Remember being constantly told during various referendums that we had one of the highest abortion rates in Europe, and to reduce our numbers we needed to learn from the Netherlands? Yet it is now confirmed, as some of us said at the time, that despite our alleged backwardness we already have a rate as low as the model we were supposed to emulate, that is, the Netherlands, writes Breda O'Brien
The 2004-2006 Strategy to Address the Issue of Crisis Pregnancy was published this week, and it is full of fascinating nuggets of information, including that Ireland has one of the lowest abortion rates in the EU. Some of the highest rates are to be found in Sweden, Denmark and Britain, which have rates that are more than double that for Ireland. The figures from the Scandinavian countries defy conventional wisdom.
The root cause of the Irish rate of crisis pregnancy and abortion is alleged to be the lack of easy access to contraception and comprehensive sex education. Yet, easily available, socially acceptable contraception and sex education in Sweden and Denmark do not prevent them having an abortion rate twice as high as ours. Unfortunately, that interesting disparity is not discussed in the strategy.
On the positive side, the strategy does emphasise the importance of parents in forming attitudes. There is a commitment to "research and consult with parents on their knowledge and attitudes and their perceptions of ways to develop their own skills in the education of their children in relationships and health matters".
This is the best place to start in sex education, because despite many parents' feelings of inadequacy, and their hopes that schools will take over the task, no one knows their children better or is better placed to influence them than parents.
The strategy also acknowledges that what is called "abstinence-plus" works best in sex education. Abstinence-plus teaches young people that the safest route is to delay becoming sexually active, but also gives them facts about contraception. The strategy is at pains to point out on several occasions that "abstinence-only" education (that is, leaving out the contraceptive message) is not as effective. This is somewhat amusing, since it is doubtful if abstinence-only education is used to any great extent in any school in Ireland.
Young people are much more likely to receive no sex education at all, or so-called "value-free" education, than abstinence-only education. Nor does the report point out another counter-intuitive finding of research. One of the most successful outcomes of abstinence-plus education is that it significantly delays the young person's initiation into sexual activity.
The abstinence message of abstinence-plus programmes works. Full information about contraception may also help to delay sexual activity, because many young people are unaware of the high failure rates of condoms with regard to pregnancy.
Nor do they know that a condom does not provide protection against many serious sexually-transmitted infections such as Chlamydia. In a 1999 study of American women who availed of in-vitro fertilisation, Chlamydia was cited as the reason why 27 per cent of them were infertile. The most recent available Irish figures show 754 cases of Chlamydia detected in the first half of 2001. Given that it is symptom-less in women, how high are the undetected figures?
The strategy calls for a review of Relationship and Sexuality Education (RSE) in schools, but oddly, given its earlier praise for it, does not call for a teenager-friendly abstinence-plus message. The current training provided for RSE is closer to a neutral approach, which is then meant to be adapted for use according to the ethos of the school. I am unaware, but would be delighted to hear, of serious attempts to adapt the Department-provided materials in a way that reflects the ethos of schools.
Nor does the strategy call for provision for smaller groups of 8 to 10 in the delivery of RSE. Any teacher involved in RSE will tell you that it is a travesty of education to attempt to deal with sensitive and intimate topics in a classroom with 30 young people.
The strategy talks a lot about cultural change, but seems to lack belief that it is really possible. The culture of young people is saturated with sexual imagery and pressure. To tackle that would be real cultural change.
One of the indications that the strategy is more interested in cultural accommodation than cultural change is the fact that one of its key recommendations is to reduce the VAT on condoms. It shows a serious lack of understanding of young people. Girls who will spend a tenner on a lipstick, or €50 in a night on drink, are not intimidated by the price of condoms. Young people fail to use condoms because they lack the skills to negotiate with a partner they scarcely know, and because they are often ambivalent about being sexually active in the first place.
There is another oddity in the language of the strategy, in that they frequently use the expression "safe sex" rather than "safer sex" when referring to sexual activity undertaken with the use of contraception. The only safe sex is no sex, or with regard to sexually-transmitted infection, sex with a faithful partner where neither person has contracted an infection from a previous relationship. Contraception reduces but does not eradicate risk.
There is no reason for fatalism regarding patterns of sexual behaviour.
People can change cultural patterns, even very promiscuous patterns. Take Uganda, which is the most successful African country in the fight against AIDS. It instituted the ABC programme, which stands for "abstain from sex, be faithful, and use a condom" - in that order of priority, with the emphasis on fidelity. According to the Health and Population Evaluation Unit at Cambridge University, casual sex has been reduced by 65 per cent since that approach was implemented. HIV rates in the country have been reduced from 21 to 9.8 per cent in 1991 to 1998.
There is much that is valuable in the strategy, including the need to research and promote adoption as an alternative to abortion. It will be a pity, though, if the overwhelming message from the agency is that contraception and "value-free" sex education will solve all our abortion and sexual health problems, because the evidence is already there that it has signally failed to do so in other countries.