I beg to move,
That leave be given to bring in a Bill to require practitioners providing contraception or abortion services to a child under the age of 16 to inform his or her parent or guardian;
and for connected purposes.
The rates of unplanned pregnancy, abortion and sexually transmitted infections among under-age children in this country are shamefully high. They are higher than those in most other countries in the developed world, and certainly higher than those in any of our western European neighbours. There is an obvious reason for that: all the indications are that many children are becoming sexually active well before they are emotionally or physically mature. In children under the age of 15, the estimated figure is more than 40 per cent.
The Government have expressed concern about the situation, but their policy direction to try to tackle the problems has been misguided. Sex education in schools focuses heavily on the assumption that under-age children will be sexually active come what may and on providing all the contraception information that they need to avoid pregnancy and infection. However, statistics show that that approach is not working. It has done little to deter pupils from engaging in precocious sexual behaviour. Indeed, the plethora of information on contraception has given encouragement to children through false assurances that there will be no unwanted outcome. That is hardly surprising, as immature young people cannot be expected to make wise adult decisions. Interestingly, most schoolgirls who become pregnant or contract a sexually transmitted infection claim to have used contraception.
The aim of the Government's teenage pregnancy strategy, launched in 1999, was to halve teenage pregnancies in 10 years. That was a laudable aim, but by 2005 the rate had dropped by only five per 1,000—from the 1998 figure of 46.6 to 41.1 per 1,000. The figure for teenage pregnancies in 2005 reached 7,464 and some new mothers were as young as 13. Even the provision of the morning-after pill free of charge and without parental knowledge has had virtually no effect on numbers. Indeed, it could have been said to have encouraged some girls to increase their risky behaviour. On a visit to one of my local health centres recently I learned that far from using the morning-after pill as an emergency treatment, the same young girls are presenting regularly. Such small progress offers no hope of the strategy achieving its goal by 2009. It is time to try a different approach.
Young people are already surrounded by constant barrages of sexual images on television, in films, DVDs and magazines, and on advertisement hoardings—in fact, almost everywhere they turn. Clothing designed for pre-teenage girls often makes them look like provocative young adults. Sex and relationship education in schools should be used as an opportunity to redress the balance. Girls in particular need real-life warnings about the risks that they are taking with their emotional and physical health, and their future career and employment prospects. If the father of the child is an under-age boy, there will be no wedding and he will not be in a position to provide a home or financial support. The parents of the girl have to step forward, as from this point on full responsibility must be assumed by the girl and she will need their support as never before. How much better it would be if the parents had had the opportunity to divert their daughter from that course of action by being involved at a much earlier stage.
Under-age girls run a very real risk of contracting a sexually transmitted infection, which may have a long-term impact on their reproductive lives. Almost 90 per cent. of the children aged between 13 and 15 seeking treatment for sexually transmitted infections are girls. In north-east London, the incidence of chlamydia is one of the highest in the country. That sexually transmitted infection is different in that it is symptom-free, so girls are usually unaware that they have it until much later in life when they are married and have fertility problems that mean they are unable to have a planned family. That often leads to years of distressing fertility treatment with very unpredictable results. One of the main contributory reasons to that condition is too early sexual activity.
Pregnancy often comes unexpected and unplanned and the girl, who is still a child herself and still at school, finds that her life has suddenly taken a different course. A child who has been engaging in adult behaviour suddenly faces serious, life-changing decisions when she does not have the adult skills or resources to cope. Many parents are unaware that their child is sexually active and the news that she is expecting a child of her own comes as a huge shock. The girl may seek advice elsewhere, for example from her GP, a health centre or a family planning service, to avoid facing the music at home.
Advice on abortion may be provided and accepted without the parents' knowledge. Just a few weeks ago, I received a letter from a constituent who had been required to leave his place of work, find a chemist and buy a tube of antiseptic cream, go to his son's primary school where the child had grazed his knee, apply the cream and then return to work. Apparently that procedure was too risky to be undertaken without parental involvement. We live in a contrary world that rates the application of cream to a grazed knee, or a visit to the dentist, for which parental consent is also required, as a greater risk than an abortion on a minor.
For parents, the discovery that their daughter had an abortion that might have been avoided if they had not been kept in ignorance can be an even greater shock. The long-term emotional and physical impact of an abortion can be serious, and it is the parents who will provide care and support for their daughter. Those same parents might well have decided to support their daughter in bringing up her child, once they had overcome the initial shock of discovering their child's pregnancy, and had had time to reflect.
That brings me to the main purpose of the Bill. The provision of lots of sex information has not worked, so sex information should be replaced with sex education. In education about the real risks involved and the likely outcomes, the advice to under-age girls should be to abstain, to wait, to delay, and to resist, rather than to use contraception and believe that they will not come to any harm. Parents need to be part of that process. In 1984-85, under the Gillick ruling, and more recently in the United States, where parental involvement is required, the evidence showed that the number of unwanted pregnancies did not go up, but the number of sexually transmitted infections went down.
The decision to provide contraception or abortion advice or treatment to under-age children must involve the parents. It is the parents who have full responsibility for, and the greatest interest in, their children's health and welfare and the closest long-term personal bonds with them. Parents have the best opportunity to guide their children to resist peer pressure, and to make wise decisions about their sexual behaviour and their future reproductive lives. Quite simply, parents have not just a right to know, but a need to know.
There is an important caveat in the Bill to protect a child whose parents might be violent or abusive. In those circumstances, where the child finds herself in need of advice, practitioners may appeal to the courts, in camera, for a decision to be made. The Bill would be an important step in trying to reduce the number of unwanted teenage pregnancies and abortions among under-age children. It attempts to do that by strengthening families and entitling parents to be involved in making important decisions.
I oppose the motion and urge the House to decline giving the Bill its First Reading. The proposals made by Angela Watkinson raise serious issues to do with child protection and patient confidence, and that is aside from their potential impact on the sexual health of the part of the population concerned. I speak from the perspective of a medical practitioner and a long-standing member of the British Medical Association's medical ethics committee. I place on record the fact that my partner works in sexual health policy for a charity that deals with the subject.
The hon. Lady failed to mention the current rules, and to say what guidance exists for health care professionals in this difficult subject. For example, before providing contraception to young people, health professionals must consider whether the patient understands the risks and benefits of the treatment and the advice given, and must discuss with the patient the value of parental support. Doctors must encourage young people to inform parents of the consultation, and if the patient is unwilling to do so, they must explore the reasons.
It is important for persons under 16 seeking contraceptive advice to be aware that although the doctor is obliged to discuss the value of parental support, the doctor will respect their confidentiality, if necessary, and the fact that they are unwilling to involve their parents, for the reasons given. Before providing contraceptive advice, the doctor must also take into account whether the patient is likely to have sexual intercourse without contraception, and assess whether the patient's physical or mental health, or both, are likely to suffer if the patient does not receive contraceptive advice or treatment.
Finally, the doctor must consider—this is the key test—whether the patient's best interests require the provision of contraceptive advice or treatment, or both, without parental consent. It is consideration of the patient's best interests that must govern a doctor's behaviour in those difficult circumstances, rather than ideology or unsubstantiated concerns about the public health policy impact of that important requirement for confidentiality, such as those expressed by the hon. Lady.
The guidelines to which I have just referred are the Fraser guidelines and stem from the Gillick ruling in 1985. At the time, the then Conservative Government recognised that the Law Lords deemed their guidance lawful. They instituted a review of their policy and guidelines as a result of the ruling and no significant change was made. The guidelines that I have set out are broadly those supported at the time by the Conservative Government and the then Health Minister, Barney Hayhoe.
When the guidelines were challenged again in the Axon case, the current Government welcomed the fact that their guidelines were clearly upheld. The position that I have set out is supported by the British Medical Association, a number of children's charities and people involved in the delivery of sexual health advice to young girls.
The hon. Lady said little or nothing about the principle of clinical confidentiality and the rights of children in some circumstances to that confidentiality. She said little or nothing about the potential effect of her proposal on the welfare of individual patients who may be at risk of abuse if their confidentiality is not respected including, on rare occasions, from their parents, sadly. If she seriously thinks that it is an acceptable policy to invite a vulnerable young girl to apply to the court for permission for her parents not to be told when she has clear concerns about her safety, she misunderstands the real world in which some people exist.
It is only on rare occasions that parents are not told or that young people do not involve either their parents or another adult in seeking advice. It is on those rare occasions that we have to have concern, not just for rights and principles, although rights upheld in British common law as well as in human rights law mean that we must have regard to the safety of individual patients. As Brook Advisory Service points out, a father can say, "If you come home pregnant, you're dead." That is not just a rumour; it can happen, and we must be very careful when considering the welfare of young girls in that situation.
The hon. Lady based her arguments on claims that I believe to be contentious: that sexual health would be improved if girls were threatened with their private lives being opened up to their parents without their consent, come what may. The evidence for this is poor; I note that her speech lacked any significant references to peer-reviewed literature. On the contrary, there is evidence that there is a deterrent to access by the threat of parents being told. Brook Advisory Service, a frontline provider, did a survey of its clients, two thirds of whom said that confidentiality was the single most important factor that affected whether they were willing to seek help. The British Pregnancy Advisory Service has recognised the real concerns that exist in this area.
There are problems in the current strategy—I accept what the hon. Lady says—but she must recognise the real dangers that exist. As BPAS says,
"We all wish that every teenager could go to their parents to discuss personal issues like contraception, but the reality is that many of them can't. This may be due to abuse, relationship breakdown, or the parents' own problems. Some parents have such strong religious convictions that the teenager fears that they will be thrown out of home, or will be forced to marry and bring up a child they don't want and can't cope with."
If the hon. Lady were saying that the Government's sexual health strategy had not been as effective as we might have liked and that targets may well be missed, we could agree. If her issue was that we wished to reduce all sexually transmitted infections, teenage pregnancies and teenage abortions and, importantly, seek to raise the age of first intercourse, we would agree. The best approach, however, is to continue to improve access to contraception as well as the quality of sex education. I believe—and others support the proposal, including some of those whom I have mentioned—that sex education should be part of the national curriculum. There should be much more effective, earlier access to information in age-appropriate language. It is true that young girls face a barrage of sexualised images, and they are under increasing pressure to sexualise at an early age. I regret that and, indeed, I condemn it, as does everyone on our side of the argument. The answer, however, is not more ignorance, which is what the hon. Member for Upminster has prescribed: it is more information. Other European countries have shown that the earlier provision of clear information in age-appropriate language reduces the number of sexually transmitted infections, pregnancies and abortions, as well as —and this is significant—giving girls and boys the power to resist peer pressure and, in the case of girls, to resist boy pressure, as they have the self-confidence to deal with those difficult negotiations in their teenage years.
I accept that reform is needed, but in an area different from the one proposed by the hon. Lady. We need easier and fairer access to services, and we need better access to sex education. It is regrettable that the only private Members' Bills that are introduced on the subject seek to limit access to services, rather than improve them. There is a challenge for all Members to seek to liberalise the law on sex education and access to those services, rather than to constrain it.
The hon. Lady's proposal—I accept that it is well intended—is the wrong way forward. I urge the House to oppose the measure, and to refuse to give the Bill a First Reading.
Order. I do not know whether the hon. Gentleman was in the Chamber when I gave a ruling earlier today on that matter. If he looks at the transcript, he will see my ruling.