casenotes

A series of reports on issues facing children today

ChildLine

Alcohol and teenage sexual activity

Young people talking to ChildLine about the role of alcohol and drugs in teen pregnancy
Key points Just under 140,000 children and young people called ChildLine in 2004/05. Of that number, 5,843 (5,459 girls and 384 boys) spoke about pregnancy. ChildLine records are not able to show what percentage of calls were about actual pregnancies, as opposed to pregnancy scares or requests for general information. Not all callers tell ChildLine their age, but of the 4,954 young people who called to talk about pregnancy and told ChildLine how old they were, more than three in four were 15 or under. Whereas alcohol use was frequently cited as a factor associated with unprotected sex leading to pregnancy, young people who spoke about drugs rarely blamed them for the pregnancy; instead, they spoke of their anxieties about their ongoing drug use during pregnancy and the potential health risks for the baby. More than 15% of all the calls that ChildLine receives about peer pressure are related to sex. Some girls spoke of peer pressure sometimes from other girls to begin having sex as young as age 12, and said that they used alcohol to help them get over their own reluctance to become sexually active. Young people in the UK live in a world where alcohol, drugs and sex are commonplace but many of those young people are not being given the information they need to navigate that world safely, say ChildLine counsellors.

Context: sex, alcohol and education

Teen pregnancy The UK has the highest teenage pregnancy rate in Europe,i but this does not have to be the case. Young people in the UK are little different from those throughout Europe. They do not begin having sex especially young by European standards,ii nor do they drink more than teenagers in all European countries.iii Like all teenagers they are faced with a sometimes confusing array of options and pressures. However, they appear to suffer from a woeful lack of useful guidance on how to make sensible decisions regarding sex, alcohol and drugs.

C h i l d L i n e casenotes Alcohol and teenage sexual activity

Contraception use is strikingly low amongst UK teenagers.iv This is reflected in calls to ChildLine, where young people speak of lives in which sex is often more readily available to them than reliable, easily understood information about how to practice it safely. Calls to ChildLine also reflect the increased likelihood of non-use of contraception when sex happens in the early teenage years, and the increased likelihood for these young people that alcohol will be involved and that the girl will regret the experience. Sexual pressure These calls to ChildLine reveal a profoundly worrying level of pressure on young people to be sexually active, often at a very young age and before they are ready for such a relationship. However, they also reveal an unfortunate lack of effort on the part of the adults who should be educating young people about sex, relationships, alcohol, and other pressures that teenagers face. It seems that these callers to ChildLine are living in a highly sexualised culture, yet are not being equipped to deal with its pressures. Sometimes they use alcohol to cope, and sometimes they are more vulnerable because of alcohol. Their lives are complex, and they need knowledge, advice and support to enable them to avoid becoming engaged in sexual activity they later regret. Helplines such as ChildLine and the online advice centres, such as the NSPCCs there4me.com, can play a key role in this education and support, and should be made easily available to each and every child and young person who needs them. However, it is clear from calls to ChildLine that, when discussing sex, young people should be getting far more education and advice from other sources than they currently are.

Ive got a few girls pregnant. I feel ashamed for not using protection I carry it, but Im too lazy to use it. Boy, 17

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C h i l d L i n e casenotes Alcohol and teenage sexual activity

Evidence
What young people tell ChildLine Children calling ChildLine to talk about pregnancy Age 12 and under 13 14 15 16 1718 Age not given Total Girls 439 848 1,128 1,157 699 338 850 5,459 Boys 19 29 70 111 60 56 39 384 Total 458 877 1,198 1,268 759 394 889 5,843 I got so drunk last night I dont remember what I did. I know I got sick, and I think I had sex Im not really sure, though. Girl, 14 I got drunk at a party. I dont remember having sex, but my friends say I did. Now Im pregnant. Girl, 13 I got drunk and had sex with a 17-year-old at a party. Ive just taken the pregnancy test and its positive. The boy has said it isnt his. I want to do my A-levels, but Ive ruined my life. Im so ashamed. Girl, 16 Im pregnant and I need your advice. I had sex when I was drunk. I dont know the father. I feel like a slag. Girl, 12

Why young people call The majority of young people who call ChildLine about sex do so because they are concerned about what they have done. Some young people do, however, call to get information in advance for instance, to discuss whether sex is legal at their age and what sort of protection they should use to avoid pregnancy and sexually transmitted infections (STIs). One 13-year-old, for example, called and said, I want to have sex with my boyfriend tonight. Will we get into trouble? She then asked how to use a condom and what it would protect her from. Alcohol as a contributing factor in teen pregnancy Many of the young people who call ChildLine to talk about unprotected sex say that alcohol played a part in their decision-making. Internationally, there is evidence that drinking leads to reduced use of contraception. Norwegian research indicates that young people are less likely to use contraception when moderately intoxicated and far less likely to use it when strongly intoxicated.v In the UK, there is evidence that young people are drinking more: while the proportion of 1115 year olds who do not drink has remained at 40% since 1988, the amount of alcohol consumed by 1115 year olds who do drink doubled between 1990 and 2000, to the equivalent of an average of five pints of beer per week.vi These findings are borne out by what young people tell ChildLine about their own sexual behaviour when drinking.

Contraception Research shows that contraception use is particularly low among young people whose main source of information about sex is their peer group.vii Many young people who call ChildLine speak of living lives where alcohol, drugs and sex are available but where relevant, easily understood education about these things, whether from family members or school, is not. I got drunk and slept with someone we didnt use a condom. I want to go to a clinic but Im too scared. Theyll want to know what happened and Im too ashamed to tell them. Girl, 13 Im four weeks late. I cant be bothered with condoms theyre a hassle and I dont want to go on the pill cos itll make me fat and Ill probably forget to take it anyway. Girl, 14 When my boyfriend and I are drunk, sometimes we dont bother with condoms.

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C h i l d L i n e casenotes Alcohol and teenage sexual activity

I told him I think Im pregnant, and he said it would be alright. Of course it will for him hes not the one whos going to have to deal with it. Girl, 15 Drug use Analysis of ChildLines caller records for 2004/05 indicates that many of the young people who called ChildLine about unprotected sex and pregnancy cited alcohol as playing a central role in their behaviour. But whereas alcohol was frequently cited as a causal factor in unprotected sex, those who spoke to ChildLine about drugs and pregnancy rarely cited drug use as a reason for unprotected sex. Instead, they spoke worryingly of their ongoing drug use (including solvent use) during the pregnancy in terms of how it might affect the health of their baby. Ive been smoking cannabis since I was 13, but I want to give up cos Im four months pregnant. Girl, 16 Im 14 weeks pregnant. I want to quit smoking hash, but its hard. Girl, 15 My boyfriends 30. When I told him Im pregnant, he called me a slapper and walked out. I havent seen him since. Since he left Ive been self-harming and doing lots of drugs. Girl, 17 Sexually Transmitted Infections (STIs) The vast majority of young people who speak to ChildLine about unprotected sex do not mention fears of infection, focusing instead on their fears of pregnancy. Some of these callers indicate that alcohol played a central role in their lack of contraception. When talking about sex, ChildLine counsellors will explain how young people can protect themselves from STIs. I need to know where to get tested for STIs. Last week I had sex with a boy at a party. I was very drunk I cant remember if he forced me or not. Girl, 14 Boys calling ChildLine about pregnancy Across the full range of problems that ChildLine hears about, girls are three times more likely to call than boys. With regard to pregnancy, boys accounted for less than one in 16 calls in

2004/05 (5,459 calls from girls, 384 from boys). In some cases they expressed fear for what was to come; in others, they expressed regret for what they had done. Last month I got off with a girl who said she was 16. I was so drunk I cant really remember what happened. But last week she told me shes pregnant and that shes only 12. I dont know what to do I want to talk to her about it, but shes blanking me. Boy, 15 Ive got a few girls pregnant. I feel ashamed for not using protection I carry it, but Im too lazy to use it. Boy, 17 Peer pressure More than 15% of the calls to ChildLine about peer pressure concern sex (288 calls about peer pressure, with 46 being about sexual peer pressure). Some young people tell ChildLine that their peers pressurise them to have sex before they are ready, and that they use alcohol to help them get over their reluctance. One notable feature of these calls is the young age at which this pressure sometimes begins: a few callers report being mocked for their virginity while still as young as 12. Another feature of these calls is that, while many girls say that boys are pressurising them to have sex, some others report that their female friends are the source of the pressure. My boyfriend has been trying to make me smoke cannabis and do stuff to him. Girl, 14 My friends have been pressurising me to have sex, so last month my boyfriend and I got really drunk and did it. I dont remember anything, but my friends say we had sex. We didnt use protection and now Im pregnant. Girl, 15 I lost my virginity last night I dont feel good about it. He was 19 and I was drunk. I thought it would be good not to be a virgin any more my friends have been taking the mick because I was. But now I feel dirty and embarrassed. Girl, 13 ChildLine counsellors views Young people in the UK live in a world where

I got drunk at a party. I dont remember having sex, but my friends say I did. Now Im pregnant. Girl, 13

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C h i l d L i n e casenotes Alcohol and teenage sexual activity

alcohol, drugs and sex are commonplace but many young people are not being given the information they need to navigate that world safely, say ChildLine counsellors. Young people and contraception Many young people who call ChildLine exhibit a tremendous lack of knowledge about contraception, say counsellors, and are too uninformed or embarrassed to make contraception a regular part of their sex lives. Most teenagers cant afford to buy condoms in the chemist, one counsellor says, and they dont know where to get them free, or are too embarrassed to ask their local doctor. Callers tell me that in their biology lessons, they might be shown how to put a condom on a cucumber, but they arent told how to go out and get condoms and then actually use them in real life situations. Its almost like a paragraph has been left out of the bottom of the lesson plan the paragraph explaining how to use contraception in the real world. Most of the young people I speak to are clearly too embarrassed to talk to their partners about contraception. Theyre more embarrassed about that than about sex itself. Cost, embarrassment, confidentiality, and lack of knowledge are recurrent issues. With emergency contraception, girls think that since you have to pay for it at the pharmacy, you have to pay for it everywhere. And when you tell them that its free if they go to their GP, they say, Oh no, I couldnt do that Id be too embarrassed. Information about sex and pregnancy ChildLine counsellors report that many teenagers appear to learn little in school sex education classes, and do not feel that they can speak to their parents about safe sex. Young people say that in class, there is lots of giggling and anxiety and if you do have a question, it would be too embarrassing to ask.

Many young people say that they couldnt possibly speak to their parents about sex: its a no-go area. Wouldnt it help if adults recognised that young people cant just sit through one lesson on sex and relationships education (SRE) and then be ready for the world? They have questions they need to ask in their own time, and in direct relation to whats going on in their lives. Wouldnt it help if all young people knew that they could get their questions answered easily and confidentially by calling ChildLine or some other service? The impression I get from my callers is that sex education is happening too little, too late. Young teens are entering into a sexual world, but they arent being given the knowledge to deal with it. Peer pressure Counsellors report that calls about sexual pressure are common, with many girls reporting being pressurised by their boyfriends, and some reporting that this pressure included physical threats or actual violence. For some girls, alcohol is used as a way of coping with an experience that they do not feel ready for, but which they do not believe they can avoid. Lots of girls ring up to say, My boyfriend wants sex and Im not ready. Or girls will call to talk about their boyfriends resistance to using condoms and their concerns about how to deal with that. One girl told me that she was being pressurised into having sex, and said that she hoped that alcohol would help her through the process.

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C h i l d L i n e casenotes Alcohol and teenage sexual activity

Recommendations
1. Improved Personal, Social and Health Education a. England Personal, Social and Health Education (PSHE), which includes education about issues such as alcohol use, and sex and relationships education (SRE), should be made a foundation subject at Key Stages 1, 2, 3 and 4. Evidence from organisations concerned with the safety of children shows us that PSHE is crucial in safeguarding children. It helps them to learn about personal safety and improve their understanding of pro-social and respectful relationships, including parenting and family relationships, as well as abusive behaviours. It also helps them develop the skills to ask for help. This can contribute to a reduction in childhood abuse and neglect.viii Similarly evidence shows that PSHE is an important intervention for preventing bullying.ix The current laws regarding PSHE, which includes sex and relationships education (SRE), are confusing. Schools are only required in statute to teach the biological aspects of sex, contraception and sexually transmitted infections, and these are often covered in science lessons. Learning about sexuality, relationships, choice, delay, safer sex, risks and pregnancy are recommended to be taught in PSHE and are outlined in government guidance,x but are not a statutory requirement. Alcohol education is also an important aspect of good PSHE provision, though it is covered to an extent under the drugs element of the National Curriculum science order. In both contexts, teaching about alcohol should include the links between drinking and sexual behaviour. Ofsted has reported that PSHE provision is very patchy. Currently PSHE provision is decided by the headteacher with the governing body using the plethora of guidance that is produced by the DfES, QCA and voluntary organisations. Some elements of PSHE, including contraception, HIV infection and drugs, have a statutory basis and teaching is required as part of the National Curriculum science order. However, the science curriculum covers only a fraction of the issues that children, young people and research tell us are important. It tends to focus more on information provision, rather than on the development of skills and an understanding of emotions, relationships and consent issues, and how to deal with them. If young people do not have good PSHE teaching, including SRE, they may: become sexually active before they are ready and before they can enjoy or take responsibility for themselves or their partners find themselves unprepared for and have unrealistic expectations of sexual relationships, often lacking the skills to communicate and negotiate with partners on topics such as contraceptive use become involved in inappropriate or coercive relationships and sexual activity express regret and emotional distress be unaware of the services and help available to them have to deal with unintended pregnancy, abortion or parenthood not know they are at risk of STIs or how to avoid them, which can lead to potential further complications such as infertility.xi b. Northern Ireland The curriculum in Northern Ireland is currently under review and PSHE is being developed: the Key Stage 3 programme is being rolled out in September 2007, with Key Stage 4 following at a later date. We strongly recommend that this should result in schools delivering a realistic PSHE curriculum, which will help children and young people deal in a more informed and confident` manner with the wide range of issues and choices that they are faced with when growing up in Northern Ireland today. We are pleased that schools will be encouraged to broaden out the topics covered, to address wider issues such as teenage pregnancy and sexual activity.

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C h i l d L i n e casenotes Alcohol and teenage sexual activity

In addition, every child and young person in Northern Ireland should have access to independent schools counselling services. c. Scotland We urge a review of the progress and implementation of recommendations on the role of schools within Respect and Responsibility, the National Strategy and Action Plan for Improving Sexual Health in Scotland, particularly in relation to: equitable provision of information about sexual health services in all Scottish schools; partnership work on developing best practice in the delivery of Sexual Health and Relationships Education; and multi-agency training for those involved. Young people should be involved in the design and delivery of sex and relationships education for example, through peer education approaches. d. Wales Estyns report on the implementation of the guidance in Circular 11/02xii in schools in Wales 2004-05 contained a number of recommendations for improving the delivery of sex and relationships education in schools. We call on the Welsh Assembly Government to review how these recommendations are being progressed, particularly those relating to specialist support and training for teachers delivering sex and relationships education, as part of the review of the Personal and Social Education (PSE) Framework. We also urge the Welsh Assembly Government in their review of the PSE Framework in Wales to ensure that children and young peoples experiences are sought, considered and reflected in the new Framework. 2. Support services in schools It is also vital to set up an advisory and support service in schools to which young people under 16 who might be engaging in sexual relationships can turn. Once a young person is given impartial information during PSHE/SRE teaching on the risks and pitfalls of engaging in a sexual relationship, in a non-judgemental group setting, with proper ground rules and codes of conduct, there must be an

opportunity for a young person to talk to an independent adult about any issues of concern to them. Without this complementary service in addition to teaching/curriculum materials, it will be difficult for some children to make a fully informed decision about whether to have a sexual relationship, whether to use contraception, what the health issues are, and whether their relationship is fully consensual. Such a service could be developed through training of teaching or non-teaching staff, or putting in place an independent counselling service and advisory support service. Peer support and advice services are also important, to enable older children to support and advise younger children about these issues. If there is any doubt in the young persons mind that the sexual relationship is not fully

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C h i l d L i n e casenotes Alcohol and teenage sexual activity

consensual, the young person must be given the understanding that they have a right to say no and that this would be upheld in law if necessary. They also need to know that they are entitled to advice and support in this regard. It is vital that children are made aware of the ready availability of barrier methods of contraception, the health implications of having a sexual relationship and the consequences of pregnancy, such as the high chances of single parenthood, reduced educational opportunities and the increased likelihood of social exclusion and poverty. Teachers should inform children that if they are having a sexual relationship and they have concerns about this relationship, any discussions with teachers or staff in the school will be treated in confidence unless there are child protection concerns.

3. More funding for listening services Children and young people need to be able to talk confidentially about sex, alcohol, and any other issues that affect their lives. This is particularly important for children and young people who are socially excluded, hard to reach, or in need of protection. For many young people, being able to speak anonymously to ChildLine about sex enables them to get vital information that they are not getting in school or from their parents. This enables them to make wiser decisions. It is vital that listening and advice services, such as ChildLine and there4me.com, be adequately funded so that children and young people have somewhere to turn when they cannot find help and are seriously worried about sex and relationship issues.

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C h i l d L i n e casenotes Alcohol and teenage sexual activity

References
i

Wellings K, et al. (2005). Teenage Pregnancy Strategy Evaluation Final Report. London: Teenage Pregnancy Unit. Social Exclusion Unit (1999). Teenage Pregnancy. London: The Stationery Office.

vii

Wellings and Nanchahal (2001), op cit. Harries J, (forthcoming) Promoting Personal Safety through PSHE. London: Paul Chapman Publishing. Office of the Childrens Commissioner (2005). Journeys: children and young people talk about bullying. London: Office of the Childrens Commissioner. Department for Education and Employment (2002). Sex and relationship education guidance. London: DfEE. Sex Education Forum (2006). Beyond Biology, which calls for PSHE, including sex and relationships education, to be made statutory. Online: www.ncb.org.uk/sef National Assembly for Wales Circular No: 11/02. Sex and Relationships Education in Schools.

viii

ii

ix ii

Alcohol Concern (2005). Young peoples drinking fact sheet: summary. London: Alcohol Concern. Wellings K, Nanchahal K, et al. (2001). Sexual behaviour in Britain: early heterosexual experience, The Lancet. 358: 184350. Traeen B, Kvalem I (1996). Sex under the influence of alcohol among Norwegian adolescents, Addiction 91: 9951006. In Alcohol Concern (2002), op cit. Alcohol Concern (2002). Alcohol & teenage pregnancy. London: Alcohol Concern.
x

iv

xi

vi

xii

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About the information in this report

Children and young people often talk to ChildLine because they know they will receive a confidential service and what they say will not go any further unless they wish. ChildLine will always make an informed judgement as to whether the child can give realistic consent to act on his/her behalf. On rare occasions this contract of confidentiality can be broken if the child is assessed to be in a dangerous or lifethreatening situation. The majority of children do not identify their whereabouts and maintain their own anonymity. The counsellor will listen and take the child or young person seriously when they call. ChildLine will help the child to talk through their concerns and what might make a difference, exploring whether there are supportive adults in their lives. Sometimes the child will practice what they would say to increase their confidence in speaking to such an adult. The counsellor will also give the child information on how other agencies can help. If the child wants ChildLine to make contact on their behalf or this is assessed as necessary, ChildLine will mediate, advocate or refer the child to a relevant agency or person, such as social services, the police, the ambulance service, or a parent or teacher. ChildLines data is not comprehensive, as the main priority for helpline counsellors is to provide comfort, advice and protection to the caller, not to gather demographic or other information for research purposes. The content of ChildLine counselling conversations is captured through written records. Every time a counsellor speaks to a young person, the counsellor notes the main reason the child called, any other concerns raised, and details of family and living circumstances revealed by the child, and a narrative of the discussion. Conversations are child-led, and not conducted for the purposes of research; but it is for precisely these reasons that they often reveal information that formal research might not uncover. ChildLine provides a confidential telephone counselling service for any child with any problem, 24 hours a day, every day. In February 2006, ChildLine joined the NSPCC as a dedicated service, in order to help, support and protect even more children. ChildLine will continue to use its own name, and the 0800 1111 phone number will remain unchanged. Volunteer counsellors will continue to provide a free 24-hour service for any child or young person with a problem. For more information, please contact the ChildLine Media Team on 020 7825 2500, email media@childline.org.uk or visit www.childline.org.uk/casenotes.asp

Photographs posed by models. Photography by Larry Bray Photography. Names and identifying details have been changed to protect confidentiality. NSPCC 2006

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ChildLine and the NSPCC joining together for children