

260. The Family Education Trust also told us that they felt that today's sexual health problems could not be attributed to lack of knowledge amongst young people, arguing that:

Young people are not getting pregnant because they think that babies are delivered by Mr Stork under the gooseberry bush. People have a pretty good idea now of the processes you have to go through to produce a baby.[230]

261. However, no research has borne out the theory that educating young people about sex encourages earlier sexual activity. In fact most research to date actually shows that high quality sex education can delay rather than bring forward the age of first intercourse and, when linked to access to contraceptive services, can help to prevent negative health outcomes such as unintended pregnancy [231] In addition to this, recent research has also shown that sex education programmes can improve young people's knowledge about sexual health and relationships, increase their personal and social skills, and can have a positive impact on the quality of their relationships, as well as increase advice and information seeking from friends, parents and other sources.[232]

262. The Family Education Trust are among many who argue that young people should be given a clear message to delay sex and, if they are already sexually active, to abstain. It is generally assumed that the later the age at which young people begin to have sex, the more careful and responsible they are likely to be, therefore reducing the likelihood of adverse sexual health outcomes, such as unwanted pregnancy or STIs. Dr Stammers argued:

Clearly the younger a teenager is the more difficult it is for them to use contraception appropriately ... when you are 14 there is not usually the emotional maturity to negotiate in the heat of the moment the putting into practice of the rules that you may already know.

263. The assertion that older teenagers may be able to look after their sexual health more effectively is supported by some international statistics—for example, according to research carried out by Durex in 2001, Netherlands, which has the lowest rate of teenage pregnancy in Europe, also has a later average age of first sexual intercourse than England (17.2 years as opposed to 16 years in England). According to data cited in the Teenage Pregnancy Strategy, the Netherlands also has a correspondingly high rate of reported condom use at first sexual intercourse (85%, as opposed to 50% in England).[233]

264. The United States has the highest teenage pregnancy rate amongst the industrialised nations, and rising rates of STIs amongst young people, and has invested very heavily in recent years in campaigns specifically aimed at promoting abstinence amongst young people as a means of tackling these problems. In its memorandum, the Family Education Trust argued that:

The most realistic approach to reducing the spread of STIs amongst young people is to encourage the postponement of the onset of sexual relationships, or their discontinuation if they have already begun at a young age. We regret that the Government's national strategy for sexual health and HIV and its teenage pregnancy strategy appear to attach little or no importance to this[234].

265. Dr Stammers told us that in his view, young people's "sexual desires develop much earlier than sometimes the ability to restrain them without appropriate help". However, Gill Frances of the National Children's Bureau argued strongly that rather than delivering a single 'top-down' message to them to abstain, those trying to influence young people's behaviour must demonstrate a genuine commitment to work with them:

It is not about telling them ... it is about whoever is going to deliver the sex education, whether it be parents or carers or social workers or teachers, actually engaging with young people and saying "What do you want?" It is about consulting with them and getting young people to participate.[235]

266. A recent systematic review of interventions to reduce unintended pregnancies amongst adolescents has in fact found that the programmes which primarily aimed to promote abstinence from sex until marriage either had no effect or negative outcomes including, in one case, increasing the numbers of pregnancies to the sexual partners of young men who received the programme.[236]

267. Our evidence from young people, which we discuss more fully below, suggests that even basic factual knowledge about sex and sexual health cannot be assumed, and we believe that providing young people with accurate and appropriate information through school relationships and sex education programmes is an essential building block for securing improved sexual health both for this and for future generations. We see no benefit in preventative approaches based primarily around promoting abstinence. However, the fact that many young people who have not had sex believe they are in a minority, and equally that a significant proportion of them regret their first sexual experience, suggests that they would benefit from more support in deciding when is the right time for them in respect of the management of relationships, and support to resist external pressures to have sex, which is why we firmly support the location of sex education within the broader emotional and social framework of sex and relationships education (SRE).

Best practice in relationships and sex education

268. The Sex Education Forum, an umbrella organisation researching and promoting best practice in sex and relationships education which is based at the National Children's Bureau, describes sex and relationships education as having three interdependent components - the acquisition of information, the development of skills and the formation of positive beliefs, values and attitudes. As described above, the acquisition of knowledge about contraception is of limited or little use to a young person without education which helps them to develop the social and personal skills to obtain contraceptives, negotiate their use with a partner and use them properly. The Sex Education Forum defines the purpose of sex and relationships education as supporting children and young people in managing adolescence and preparing them for adult life in which they can:

• Develop positive values and a moral framework that will guide their decisions, judgements and behaviour.
• Have the confidence and self­esteem to value themselves and others.
• Behave responsibly within sexual and personal relationships.
• Communicate effectively.
• Have sufficient information and skills to protect themselves and their partner from unintended/unwanted conceptions, sexually transmitted infections including HIV.
• Neither exploit nor be exploited.
• Access confidential advice and support.

269. According to the Sex Education Forum, besides information, children and young people need to learn about and to practise personal and social skills which will help them to develop and maintain relationships, to take responsibility for their own and other's sexual health, to access support and help and to make informed choices and decisions regarding their sexual health and emotional well­being. These life skills include managing emotions and relationships confidently and effectively, developing independence in thought and action and defending values as well as decision­making and skills for negotiating with friends and partners.[237]

270. But how far does what is currently provided in schools live up to this ideal and, more importantly, how far does it meet the actual needs of young people?

Relationships and sex education in 2003

271. The basic biology of sex and relationship education has a statutory framework as part of the science element of the National Curriculum. By Key Stage 3 (ages 11 to 14), a child should have learnt about how babies are made, and the changes that they will go through at puberty. By Key Stage 4 (ages14 to16), a young teenager should have learnt in more detail about the process of conception, and how hormonal methods of contraception such as the pill work to prevent it. The theory of some sexually transmitted infections should also be referred to as young people learn, as part of the National Curriculum in science, about viruses and how they are transmitted, although it is not clear to us that the connection between viruses and STIs is clearly made in schools.

272. These basic biological facts appear as isolated elements of sexual health which are covered in passing. These, along with the many other issues of relevance to sexual health, including the social and emotional aspects of sexual relationships, are intended to be interwoven within a dedicated framework of 'Sex and Relationships Education' (SRE), which sits within the Personal Social and Health Education (PSHE) curriculum. Guidance on SRE was issued by the DfES in 2000.[238] This guidance specifies that at primary school, children should be taught about puberty and menstruation, and at secondary school about contraception, abortion, and STIs including HIV and AIDS, all against a backdrop of education about relationships. It also contains useful sections about involving parents, and using peers, health workers and other professionals to help deliver SRE.

273. However, beyond the very broad distinction between primary (age 5-11) and secondary (age 11-16) education, the guidance does not specify at what ages children should receive different elements of SRE. This guidance is not statutory, as SRE beyond what is covered in science is not part of the national curriculum. This means that the Board of Governors have considerable discretion as to how it is implemented in individual schools. SRE may be covered within a school's OFSTED inspection, but in practice this may mean no more than checking the school's policy or discussing it with a teacher.

274. A recent inspection of the provision of SRE by the Office for Standards in Education (OFSTED) demonstrated that provision in this area is still patchy and inconsistent and highlighted the need for development of provision which deals with relationships, emotional issues and the development of young people's social and personal skills.[239] Amongst the particular reasons identified for this are:

• The weak position of PSHE and Citizenship in the school curriculum.
• Weaknesses in initial and in-service teacher training, and a lack of development of specialist teams of teachers for sex and relationships education.
• The absence of clear learning objectives for sex and relationships education and subsequently poor monitoring of provision and assessment of pupils' learning.
• Weaknesses in consultation processes with parents and pupils which may undermine teachers' confidence about teaching about sex and relationships particularly in relation to subjects and issues which are perceived to be sensitive.

275. In view of the clear inadequacy of provision relating to the context in which sexual behaviour takes place, we feel that a much greater emphasis on the importance of handling relationships would contribute to an improvement in sexual health. We therefore recommend that DfES give further consideration to whether existing guidance on the relationships aspect of SRE emphasises sufficiently the importance of this area.

Does this assessment match with that of current and recent school pupils?

276. Asked to award a grade to the sex education they had received in school, three young people from the Wigan Borough-Wide Youth Council gave their schools 3/10, 5/10, and 1/10.[240] Natalie Stuart, a 17-year-old from the Swindon area, described how sex education was swamped in the wider PSHE curriculum: "We did PSHE and that was mainly about drugs. I can just remember doing drugs all the time; I cannot actually remember much about sex." Sex and relationships education also needs to be engaging and relevant for young people, rather than the "couple of out-of-date videos from about ten years ago" described by Lorna Webley, and Tara Hall, two 16-year-olds from Wakefield.[241]

277. The first results from the Teenage Pregnancy Strategy evaluation reveal that over 90% of young men and women surveyed reported receiving SRE at school. Two thirds had fewer than 10 lessons. Whilst the young people indicated general satisfaction with the quality of education about sex and risk reduction they were less satisfied with advice or coverage in respect of sexual feelings, emotions and relationships.

278. Young people are interested in sex and will pick up information from other sources if it is not available in schools. Natalie Stuart told us that for her, information about STIs came from an FPA booklet passed on by friends: "It was called Love Stings and it is about someone who went to a party and he had sex with a girl and then he ended up getting something and he had to go and have a test, and that always stuck with me."[242] However, not all experiences involve such reliable sources of information. Sarah Nicholls told us that she got most of her sex education from her peer group, "word of mouth from friends."[243] Emma Henderson, a member of the National Youth Parliament, who has carried out research in Buckinghamshire, argued that "one of the things that has come through is that most people get their information from friends in school or magazines".[244] The same piece of research indicated that up to 92.6% of young people in Buckinghamshire did not know of any agencies where they could seek support or advice about sexual health issues. The Wakefield Peer Research project had similar findings, and as a result recommended that contact numbers for sexual health services should be included in every young person's school planner.[245]

279. Young people are also keen to obtain sexual health information through new media which they use every day. Another of the Wakefield group's findings was that large numbers of young people favoured a text message service for sexual health: "One young lad said, 'I can text to see how my football team is doing, so why can't I text to get advice on sex?'". However, we also heard that the internet, around which many sexual health services for young people are based, is not proving as useful as it could be, because young people cannot guarantee privacy at home, and find that computers in schools and colleges will not let them access any website with the word 'sex' in its content. We put this problem to Stephen Twigg MP, the Parliamentary Under Secretary of State for Young People and Learning, Department for Education and Skills (DfES), who told us that "Schools should consider the appropriateness of any filtering process they apply. Most do recognise that a blanket approach to filtering on websites which contain words such as sex might mean that some educational sites are filtered out".[246]

280. New technology can also help young people to learn about sexual health and the consequences of unprotected sex in a much more practical way than textbooks or lectures. Anna Eagle and Natalie Stuart, two teenage mums from the Swindon area, told the Committee how prior to the birth of their babies they had had the opportunity to learn from 'electronic babies', dolls which are programmed to cry at certain times to simulate the demands of a new born baby. Both young women (and the partner of one of the women) felt that they learned a lot from the experience, and felt it would have been helpful to have had access to this at school before they became pregnant.

281. We recommend that the Department for Education and Skills and the Department of Health work together to compile a resource for schools detailing websites with high-quality information on sexual health which should be exempted from any filters schools may apply to their I.T. systems. DfES should also consider making 'electronic babies' more widely available in schools. The possibility of a text-messaging advice service should also be investigated.

Lack of priority

282. We have heard strong evidence that sex education in schools is frequently starved of time and resources in order to accommodate subjects which are accorded a higher priority by schools because of their National Curriculum status. The Manchester Young People's Council described SRE lessons which were essentially used as 'free periods' in which to complete coursework. Sarah Nicholls also described sex and relationships education as being squeezed into the timetable, rather than having a place in its own right, and the negative consequences of this lack of priority:

I can only remember having, like, three sex education lessons and we did not really get anything done because it was, "Oh, we're having sex education instead of geography", so everyone was saying, "Hooray!", and nothing ever got done unfortunately.[247]

283. The Sex Education Forum felt very strongly on this issue, arguing that "PHSE cannot go any further unless it is statutory ... unless you make it statutory it is going to be patchy, inconsistent and equivalent to a postcode lottery".[248] Lindsay Abbott, a deputy headteacher from Slough, was equally unequivocal in her support for the inclusion of SRE as part of the National Curriculum.[249]

284. We found that Stephen Twigg MP agreed with our other witnesses on the subject of priority: "I do not get a sense mostly that there is any resistance to [teaching SRE] in schools. It is often that it is not given sufficient priority, but schools do want to do their best."[250]

285. This issue was flagged up by the Independent Advisory Group on Teenage Pregnancy, a group set up by the Department to oversee the implementation of the Teenage Pregnancy Strategy. The First Report of the Group recommended in 2001 that SRE should become part of the National Curriculum. However, although we learned that another element of PHSE, Citizenship, has recently been introduced as part of the core National Curriculum,[251] Mr Twigg told us that his department were "very sceptical" about extending National Curriculum status to SRE, as "the whole direction of policy in terms of the national curriculum ... is away from compulsory elements in secondary."[252] Mr Twigg went on to argue that in future "loosening the school curriculum might give more scope within school timetable" for SRE. We are not, however, convinced that this will afford SRE the priority it needs.[253]

286. We strongly recommend that SRE becomes a core part of the National Curriculum, to be delivered within the broader framework of PSHE along with citizenship. We want to see education on relationships and sex given a high priority since the short and long term consequences of poor sexual health for young people, including unplanned pregnancy and parenthood as well as disease, can be so serious.

Lack of experienced teachers

287. Currently, SRE lessons are given by teachers whose expertise lies in an entirely different subject. Delivering SRE requires a fairly large specialist knowledge base, without which it is impossible to meet pupils' needs, as David Morris from Wigan described:

When you saw a video, it would give you brief details about sex education and things, but if you had any questions, the teacher did not have the experience or the training to answer the questions, so you never knew.[254]

288. Teachers also need the skill to lead children and young people of all ages through what can be highly sensitive, emotive and confusing issues, where a teacher's ability to discuss things confidently and without embarrassment is paramount:

I can remember things like, we would be sat in there and the teacher would explain about a certain thing and then a boy would shout out, "Oh, yeah, you know all about that", or something like that, and you are all blocked off then. You do not want to know any more. You do not want to say anything. You feel embarrassed.[255]

289. To young people, the problem with lack of expertise seems obvious. As Erica Buist put it:

We have English teachers to teach English, but we do not have sex education teachers to teach sex education, yet surely that has a bigger impact on our lives, so it is really not doing the job properly to have an English or geography teacher teaching sex education.[256]

290. Although there is an increasing amount of high quality guidance on SRE available for teachers, this is unlikely to equip them with the skills they need. This is clearly as acute a problem for teachers as it is for pupils. Lindsay Abbott described an ongoing battle to encourage teachers at her school to embrace SRE, resulting in slow but definite progress: "they feel a bit more comfortable in the classroom now about teaching it ... they come out of the lesson saying 'I did not go quite so red today, or 'it was a lot better today.'"[257]

291. However, expecting unqualified and possibly unwilling teachers to tackle such complex and sensitive issues without adequate training and support, is, as Gill Frances put it, "unfair on the children and deeply unfair on the teachers", and will undoubtedly have a negative impact on morale as well as standards within schools.[258] The DfES is currently piloting an SRE accreditation scheme aimed at teachers with SRE responsibilities who are in their third to fifth year of practice. However, SRE is not currently covered by initial teacher training, reinforcing the impression that it is simply an add­on rather than an integral part of every young person's education. Stephen Twigg MP agreed with us that if SRE were to become compulsory, then this would probably lead to better initial training in teacher training colleges.[259]

292. While investing SRE with National Curriculum status will improve its standing, we believe that the key to improving educational standards in SRE lies in providing each school with well-trained, capable and enthusiastic SRE teachers. We recommend that the Department for Education and Skills reviews the way in which teachers are trained and SRE is managed in schools, ensuring that SRE is taught by teachers with specialist knowledge and expertise in the subject. We recognise the difficulties of scale that might attend ensuring that each primary and secondary school has a dedicated SRE teacher, but we believe that these logistical difficulties could be overcome through creative local arrangements, such as pooling a teacher or teachers across a consortium of schools within a local authority. DfES should also ensure that schools have access to, and make good use of, support from a range of individuals and agencies—such as nurses, GPs, health promotion specialists, peer educators and youth workers—when planning and teaching SRE.

The wrong focus

293. Many of the young people who gave evidence to us also felt that they and their peers were not receiving important messages about sexual health. A common problem not addressed by sex education was that for many young women, concern about pregnancy takes precedence over concern about STIs:

A number of people are aware of the pill and think that, if you are on the pill, you are protected against STIs. They are taking the pill for absolutely ages thinking they are fine and they may not be. They just do not know enough about it.[260]

294. Sarah Nicholls described a similar lack of emphasis given to the most common STIs amongst young people:

I remember the only lesson we had on sexual health, there was nothing about chlamydia or syphilis or anything like that, but it was a leaflet passed around the class about AIDS and HIV which then got taken back to the form teacher at the end of the lesson to use in next week's lesson with a different group.[261]

295. Homosexuality is another key issue that many young people felt was not receiving adequate coverage, a problem ascribed by Jay Bailey, a 16 year old student from Wigan, to the ramifications of Section 28 of the Local Government Act 1988. Although Stephen Twigg was very clear that Section 28 did not constitute a bar to teaching young people about homosexuality, Lindsay Abbott reported that many teachers found Section 28 made covering these issues more difficult.[262] As Sarah Nicholls pointed out, this is at odds with the move towards inclusiveness in many other forms of educations: "in RE you do not just get taught Christianity, but you get taught Buddhism and everything, so why not get taught about everything in sex education?"[263] Gemma Minty, a 16 year old student from Wigan, described the consequences of excluding homosexuality from sex education very eloquently:

I think that first of all you need to break down the barrier between young gay, lesbian and bisexual people and straight people because at the moment the barrier is so high. You can see kids running round and saying, "Oh, your shoes are gay", without them actually knowing the meaning of the word "gay". If they were taught from an early age that some people ... have two Dads or two Mums, then the barriers would gently fall and then perhaps sex education could be more open, you could explore the alternative ways of having sex.[264]

Meeting the needs of both boys and girls

296. Our witnesses were not always in agreement about the merits of single-sex SRE. Although it may allow certain issues to be covered with less embarrassment, as Simon Blake argued, young men and women ultimately need to learn how to negotiate sex and relationships together, and single sex SRE can impose artificial barriers. As Sarah Nicholls told us, "the young ladies should be allowed to get just as much sex education and information on what goes on with a boy as they should with themselves because at the end of the day they are both coming together to have sex, so they need to know what is being offered in both parts."[265]

297. However, a more frequent complaint from our two panels of young people was that young men's needs were not met by sex education that was usually very female orientated. This is a particular issue given that, according to our witnesses, young men may actually be more vulnerable to peer pressure than young women. Natalie Stuart was the first to raise this:

I think there is more pressure on boys sometimes, because boys, even if they are friends, they sit there and make fun of them, but girls obviously,—with Anna I would not start saying, "Oh, go on, go on", and force her into it if I am her real friend, but boys do even if they are friends, do they not?[266]

298. This view was supported by David Morris:

For men image is a very big thing. If you are part of a group of males and they have all done it, then obviously they are going to really intimidate you and really put you out and try their hardest to make you an outcast, so therefore you think, "They have done it. I have got to do it or else therefore I am not part of the gang." It is male image. You have got to be the man as such.[267]

299. The Department for Education and Skills is currently engaged in work with the National Children's Bureau on guidelines specifically aimed at how to best engage boys and young men in schools-based sex education. We recommend that this guidance forms a specific plank of the National Curriculum on SRE, as clearly young men's needs have hitherto not been adequately addressed, despite the fact that they represent half the problem and half the solution to improving young people's sexual health. We were also struck by the fact that during the course of this inquiry, the vast majority of the people we met and took evidence from who were involved in sex and relationships education, and sexual health promotion for young people were female. One of the young men who came to give us evidence gave lack of specific male input as a key problem in the delivery of relationships and sex education for young men, and this is clearly a difficult problem that needs to be addressed. While we understand that it may not be practical for every school to provide both a male and a female teacher for SRE, schools must ensure that young men have access to SRE delivered by males, perhaps through using male peer educators, community workers and health professionals.

What age?

300. The age at which sex and relationships education should begin is controversial. It is clearly vital that each subject to do with sex and relationships is covered at an age which is appropriate to children's differing needs, so that it does not intrude on or complicate other areas of a child's social development. Research carried out by the Health Development Agency suggests that SRE programmes are most effective when they start before young people become sexually active.[268] However, without exception the young people from whom we took evidence felt that the sex education they received had started too late:

When I was in primary school, it was more like puberty sex education where you got shown how to use a Tampax. So it started there and then we had nothing and it started again at 14

It was too late?

Yes, it was because we already knew it all anyway.[269]

301. Rachel Ward went on to argue that "the basics of sex should be taught in the last year of primary school, but that it should go into more detail around about the age of 13."

302. Lindsay Abbott described the comprehensive SRE programme she delivered in Slough, spanning each year in secondary school, covering contraception from the age of 12-13, and STIs from the age of 13-14:

In Year 7 we look at why you are different and it is okay to be different. We start them off in the room and they are all different sizes, they have all got different shoe sizes and you are all different inside and we do a whole package on relationship. Then in Year 7 we look at puberty and I teach that separately because the kids feel more comfortable about that in Year 8 we go on to talk about contraception and that is where I would show them the contraception available, they would talk about them in classrooms, and still stick to relationships. In Year 9 we do HIV and sexually transmitted infections. We look at the media as well throughout Years 7, 8 and 9. In Year 10 we look back at relationships and the beginnings of the family unit. In Year 11 I look at actually having the family and how much it costs.[270]

303. It is imperative that all school-based relationships and sex education gives young people the opportunity to learn and think about the broader aspects of sex and sexual health, including emotions, relationships and families, and including the existence of different family structures. It is also vital that young people have a good understanding of the facts surrounding sexual health before they need them. Current guidance states that all primary aged children need to know about how a baby is born and about puberty before they experience the onset of physical changes; and that secondary school pupils should understand human sexuality, be aware of their own sexuality and know about contraception, sexually transmitted infections and HIV. We have seen little evidence through this inquiry that the SRE guidance is being implemented in a consistent way, especially in relation to more sensitive areas such as sexual feelings and emotions, sexual orientation and HIV and AIDS. We therefore recommend that the Department for Education and Skills establishes mechanisms (until such a time when SRE has National Curriculum status) both to monitor the implementation of the guidance and to assess the extent to which relationships and sex education, which addresses the needs of young people, is being delivered by primary and secondary schools.

Parents

304. Closely linked to the age at which sex and relationships education should start is the issue of the appropriate role of parents in sex and relationships education. While all the adults who gave evidence on this subject felt that parents should be supported and encouraged to talk to their children about sex and relationships themselves, the young people felt strongly that their privacy should be respected at all times. As one of them trenchantly put it: "It is not a subject to be shared. The parents would not expect to share their sexual lives with their children, so why should the children be expected to share theirs with their parents?"[271]

305. Currently, parents have a right to withdraw their children from SRE if they wish. Although only a tiny minority exercise this right, the young people we took evidence from felt very strongly that although parents should be aware of what was contained in SRE programmes so they could support their children at home, young people's entitlement to SRE should not be compromised by their parents.[272] We welcome the efforts currently being undertaken by the Department of Health and the Department for Education and Skills with regard to helping parents talk to their children about sex, as we feel that this type of engagement has a vital role to play in ensuring young people receive rounded sex education.

Improving sexual health

306. The Implementation Action Plan gives considerably more information on sex education than the Strategy. According to the Implementation Action Plan:

"A new emphasis will be given to STIs and HIV as part of the work already underway to improve education about sex and relationships and tackle teenage pregnancy. Effective teaching should enable young people to understand human sexuality, build self-esteem and understand the reasons for delaying sexual activity. Further work will include in particular:

• Practical guidance for teachers including lesson plans and case studies through the new PSHE website;

• Guidance on initial teacher training within the new Teacher Training Agency handbook;
• National roll out of the pilot scheme to accredit SRE teachers, and a new pilot training scheme for school nurses and others involved in delivering SRE in schools;
• Partnership work through the National Healthy School Standard to improve the quality of SRE in schools, and through Connexions to ensure young people are referred to appropriate services;
• Consideration of options for promoting better support on sex and relationships issues within Further Education;
• Better support for parents in talking to their children about sex and relationships through the Involving Parents in Prevention teenage pregnancy initiative."

307. We endorse these efforts, although, as discussed above, we do not feel they will go far enough towards guaranteeing quality and priority in SRE without national curriculum status. In addition to these measures, we have learnt about many innovative approaches to SRE throughout the country during the course of this inquiry. Many of the young people we took evidence from had worked with their peers to promote sexual health, and felt that having sex education delivered by young people their own age, in a language and style they could relate to, had been very successful. However, we are also aware that training a new group of young people to act as peer educators every year might be expensive. We strongly support the use of peer educators, and recommend that the Department for Education and Skills and the Department of Health should work together to continue to promote this approach in all schools, although we believe this should be a supplement to rather than a replacement of formal schools-based relationships and sex education.

308. Young people also placed great value on the input of healthcare professionals to their SRE, often finding it was easier to talk about sensitive subjects in complete confidence to someone they would not be seeing on a regular basis. As well as getting information first hand from 'the experts', we heard that this approach could also serve to familiarise young people with staff from local clinics, making them feel more confident about finding, negotiating and using health services. However, links between schools and services do not always work together to meet young people's needs, and we heard evidence from one young person that due to difficulties with location and opening times, the only time young people could access a clinic for emergency contraception was by taking time off school, which could lead to real difficulties.

309. When we visited Sweden in December 2002, we saw an extension of this approach, with each secondary school having a designated Youth Clinic. All pupils in the Ninth Grade (aged 14-15) visit their Youth Clinic, to familiarise themselves with where it is, meet its staff, and learn about what services are on offer. Education is often delivered jointly by youth clinics and schools. In England, there is no equivalent dedicated NHS provision for young people. As against the 200 youth clinics in Sweden, a country with a population under nine million, there are 17 Brook clinics offering services exclusively to young people in the UK, with its population close to 60 million. However, we feel that models such as the Tic Tac project, in Paignton, Devon, have the potential to offer even more accessible advice and services for young people without expensive reconfiguration of health services.

310. Tic Tac (The Teenage Information and Advice Centre) was launched in February 1998 in Paignton Community College, a comprehensive secondary school with 2,000 pupils. The Centre is housed in a small building within the school grounds but separate from the main school building, and has a 'drop in' lounge area where young people can pick up information and leaflets, or simply sit and relax. The Tic-Tac co-ordinator is always on hand to chat to young people, and is a familiar and trusted figure. The session is staffed by a health professional every day of the week, and young people approach the co-ordinator privately and arrange to see a doctor, nurse or health visitor, all of whom are able to offer confidential advice. Users of the service are given firm assurances that discussions with the health professionals based at the Tic Tac project will not be disclosed to their teachers, parents or peers. We were also told by young people that there was no stigma attached to going to the Centre, even although it was on the school site and visible to teachers and other pupils, because rather than being a specific sexual health clinic, the Centre functions as a general advice centre where pupils can go for information about a wide range of issues, including general health, diet, fitness, stress, bullying, or just for a cup of tea and a chat.

311. The project appears to have struck a unique balance between being extremely accessible, without being so clearly linked to the school that young people feel it is too closely connected with either their teachers or parents. The Centre operates alongside the school-based sex and relationships education programme, and reports that peaks in demand for the Centre often directly follow coverage of complex issues in SRE which pupils then want to know more about. Although the health professionals who staff the Centre will give contraceptive and sexual health advice and an initial supply of contraceptives, as well as emergency contraceptives, all the health professionals strive to make the Centre a gateway to other local services rather than an end in itself, an approach they say has worked well.

312. The Tic Tac project in Paignton, clearly an example of best practice in meeting, in a confidential manner, young people's sexual health needs, has been heavily driven by local enthusiasm and leadership, which has helped steer it through continuous funding uncertainties as well as negative publicity. It is seen as an integral part of raising educational standards in the school. However, we also heard of several examples of other schools which were keen to adopt the model, but which were obstructed by school governors. We believe that the Government should actively promote this model of joint service provision and education for young people, and make dedicated funding available to establish an appropriate number of such services within each local authority area. Although we recognise that it may not be practicable to have such a service attached to every school site, arrangements should be made between smaller schools to establish shared facilities or to devise links with dedicated clinics. We would also urge the Department to pilot a youth clinic along the lines of those we visited in Sweden: these may be more effective in reaching those not attending school.

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222   Teenage Pregnancy, Social Exclusion Unit, 1999, p 7 Back

223   We have reluctantly stuck to the term "sex and relationships education" in this section where our witnesses or others have used that term. In our view, the term "relationships and sex education" would be preferable, in that it accords appropriate priority in the sequence to relationships over sex and we use that term elsewhere. Back

224   Q 545 Back

225   Teenage Pregnancy, p 37 Back

226   Q 952 Back

227   S Prendergast, This is the time to grow up; Girls' experiences of menstruation in school, Health Promotion Research Trust, 1992; Young People and Health, Health Education Authority, 1999 Back

228   Prof Paton et al, Journal of Health Economics, 4 March 2002 Back

229   Qq 762, 781 Back

230   Q 790 Back

231   Effective Health Care Bulletin, Centre for Review and Dissemination (CRD), York 1997  Back

232   DiCenso et al, "Interventions to reduce unintended pregnancies among adolescents: systematic review of randomised controlled trials", BMJ 2002;324:1426. Back

233   Teenage Pregnancy, Social Exclusion Unit, 1999, Table 1, p 29 Back

234   Ev 234 Back

235   Q 788 Back

236   "Interventions to reduce unintended pregnancies among adolescents: systematic review of randomised controlled trials", DiCenso et al, BMJ 2002;324:1426. Back

237   Ev 226 Back

238   Sex and Relationships Education Guidance, Department for Education and Skills, July 2000 Back

239   Sex and Relationships Education in schools, OFSTED, April 2002 Back

240   Q 985, Q 987 Back

241   Q 834 Back

242   Q 994 Back

243   Q 832 Back

244   Q 846 Back

245   Q 859 Back

246   Ev 418 Back

247   Q 835 Back

248   Q 461 Back

249   Q 482  Back

250   Q 1122 Back

251   Q 1139 Back

252   Q 1132 Back

253   Q 1124 Back

254   Q 835 Back

255   Q 1024 (Natalie Stuart) Back

256   Q 880 Back

257   Q 480 Back

258   Q 797 Back

259   Q 1133 Back

260   Q 906 Back

261   Q 884 Back

262   Q 501 Back

263   Q 883 Back

264   Q 978 Back

265   Q 883 Back

266   Q 1020 Back

267   Q1026 Back

268   Ev 121 Back

269   Qq 949-50 Back

270   Qq 475-77 Back

271   Q 869 (Erica Buist) Back

272   Qq 874-75 Back

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Prepared 11 June 2003