Respect and Responsibility: Strategy and Action Plan for Improving Sexual Health
Section 3 Preventing Sexually Transmitted Infections and Unintended Pregnancies
18. Sexually Transmitted Infections, including HIV, affect people of all ages in Scotland, although incidence is greatest among those under 25. High chlamydia prevalence amongst young men and women is of particular concern, albeit the increasing numbers may be, in part, due to more people being tested.
19. These infections can give rise to health complications and affect fertility, placing increasing demands on clinical services that can be prevented through the encouragement of safer sex practices.
20. To respond to recent increases in HIV prevalence, especially among heterosexual people and gay men, efforts should continue to be made to minimise barriers to testing as well as ensuring that those most at risk from infection are tested.
21. This strategy has already shown the clear links between sexual health and cultural and social influences. However, if sexually transmitted infections are to be combated, action also needs to be taken on other factors, which are associated with the spread of disease. These include poor and inequitable access to clinical services including contraception and ineffective partner notification measures. There is a need also to tackle the incidence of sexually transmitted infections amongst high risk or socially excluded groups and those in prisons.
22. Many women and teenage girls experience unintended or unwanted pregnancies. While pregnancy and parenthood are positive choices for some young people, for others unintended pregnancies and parenthood, are associated with negative social and psychological consequences such as incomplete education, poverty, social isolation and low self-esteem.
23. The improvements in sexual health experienced elsewhere are achievable throughout Scotland, with better co-ordination and a more supportive environment. This is supported by evidence drawing from experience already in Scotland and elsewhere in the links between education and services in other countries. 7
24. Securing improvement, therefore, depends on involving parents, carers, young people and partners and not on action by health care services alone. It is also important to address the influences that determine sexual wellbeing, such as raising educational aspirations and self-esteem, enhanced social inclusion, tackling alcohol and drug misuse, domestic violence and homelessness.
25. An integrated approach, which links sexual health policy to other related policy areas at both national and local levels, and recognises the wider implications on sexual health, is therefore necessary. In particular, it is important that the principles of equality and respect and accessibility to clinical services and lifelong learning apply to sexual health just as they do to all other aspects of health improvement and care, whatever our race, ethnicity, disability, gender or sexual orientation, age or religion.
THE ROLE OF SCHOOLS
26. Schools have a crucial part to play in fostering healthy attitudes towards relationships, sex and sexuality in young people. All schools are expected to provide sex and relationships education. High-quality sex and relationships education should be delivered in an objective, balanced and sensitive manner by professionals who are trained for this role and who are able to support and complement the role of parents and carers as educators of children and young people. Sex and relationships education should also be delivered in a way which is consistent with the principles and aims of national guidance on the conduct of sex education issued by the Executive in 2001, 8 for instance in encouraging appreciation of the value of stable family life and including the value placed on marriage by religious groups and others in Scottish society and should link to other relevant areas of the curriculum such as Personal and Social Education and Religious and Moral Education. Sex and relationships education should be co-ordinated through local school co-ordinators and designated officers within local authorities to ensure this quality and consistency.
27. It is recognised that sexual relationships are best delayed until a person is sufficiently mature to participate in a mutually respectful relationship. Sex and relationships education programmes should take the form of comprehensive or 'abstinence-plus' education, which aims to delay sexual activity. As at present, sex and relationships education, combined with communication skills development, as well as information on sexual health services and contraception, will add further to this outcome. The most successful sex and relationships education programmes will also include the following characteristics:
they are multi-disciplinary and take advantage of the skills that can be provided by the range of statutory and voluntary providers in the local community;
they are flexible in terms of timing and content and use a range of formats appropriate to young people;
they feature support for teachers in their role as educators through training and links with the wider network of sexual health professionals in the local community;
they are integrated with relevant health care services; and
they emphasise within the current legal framework delaying sexual activity until a young person is mature enough to participate in a mutually respectful relationship as well as communication skills and knowledge of sexual health services.
28. A number of schools have made progress in developing sex and relationships education policies in line with national guidance and reflecting the views of their school community. Denominational schools have developed relationships and moral education programmes which are currently being implemented. Progress is also being made through Healthy Respect partners in developing an educational curriculum framework.
29. Materials used in sex and relationships education programmes should always be staged and age-appropriate. The 5-14 National Guidelines on Health Education developed by Learning and Teaching Scotland are still operative, and provide valuable guidance in this area. Work in nurseries and the early years of primary school will, of course, continue to focus on relationships and how we care for one another, and will not involve sex education.
30. Supporting teachers is key to the successful delivery of sex and relationships education, and the Executive is committed to ensuring that teachers receive appropriate training and continuing professional development, as well as knowledge about service delivery. Teachers will also benefit from being part of an integrated team delivering school-based sex and relationships education which receives clear policy direction regarding roles and responsibilities and whose work complements that of parents and carers, who will also be informed and supported as educators in sex and relationships.
31. At the present time, some vulnerable children and young people may not have access to comprehensive school-based sex and relationships education. The Executive views supporting the ongoing implementation of the McCabe Report, as key to remedying this. Innovative work and pilot projects on addressing the education needs of young people have been developed within and outside the school setting, in concert with Health Boards and local authorities. The Executive will build on such work to ensure that all pupils, including vulnerable and excluded young people, receive high-quality sex and relationships education.
32. It is vital that sex and relationships education is supported by accessible health services for young people. While there is no single model for the development of links between services and schools, effective practice will involve collaboration and joint action between NHS Boards and local education authorities in close consultation with the school community, in line with national guidance, with the aim of ensuring that pupils across Scotland have equitable information about sexual health services and how to access them. It remains our policy that, as at present, whilst advice on access to contraception is available, emergency hormonal contraception (colloquially known as the Morning After Pill but which can be prescribed up to 72 hours after the risk event) should not be made available in schools.
The Executive will facilitate the delivery of high-quality approaches to sex and relationships education consistent with national guidance, including multi-agency training, through partnership working and involving education authorities, partner agencies, parents and other key partners.
The Executive will work in partnership with Directors of Education, Social Work and key stakeholders on how best to deliver sex and relationships education in schools, other settings and to vulnerable and disaffected young people, as well as implementing the recommendation of the McCabe report around continuing professional development.
NHS Boards, in conjunction with key partners, should ensure that resources for sexual health promotion are provided so that good quality and well resourced specialist services are able to support local initiatives.
Local Authorities and NHS Boards, in consultation with Community Planning partners, should work to ensure their Community Plans, local health plans and Children's Services Plans complement their local inter-agency sexual health strategies.
NHS Health Scotland, in conjunction with other stakeholders, should develop information in a variety of formats targeted at parents and carers and youth and community groups.
NHS Boards, in conjunction with other statutory and voluntary sector interests, should provide programmes for parents and carers to enhance communication skills around relationships and sexual health.
NHS Boards, in conjunction with Community Planning Partners, should work with further and higher education, community education and youth work services and the wider voluntary sector to develop effective sexual health promotion and outreach services for adults.
NHS Health Scotland, in conjunction with other stakeholders, should consider actions to support positive sexual health in the workplace and affirmative action to address issues in relation to sexual orientation and HIV status.
Work to define and address the sexual health needs of older people will be undertaken by NHS Health Scotland in conjunction with other stakeholders and link with older people's strategies developed by NHS Boards.
The Sexual Health and Wellbeing Learning Network, in conjunction with the relevant stakeholders, will facilitate awareness of the sexual health needs of people with learning disabilities, and make recommendations for research-based programmes and materials.
Local authorities will ensure that all schools are able to demonstrate that they provide pupils with equitable information about sexual health services and how to access them.