Social workers now have to add sex education to their workloads as the government moves to tackle the UK's high rates of teenage pregnancy. Audrey Thompson asks whether this will be a task too far

Providing sex education to Britain's teenagers may remind some people of a Monty Python sketch from the film The Meaning of Life.

John Cleese, a black-gowned, public school teacher, gives instruction to his class of teenage boys. He first gives them a quick-fire test on the many ways to "stimulate" the female, before he flicks a switch that folds the blackboard down into a four-poster bed. His wife then enters the room and they both undress in front of the class.

A naked Cleese then climbs on top of his wife to demonstrate the practical art of love-making to a class by now thoroughly unimpressed and quite bored.

Having sex doesn't seem to be much of a problem for many of Britain's teenagers - quite the opposite, which is half the trouble. But what is a problem is their lack of information, and the high degree of misinformation, that prevents them protecting themselves from unwanted pregnancies and sexually transmitted diseases.

Each year more than 90,000 teenage girls become pregnant in England alone. In 1997, says the Family Policy Studies Centre, it was 95,500. Of those, 8,300 were girls under the age of 16. As a consequence, says the Social Exclusion Unit, teenage mothers are "less likely to finish their education, less likely to find a decent job, and more likely to end up both as single parents and bringing up their children in poverty".1

Rita Stringfellow, chair of the Local Government Association's social affairs and health committee, says the government should make sex education part of the national curriculum and not allow parents who object to withdraw their children. Many of these teenagers are highly likely to be in and out of local authority care or receiving extensive social services intervention. National Children's Bureau research showed that a quarter of care leavers had a child by the age of 16.2 It's obvious, therefore, that social workers and social care staff also have a very significant part to play in addressing the issue.

The government now expects, as part of its national action plan, that initial and post-qualifying social work training courses adequately cover pregnancy prevention and support for teenage parents. It's also demanding, through Quality Protects, that social services find demonstrable ways to help reduce the high numbers of teenage pregnancies. Indeed, adequate plans will be a condition of local authorities receiving the Children Social Services Grant from 2000. This is a significant change from previous years as social workers, particularly residential staff, have been made to feel extremely nervous about giving any information or advice to young people about sex.

Helen Lewis, a project manager with the NCB who wrote the report Improving the Health Care and Health Education of Looked-After Children, says: "Some social workers feel anxious that the line between giving information and giving advice is a very hard line to draw. There's no such thing, after all, as neutral information."

Social workers are especially afraid of disciplinary action, she adds, particularly around Section 28 of the Local Government Act 1986 which prohibits the promotion of homosexuality as an alternative lifestyle. So how exactly would a social worker give advice to young people confused about their sexuality?

Local authorities are now required to provide social workers, social care staff, and youth workers with in-service training that properly equips them for the sensitive task of dealing with young people's sexual health. The National Children's Bureau together with the FPA, an organisation promoting good sexual health, are developing such training, currently being piloted with social workers in the London Borough of Kensington & Chelsea.

FPA training manager Suzy Mackie says: "Social workers will have to engage children in discussions about sexual health. Once the sole preserve of the family, teachers, health services and counsellors, it is now clear that to have any effect on teenage pregnancy rates local authorities will have to do a lot of the work around prevention.

"Young people in care are no different from any other young person wanting information about sex," she adds. "But they might not have the family who can give it to them, and might not be in school so miss out on sex education. They might not have a stable peer group as they keep being moved on. Most of all, they might have been sexually abused which is a whole other issue to deal with."

The more social workers get involved in sex education, the more they will need the backing of social services policy and a practice framework to carry out such a role.

The Department of Health and the Department for Employment and Education are producing joint guidance for social workers and youth workers that "makes it clear that they can, and should, direct young people to seek advice and contraception if it appears that they are contemplating sexual activity or are sexually active". But it is also very important, says Mackie, that local authorities produce their own specific policy and practice framework to support staff carrying out this often controversial role.

The Sex Education Forum, which produced a booklet on sex education policy,3 states that an effective policy should ensure that "staff and foster carers are supported and aware of their role: that they know what they are able to do and how to do it".

The rate of teenage pregnancies in Britain is the highest in western Europe - the result of a combination of low expectations on the part of young people, ignorance and mixed messages. At the end of the twentieth century, says the SEU, Britain cannot afford such high rates of teenage conception and parenthood.

Recently, in a case in Scotland, a 12-year-old girl with learning difficulties in foster care became pregnant after receiving, according to her parents, contraception rather than what they had asked for: good sex education information. Obviously the aim of including social workers in tackling young people's sexual health is to ensure that as many vulnerable young people as possible get the information they want and need in a way that is appropriate to their age and understanding.

The government's ambitious goal is to halve the number of teenage pregnancies within ten years. To that end it's very wise to take advantage of the role of social workers and the valuable contributions they can make.

1 Social Exclusion Unit, Teenage Pregnancy, The Stationery Office, June 1999

2 N Biehal et al, Prepared for Living? A Survey of Young People Leaving the Care of Local Authorities, National Children's Bureau, 1992

3 H Patel-Kanwal and G Lenderyou, Let's Talk About Sex and Relationships: A Policy and Practice Framework for Working with Children and Young People in Public Care, Sex Education Forum/National Children's Bureau, 1998

Under-age sex in the UK

• Teenage pregnancy is a problem which affects every part of the country. Even the most affluent areas in England have teenage birth rates which are high by European standards.
• It's far worse in the poorest areas and among the most vulnerable young people, including those in care and those who have been excluded from school.
• Although under a third of young people are sexually active by 16, half of those who are use no contraception the first time. With hindsight most young women wish they had waited and, for a significant number, sex is forced or unwanted.
• Teenagers who do not use contraception have a 90 per cent chance of conceiving in one year and those who do not use condoms are also exposed to a range of sexually transmitted infections.
• In a single act of unprotected sex with an infected partner, teenage women have a one per cent chance of acquiring HIV, a 30 per cent risk of getting genital herpes and a 50 per cent chance of contracting gonorrhoea.
• Of those who do get pregnant, half of under 16s and more than a third of 16 and 17-year-olds opt for abortion. That means just over 15,000 under 18-year-olds a year are having an abortion.
• Ninety per cent of teenage mothers have their babies outside marriage, and relationships started in the teenage years have at least a 50 per cent chance of breaking down.

• Teenage parents are more likely than their peers to live in poverty and unemployment and be trapped in it through lack of education, child care and encouragement.
• The death rate for the babies of teenage mothers is 60 per cent higher than for babies of older mothers and they are more likely to have low birth weights, have childhood accidents and be admitted to hospital. Their daughters have a higher chance of becoming teenage mothers themselves.

Source: Social Exclusion Unit, Teenage Pregnancy, The Stationery Office, 1999