Respect and Responsibility: Strategy and Action Plan for Improving Sexual Health
Section 2 Promoting Respect and Responsibility
9. Many people in Scotland experience positive relationships and good sexual health. But there is a considerable growing burden of sexual ill-health, and addressing this requires an understanding of the breadth and complexity of this area of work.
10. This strategy recognises that there are many different faiths and cultures in Scotland, and that it is essential that all service providers and service users recognise and respect that diversity. The principles of equity, respect and accessibility to clinical services and lifelong learning apply to sexual health, whatever our race, ethnicity, disability, gender or sexual orientation, age or religion.
11. A holistic approach to sexual wellbeing, which at the same time recognises the diversity of moral, cultural and ethical views, can be expressed through the range of initiatives identified in this strategy. It also provides scope for a range of professionals and others to play a part in enhancing knowledge, improving decision-making skills and challenging attitudes, as well as promoting key messages, and in reaching some of those who are most vulnerable to sexual ill-health.
THE WIDER INFLUENCES ON SEXUAL HEALTH
12. Economic, social and cultural influences all impact on sexual wellbeing and often give rise to inequalities. In particular, there is a strong link between social disadvantage and early initiation into sexual activity. Those with lower aspirations are more likely to become sexually active at a young age, less likely to use contraception 4 and therefore more likely to contract sexually transmitted infections and go on to become young parents. The overall rates of teenage pregnancy for the most deprived areas are more than treble than for the least deprived areas. 5 Conversely, those with good educational and employment prospects are more likely to use contraception and more likely to terminate unwanted pregnancies. Planning to avoid unintended teenage pregnancies is closely linked with having a stake in the future, a sense of hope and an expectation of inclusion in society. There are also links to the cultural and social expectations of the lives and experiences of girls and boys. Drug misuse and the disinhibiting effects of alcohol, the media and peer and social pressures can all influence sexual behaviour, as can the experience of sexual abuse in childhood. The 2002 Scottish Schools' Adolescent Lifestyle and Substance Use Survey (SALSUS) National Report, commissioned by the Executive found that 17% of 15-year-old girls and 12% of 15-year-old boys surveyed, reported having had unprotected sex during the last year as a result of drinking alcohol. The same survey found that drug users were more likely to have had underage sex and at an earlier age. 6
13. The Executive's wider policies on lifelong learning, including parenting skills, equity and diversity, social inclusion, alcohol and drug misuse will therefore bear significantly on sexual wellbeing; and a key aim of this strategy will be to ensure that relationships and sexual health, based on the values set out above, should be firmly integrated into the delivery of these policies.
THE ROLE OF SCHOOLS
14. Parents play a key role in all aspects of their children's education. It is essential that parents and carers are consulted on the development and revision of sex and relationships education programmes as and when that arises; and parents and carers should be given the opportunity in advance to view key teaching materials and to ask questions about any aspect of a sex-education programme. Schools should also give pupils an opportunity to identify and express their own needs.
15. Education Department Circular 2/2001 concerning the conduct of sex and relationships education in schools, developed following extensive consultation culminating in the Report of the Working Group
on Sex Education in Scottish Schools (the McCabe Report) which was widely welcomed, sets out a framework for the development and delivery of sex and relationships education in Scotland, along with the provisions of section 35 of the Ethical Standards in Public Life, etc. (Scotland) Act 2000, which puts a duty on councils to have regard to 'the value of a stable family life in a child's development' in developing sex and relationships education programmes. Circular 2/2001 places the values of respect and responsibility at the heart of sex and relationships education:
"Pupils should be encouraged to appreciate the value of stable family life, parental responsibility and family relationships in bringing up children and offering them security, stability and happiness. Pupils should also be encouraged to appreciate the value of commitment in relationships and partnerships, including the value placed on marriage by religious groups and others in Scottish society. At the same time, teachers must respect and avoid causing hurt or offence to those who come from backgrounds that do not reflect this value. All pupils should be encouraged to understand the importance of self-restraint, dignity, respect for themselves and the views of others."
THE MEDIA AND MASS COMMUNICATIONS
16. Sexual imagery pervades many aspects of modern society and is often used to sell products. Its portrayal of sex and relationships tends to reinforce stereotypes about differing expectations in activities and behaviours, often in a sensational fashion and in a way which ignores the risks associated with sexual behaviour. It can also reinforce the social stigma around sexual relationships and sexual health services and sensationalise the issue. Media messages can lead to pressure and confusion over the realities of relationships and sexuality, particularly for young people, and can imply that casual attitudes to sexual issues are risk free and acceptable.
17. Yet the media can be a powerful communication tool, with the capacity to provide positive information about sexual health. Thus our work with the media will seek to support action to improve sexual health through accurate and balanced reporting, promoting the core values of this strategy and including the message that abstinence and delayed sexual activity in young people are socially acceptable choices and that sexual relations should be based on self-respect and respect for others.
IN PROMOTING RESPECT AND RESPONSIBILITY, THIS STRATEGY WILL:
- encourage a cultural shift towards a more open and positive view of sexual relationships and sexual health that recognises the range of views on the issue;
- promote an ethos that encourages relationships based on equality, maturity and respect, with abstinence a legitimate choice;
- challenge gender stereotypes and reinforce the responsibility of both men and women for protecting their own sexual health;
- provide support for parents in the community with their children about sexual relationships and sexual health;
- increase awareness of ways to reduce poor sexual health outcomes;
- raise awareness of services at both a local and national level; and
- encourage interaction with the public on sexual health matters.
To facilitate a co-ordinated approach to the integration of sexual health in wider Executive policies and initiatives, a Ministerially-led National Sexual Health Advisory Committee - with cross-departmental and a wide-ranging membership - will be established with the aim of advising on policy, monitoring and supporting the implementation of this strategy.
The National Sexual Health Advisory Committee will seek to ensure that no-one is excluded from appropriate sexual health services, whatever their life circumstances, by means of a comprehensive equality and diversity impact assessment process. In line with the developing SEHD/NHSScotland equality and diversity approach, this will address issues relating to people's age, faith, race/ethnicity, disability, sexual orientation and gender as well as cross-cutting issues such as poverty, mental health, homelessness and involvement in the criminal justice system.
At NHS Board level, there will be a responsibility to deliver a co-ordinated approach to sexual health and help ensure that community plans and health improvement plans address the issues that impact on sexual health, especially in relation to inequalities and take account of the diversity impact assessment process.
The Scottish Executive will develop an action plan to tackle stigma and discrimination to encourage a more positive view of relationships and sexual wellbeing in all Executive policies, as part of the ongoing health improvement agenda.
The Scottish Executive will continue to support the full implementation of the Report of the Working Group on Sex Education in Scottish Schools (the McCabe Report) and reinforce the principles of existing guidance.
Parents can play their part in the sex and relationships education of their children both directly and through stable family and home life and by their involvement in their children's general education and school, voluntary organisations and faith-based groups that have contact with their children.