§ 8.8 p.m.
§ Lord Winstanley rose to ask Her Majesty's Government what steps they are taking to improve counselling and other services for young people in order to combat the increase in the number of abortions performed on teenagers, particularly the increasing number performed late in pregnancy.
§ The noble Lord said: My Lords, I beg leave to ask the Unstarred Question standing on the Order Paper in my name. The Question itself, I think, is largely self- 474 explanatory, but before elaborating upon it perhaps I may take the liberty of reminding the noble Baroness of some facts of which I am quite sure she is aware, but they are the facts which have prompted me to table this Question.
§ In 1984 there were 4,158 abortions performed on girls under 16 years of age. In the same year, 1984, there were 33,414 abortions performed on girls of ages between 16 and 19—more than 37,500 abortions on teenagers during 1984. The second of those figures—the 33,500 abortions on girls between 16 and 19—points to one of the effects of the activities of Mrs. Gillick, which, by focusing attention so very narrowly on the under-16s, I think has rather resulted in the needs of the over-16s being overlooked and perhaps neglected.
§ On the basis of figures supplied by the noble Baroness's department, I can say that 1 in 10 of all girls having their 15th birthdays this year will have an abortion before their 20th birthday. I regard that as a depressing and alarming prospect. I was the second sponsor of the Abortion Act 1967 which was piloted through another place by my right honourable friend Mr. Steel, and, as a doctor, I was responsible for the replies at Committee stage and on the Floor of the House at Report stage on the medical aspects of the Bill.
§ At that time I rather took exception to being described by some people as pro-abortion. I am not pro-abortion. I think no one in his right mind would be pro-abortion, but I believe there are circumstances in which abortion is perhaps the least undesirable course to be adopted. However, I am bound to say that it would be tragic if we arrived at the situation in which abortion came to be regarded as an acceptable alternative to family planning and birth control. I fear that the figures I have given to the House just now suggest we are coming towards that stage.
§ Let me now move to the figures of late abortions which are referred to in my Question. Forty per cent. of abortions performed after 12 weeks—and that is late, if I may say so: too late—are performed on teenage girls under 20. Of abortions performed after 20 weeks, which is far too late—indeed, dangerously and tragically late-50 per cent. are performed on teenage girls. Those figures come from a study by the Royal College of Obstetricians and Gynaecologists entitled Late Abortions in England and Wales, published in 1984.
In the same report, the Royal College of Obstetricians and Gynaecologists go on to point to a need for more education. They go on to say this:
Except in the case of married women aged 20 or over, there is often hesitation or reluctance to seek help or advice from their general practitioners. Many more youth advisory centres, available for information, health and counselling and whose situation, role and telephone number are well advertised, should be established to help to fulfil these functions.
I turn to a more recent report, that by Isobel Allen entitled Counselling Services for Sterilisation, Vasectomy and Termination of Pregnancy, which was commissioned and funded by the Department of Health. It states, perhaps even more alarmingly:
There was some evidence that young people did not always find themselves made welcome by general practitioners and family planning clinics when seeking contraceptive advice.
In that case it is not perhaps altogether surprising that they did not always seek that advice.
On the report of the Royal College of Obstetricians and Gynaecologists, the then Minister of Health, Mr. Kenneth Clarke, said this:
The recommendations of the Royal College of Obstetricians and Gynaecologists point to a need for more education, especially for younger women, to make them appreciate the urgency of early consultation and decision-making when pregnancy occurs. We shall be consulting our colleagues in the Department of Education and Science about the prospects for more health education and counselling facilities for young people in this sensitive area.
Did those consultations take place? Perhaps in due course the noble Baroness will be able to say whether they took place and, if they did, what steps resulted from them.
Certainly there is little doubt about the present inadequacy of counselling services. Here I quote again from a study entitled District Health Authority Family Planning in England and Wales, prepared by Audrey Leathard and published by the Family Planning Association in 1985. It states:
Still only 50 per cent. of health authorities have designated youth advisory sessions and many of those are threatened with closure.
Why should they be threatened with closure? Is it the cost about which the department is worried? If so, then the department is sadly misled. There is no question that few things are more cost-effective than proper counselling and family planning advice for young people. The clear message from a study by W. A. Laing, published by the Policy Studies Institute, entitled Family Planning—The Benefits and Costs, is that benefits to health and social services from free family planning services substantially exceed costs.
§ It was the conclusion of a major international study carried out by the Guttmacher Institute of New York in 1985 that it is those countries with the most prevalent sex education, the most easily accessible birth control services and the most open discussion of sexual matters which have the least teenage abortion and unwanted teenage fertility. So surely cost should not be a matter that should put off the department. If we take the inadequacy of the services provided—and we have said that 50 per cent. of area health authorities are not providing those kinds of counselling services—then the burden is left more and more to voluntary bodies of one kind or another, which provide the safety net.
I should like to refer in particular to the Brook Advisory Centres. Even they in certain places such as the centre in Tottenham Court Road are threatened with closure because of doubts and anxieties about funding. Here I am reminded of the guidance published by the Department of Health, I think at the time when the noble Lord, Lord Ennals, was the Secretary of State in 1974. Paragraph G45 states:
Agency arrangements with Brook Advisory Centres should continue for the time being as NHS agencies open to all.
It now seems they may well be open to nobody unless they are adequately and properly funded.
§ I have the honour to be the president of another charity, Gingerbread, which acts rather for those who have not had the kinds of services we are referring to. It does invaluable work and the kind of service it provides is absolutely essential. For example, in Bradford it has a support service which is mounted and provided entirely by teenage single-parent 476 mothers at almost no cost to public funds but which is doing absolutely admirable work to support people, many of whom perhaps did not have effective support and advice at a much earlier stage.
§ Finally, I should like to say that I welcome the new guidelines which have been published by the department. Perhaps I may say that I welcome rather more heartily the British Medical Association Council's statement which rather underlines the principles of confidentiality while it clarifies the ambiguities which have arisen from the advice given by the General Medical Council. That is surely something which must be stressed if we are to encourage these young people to seek advice at the time they need that advice.
§ Certainly parental consent is an important matter but it seems to me that those who talk, as some do, about parental consent are inclined to assume the existence of parents to whom and with whom girls can relate. In my experience in general medical practice, there are many occasions when there is no parent to whom a girl may relate in the kind of way we would like to see. In the absence of that, it is essential that the confidentiality of the relationship between that child or that girl and the doctor should be preserved.
§ I will say no more. I look forward to hearing the speeches of other noble Lords, and in that connection perhaps I may say that I am very sorry that we are not after all to hear the noble Lord, Lord Molson, who was to speak. Your Lordships will recollect that the noble Lord himself steered the Abortion Act through your Lordships' House. He is unfortunately unwell, but he asked me to say that had he had the opportunity to speak he would have supported the case which I have put before your Lordships' House this evening.
§ I await particularly the replies to be given in due course by the noble Baroness. I should like to ask her once again about the discussions which were to take place between her department and the Department of Education and Science with regard to improving health education facilities and counselling for young people. Did those discussions take place, and what was the result? I should also like to ask the noble Baroness to tell me what steps have been taken to fulfil the high ambitions of the former Minister of Health, Mr. Kenneth Clarke, who stated quite clearly that he wanted to see better counselling services and better health education for young people. I should like to hear what steps are now being taken.
§ I should like also to hear from the noble Baroness what steps are being taken to supply the missing counselling services from the 50 per cent. of health authorities which I am told do not now possess them.
§ I should like to hear from the noble Baroness that her department recognises the burdens borne by the voluntary bodies, the Brook Advisory Centres and others, and that not only does it recognise those burdens but recognises their financial burdens and will do what it can to relieve them. I look forward to hearing the noble Baroness's reply and to hearing other noble Lords and noble Baronesses.
§ 8.20 p.m.
§ Baroness Faithfull
My Lords, this Unstarred Question, thoughtfully and courageously put before your Lordships' House by the noble Lord, Lord 477 Winstanley, provides us with an opportunity to debate a subject which touches every family in this country regardless of social status, creed and race. I presume to speak in the debate as one of the vice-presidents of the British Association of Counselling, and I draw on my experience as a social worker.
In a golden, ideal world, where personal relationships were deep and clear, many of us would wish that there would be no call for abortions or for contraception. This is not an ideal world. It is, nevertheless, a world with some ideals. I abhor abortion, but honesty compels me to say that on a few occasions in my working life I have counselled an abortion for girls under and over 16 years of age. Perhaps I might say that many years ago I was concerned in the case made famous by the late Alec Bourne.
On the social plane, in my experience an abortion for a girl with feelings can be a damaging experience. For an unfeeling girl, in some cases an abortion provides her with the thought that she might lead a promiscuous life without contraception and without giving birth to a child. I would not presume to speak on the medical aspects of abortions, but I believe that where possible and practicable the need for abortions should be avoided.
But if one cannot have ideals, one should at least be realistic. That is, perhaps, an ideal in itself. Contraception, carried out thoughtfully with social and medical advice and with counselling help, can prevent abortions and unwanted children. In the realm of abortion and contraception there needs to be a partnership between the medical profession and those trained to counsel. If a girl under or over 16 years of age is unwilling for her parents to be consulted, I believe that she should be offered counselling services. Such a service cannot be given by a general practitioner with over 2,000 patients on his register.
Why do some girls feel unble to talk to their parents? First, as the noble Lord, Lord Winstanley, said, there are sadly in this country thousands of girls whose personal relationships with their parents are minimal or non-existent. If the foundation of love and care through childhood has been erratic, unkind, cruel or absent altogether, the young girl or adolescent will not, indeed cannot, appeal to her mother, and, in some cases, she would not receive help if she did. Such girls seek for affection outside their home and that, more often than not, results in sexual relationships. I submit that such girls should be offered counselling.
Secondly, many of those girls have a stable and loving relationship with their parents. However, in adolescence, when young people are seeking to assert themselves and be independent but yet at the same time are emotionally insecure, they need a third person to consult. It may be a godmother, an aunt or a family friend. Some girls have no such fallback. It is no reflection on the love, adequacy and skill of a parent that an adolescent girl seeks a third person to whom she can talk. Where there is no relative or friend of the family, surely she should be offered the services of a counsellor.
May I recommend that there should be a dialogue as between the British Medical Association, the General Medical Council, the general practitioners' committees and the British Association of 478 Counselling, so that we can work towards a partnership as between doctors and counsellors? Ideally, there should be available a counsellor to each practice. At present, general practitioners can appoint ancillary staff and reclaim 70 per cent. of their salary from the Department of Health and Social Security. That does not apply to counsellors. I make a plea to Her Majesty's Government that they should count skilled, experienced and trained counsellors as ancillary staff.
Meanwhile, there is growing and developing interest in counselling. May I ask the Minister whether there is any hope of a grant to the British Association of Counselling? Application has already been made to the Department of Health and Social Security for renewal and extension of the grant. May I also ask the Minister whether her right honourable friend will convene further meetings—I understand from the noble Lord, Lord Winstanley, that some have taken place—to finalise discussions, so that a plan can be worked out as between her department, the British Medical Association, the General Medical Council, the general practitioners' committees and the British Association of Counselling so that each general practice can have attached to it a counsellor who is skilled, practised, trained and experienced? In that way, with a structure such as I have suggested, perhaps we can go some way towards helping the girls who at the moment are having abortions and who are in sore need of help and counselling.
§ 8.27 p.m.
§ Lord Rea
My Lords, when talking about a delicate topic such as teenage sexuality and its problems, we should not forget that most young women today become sexually mature much earlier than we realise—at some point between 12 and 15 years of age. The better nourished and more healthy children in fact are—and ours in this country are very healthy and well nourished—the more towards the lower end of that age span they tend to mature. The average age of puberty in girls now is 13, whereas two or three generations ago it was nearer 15.
Tonight we are concerned that 9,400 conceptions occured in girls under 16 in 1983, of which 5,300—nearly three-fifths—were terminated. That number of abortions is beginning to creep up, having been level for a few years. According to a British survey, one girl in five has had sexual experience by the age of 16. Those girls have a one in ten chance of becoming pregnant. Comparing that internationally, it appears to be about par for the course in developed countries. According to some research findings which I have before me—the report of the Allan Guttmacher Institute, which the noble Lord, Lord Winstanley, mentioned—the United States does considerably worse than we do. There, one in four of their 16 year-old girls are sexually experienced and each of them has a one in six chance of becoming pregnant. Sweden, on the other hand, does considerably better. There, one in three of their 16 year-old girls is sexually experienced—noble Lords are aware that Sweden is well known as the most sexually liberated society—but of those Swedish girls, only one in 20 becomes pregnant. If our rate was as good as the Swedish, there would be half as many pregnancies among girls under 16 in Britain today.
479 There is nothing a governmemt can do to stop sexual activity among young people. The trend to a freer attitude towards pre-marital and extra-marital sex is international and represents, perhaps an overdue, recognition of the biological facts of life. In traditional societies, marriage, which is often arranged, takes place fairly soon after puberty which, in any case, occurs later in communities with some degree of malnutrition and that applies to something like half the people in the world today.
Where marriage is delayed for 10 or more years after sexual maturity is reached, teenagers need help to cope with the problems caused by their sexuality. The Department of Health and Social Security's guidelines of 1974 were pragmatic and sensible, and the question we are asking tonight is: Why have these guidelines not been put into better effect? I have spoken about under 16 year-olds, because this seems to be the most urgent problem today but, as the noble Lord, Lord Winstanley, has pointed out, the same arguments apply to the much larger number of pregnancies which occur to single girls between 16 and 20 and, to some extent, to older women as well.
Girls and their boyfriends can get advice from family planning clinics run by district health authorities and from the many Government supported voluntary bodies, some of which have been mentioned today, or from their general practitioners. All of these are free at the point of service. One might well ask why, despite this provision, so many pregnancies occur and I submit that there are a number of reasons.
Some girls—and I think the noble Baroness, Lady Faithfull, touched on these—get pregnant in order to break away from an unhappy or badly housed family situation, to have someone to love who in turn loves and depends on them. Mostly this is a subconscious motivation, but sometimes it is quite deliberate, to get a priority claim for rehousing by the local authority—to jump the queue, in other words. Most general practitioners—and I am one—and many social workers will be able to give examples of where girls have deliberately chosen to become pregnant in order to qualify for housing. One wonders whether, if public housing units were more available to young people, this motivation to become a single parent would be so strong.
The family doctor is usually accessible and well-known to the teenager, so why do young people not use his or her services more? The reason may be that it is just because they know the general practitioner so well. Even the receptionist in a practice may have known a girl from infancy—and also her parents. The staff of health centres or general practice units may be classified in the parental or authoritarian category. Sexual behaviour by teenagers may have been increasing but it is always, and always will be, an intensely private matter to them and it may be easier for them to talk to a new, perhaps unfamiliar, and sympathetic face.
Recently, also, there has been the worry that general practitioners might break confidentiality and inform parents of the encounter if a girl is under 16, even if she does not wish it. The recent reversal in your Lordships' House of the appeal decision in favour of Mrs. Gillick may have allayed their fears to some extent. But the 480 General Medical Council's recent advice, that doctors can inform parents of requests by their daughters for contraceptive advice if a doctor thinks a girl is immature, has raised some doubts. We have recently had statements from the BMA and the DHSS which, as the noble Lord, Lord Winstanley, has pointed out, are somewhat reassuring on this point.
Family planning clinics are seen by some young people as not designed for them. They are seen as more appropriate for maturer women, and young people may imagine that disapproval of their sexual behaviour may be expressed, whether or not that is true. Many clinics have appointment systems which do not fit in with teenage timetables or habits.
At this point, it is worth repeating paragraph 42 in the Department of Health and Social Security circular of 1974, which states:People of all ages, married and unmarried, attend ordinary clinic sessions and all should be made welcome at them. However, it may be advantageous to hold some separate sessions for young people either in health centres, hospital out-patient departments or similar settings where a variety of health or social services are provided, or in a quite separate informal non-institutional setting, whichever is thought likely to be most well attended. Whatever place is chosen for these sessions, an informal and friendly atmosphere is desirable, as is the choice of staff with whom the young can find it easy to communicate and who are sympathetic to their problems.There is considerable variation throughout the country in teenage pregnancy rates and in the proportion of those pregnancies which end in abortion. In general, higher teenage conception rates occur in the North and in Wales, and in east London compared with west London. In the North, less than half of these conceptions end in abortion; in the South, it is more than half. There are twice as many actual births to teenagers in the North as in the South.
These figures reflect a trend for higher pregnancy rates to occur in socially deprived regions, and for a higher proportion of the smaller number of pregnancies in more privileged areas to end in abortion. One known reason for this is that, in less favoured areas or social groups, girls delay longer before reporting their pregnancy. There are a number of factors which lead to this, some due to social attitudes, some due to ignorance and some due to poor availability of services.
The whole picture is an example of the "inverse care law" of inequalities in health care provision. As in other cases—for instance, cervical cytology where this applies, which is not available to those who most need it—it seems that a policy of reverse discrimination is the right one. In other words, resources should be mobilised most fully where the problem is greatest.
It is worth looking at the Swedish and American experiences in relation to our own. In the United States, despite greater affluence, there are more pockets of deprivation and poverty than here. It is more difficult for young people to obtain contraceptive advice, and as a result the pregnancy and abortion rate is higher with the attendant unhappiness and perpetuation of social problems which that entails. Attitudes to extra-marital sex in the United States are complex, with much commercial and media promotion and exploitation of sex, while at the same time there are frowning attitudes to sex which make young people feel guilty about it and less likely to seek help.
481 In Sweden, on the other hand, there is a much more open attitude towards sex. Health education in schools is more thorough and includes an official sex education curriculum in which all aspects of sexuality are covered with a frankness and completeness which is often lacking in the United Kingdom. In addition, the availability of contraceptive advice and supplies is made easier by linking schools with contraceptive clinics. Since 1975 when this link was established, teenage abortion has fallen despite a liberalisation of the abortion law at that time. In the United Kingdom and in other countries—for instance, the United States and France—abortion in young people has risen since that time.
In conclusion, may I put certain questions to the noble Baroness the Minister? Do the Government recognise that there is more to be done? Are they concerned that the teenage abortion rate is rising again? Do they agree that unwanted teenage pregnancies and abortions are more costly than the means of avoiding them? Will she agree with the statement of her colleague Mr. Kenneth Clarke, whom the noble Lord, Lord Winstanley, quoted, that the costs associated with an unplanned pregnancy are significantly greater than those of measures designed to prevent it?
The noble Baroness will almost certainly agree that contraceptive services and health education should be increased or improved as some of us have suggested, and I imagine will continue to suggest, during this Unstarred Question. The noble Baroness will say that district health authorities, education authorities and the Department of Education and Science will be encouraged to do better. But I wonder whether this is enough. Should there not be clearer, more explicit central directives backed—this is perhaps a difficult point—with earmarked funds to help health authorities and local education authorities? They are in a great deal of difficulty at the moment. They do not have any spare funds and they are having extreme difficulty in maintaining existing services.
I maintain that that would be an investment which would repay its costs in a very few years in financial terms, let alone in reduction of human unhappiness. It would be more costly to increase abortion facilities in the National Health Service. These are already grossly insufficient and too many young women are forced to turn to the private sector. I would hope that this is a growth industry which even this Government, who believe in private enterprise, would not wish to encourage.
§ 8.41 p.m.
§ Baroness Masham of Ilton
My Lords, this very important Question asked by the noble Lord, Lord Winstanley, follows on well after an Education Bill which is going to increase parent participation in the running of our schools.
How low can our society sink? In the past few days we have heard of a hateful robbery and rape case which, like so many before, has shocked the nation. We have also heard of a girl aged 8 years being involved with prostitution. I have asked many young people why there is so much promiscuity. They blame the 1960s. What happened in the 1960s?—the Abortion Act 1967, among other things. Perhaps without realising it, many young people are letting a 482 very violent act happen to them. Once an abortion has been performed, however early or late, a murder, however tiny, has been committed. In years to come the guilt may grow and depression develop. There is now the escape from being pregnant for long by being able to have an abortion. With the risk gone, many young people seem to think that they should sleep around. They go along with the idea that it is the done thing to do. Pregnancy tests and clinics are advertised in many popular magazines.
I have not heard the Church or the schools speak out very loudly or clearly telling the young people about the dangers of sleeping around. But the Roman Catholic Church does speak clearly (and always has) against abortion as a whole. If there was a Roman Catholic Bishop in your Lordships' House I am sure that he would be speaking tonight. The Churches should be more positive and warmhearted and then I think more young people might attend.
So many of the parents are divorced and the torn and damaged children group together and develop their own culture. All children, I think, should have clear, correct counselling in schools, undertaken by health professionals so that teachers do not have to struggle with embarrassment which some of them might feel. Of course this should be done in conjunction with the schools, and maybe some teachers would in time want to undertake this need. If we value our young people, both boys and girls, they should all be warned that it is possible to catch gonorrhoea, herpes, AIDS, syphilis and cervical cancer. This might make them think about the risks they are taking and lessen the chance of getting pregnant, leading to abortions.
A few weeks ago I was speaking with a young doctor from Westminster Hospital. He said that many of the young girls who turned up at his department imagined they had something wrong with them. He feels that the situation is very complicated and sometimes bizarre. I asked one young girl who became pregnant because she wanted to see if she could before getting married why she had had an abortion, and she just said, "The other girls do it, so I didn't see why I shouldn't".
Some years ago I was waiting in a church with our adopted son, aged about 10, before a wedding we were attending, when he suddenly said to me, "Do you agree with abortion?" I said, "No". He said, "I am glad you said that". He may well have been thinking about what might have happened to him.
This Question asked tonight is a desperately important one. It has psychological as well as physical aspects. If we want a future nation of healthy, happy young people we should look in depth at these needs. We need to act now. Perhaps we could amend the present Education Bill or another Act by incorporating a clause to give the vital provision of much-needed health education, including first aid, basics of health and hygiene, the dangers of drug and alcohol abuse and, above all, counselling our young people in order to combat the increasing numbers of abortions; and this, I think, should be a statutory provision.
§ 8.46 p.m.
My Lords, the House is indeed indebted to the noble Lord, Lord Winstanley, for having initiated this very important debate. It comes at a particularly important time, for three reasons. First, as we all know, new guidelines have 483 been issued recently to doctors by the DHSS on the Law Lords' decision in the Gillick case. Secondly, this coming week two new organisations concerned with family standards will be launched. I shall speak about these in a minute. Thirdly, yesterday was Mothering Sunday when the thoughts of many of us, including even non-Christians, are directed towards the positive role of the mother and the family.
I am neither a doctor nor even a parent. I have spent the greater part of my adult life abroad. Why then am I speaking tonight? I do so because I am connected with seven organisations concerned with children and the family. These are: the Parliamentary Family and Child Protection Group; Family and Youth Concern (the Responsible Society), one of the older groups in this sphere which contains a high proportion of doctors and other professionals; CARE Campaigns (Christian Action Research Education); Moral Rearmament; and the Christian Broadcasting Council, of which I am treasurer. Tomorrow sees the launch of the National Council for Christian Standards in Society, promoted by my noble friend Lord Halsbury, who I wish could be here to take part in our debate tonight. Finally, there is the Conservative Family Campaign, due to make its bow on Friday.
All these groups—and there are others—are, or soon will be, working in slightly different ways to restore moral and religious standards to family life on the lines of the appeal which my noble and learned friend Lord Lane made in his Darwin lecture in 1983; namely,To help in the process of restoring some of the standards of behaviour which used to guide us all and particularly the youngsters".Over the past few years these groups have been attracting growing support from a public which is becoming increasingly aware of the pitfalls of the permissive society, particularly in the realm of children's sexual behaviour. The views I shall express this evening, although of course coloured very largely by my own thinking, are thus essentially those of these various groups—and, I like to feel, those of a much wider public which has not yet identified itself with any particular organisation—rather than the views of a middle aged Cross-Bench crank.
The Question we are now debating is essentially about counselling young people with a view to avoiding unwanted pregnancies. I shall return to that point shortly. First, I must say a word or two about the hazards of early sexual activity, a difficult and delicate subject about which far too little is known—as has already been mentioned by my noble friend Lady Masham.
There are of course the physical aspects. There is the problem of cancer of the cervix, about which the two noble Lords who are doctors will know very much more than I. There is also the growth of sexually transmitted diseases among young people. I believe I am right in thinking that in 1983 there were more than 500,000 cases seen in Britain. But there are psychological as well as physical aspects to be considered. For many young girls, early sex is more than mere physical gratification. It often leads to the awakening of the homemaking instinct; the longing for a child and for a fulfilling and permanent relationship. When those desires cannot be realised, depression 484 often sets in—leading in some cases even to attempted suicide. Even if the young girl does not become suicidal—and fortunately few of them do—her joyful efferverscent mood often becomes subdued in a kind of ill-concealed disillusionment and anxiety.
Another very important aspect of early sexual activity is the weaking of bonds within the family. According to Christine Farrell, who conducted research into this subject in 1978,Becoming sexually experienced affects communication between parent and child, and for all social groups sexual experience lessens the impact of parental influence … Those not sexually experienced showed a greater attachment to their families.How true that is.
One can surely argue that early sexual activity, especially when it leads to promiscuity, and the irresponsible attitude of many children today towards such conduct, can hardly be the best preparation for marital fidelity. How can those hasty, furtive fumblings in cars or in bedrooms, with an ear cocked for the parents' return, help towards a stable marriage?
In the light of all those considerations, what sort of counselling do children receive? I would say—as other noble Lords who have spoken this evening have hinted—that it is woefully inadequate. But worse, it is often misleading and amoral, if not downright immoral. Although I do not wish in any way to denigrate the noble profession of two noble Lords who have spoken, it seems that there are many doctors who are too busy or too unsure of themselves to give proper advice—and who dish out contraceptives like cough lozenges. By contrast, a doctor has written:Premarital chastity is attractive and innocent, strong and vigorous. It strengthens character, enhances personality, builds self-control, maintains purity and protects privacy. Chastity is a preparation for a happy marriage".Why cannot the DHSS incorporate those words, or something like them, into the guidelines to doctors?
To turn now to the schools, which aspect has been touched upon by my noble friend Lady Masham, I believe that many people would accept that the general standard of sex education is highly unsatisfactory and often morally harmful. It is harmful because, for the most part, it concentrates on the purely physical aspect of sex—often in the most explicit and provocative way, with no trace of moral guidance. Allied to that is, I am afraid to say, the attitude of the Brook advisory clinics, which no doubt do good work in some spheres, but whose declared policy is that the customer is always right and that sex is fine provided one takes proper precautions; a doctrine enunciated in their booklet Safe Sex for Teenagers. Even more harmful is the booklet (though not issued by the Brook clinics) entitled Make it Happy, which is on sale without restriction. It advocates a totally amoral, hedonistic approach to sex; justifying any kind of conduct, including homosexuality and even incest, provided it is enjoyable.
What of the Churches, my Lords? What indeed! How sad we all are tonight to see the spiritual Benches empty. After nearly five years in this country, having lived for a long spell abroad, I am still unable to understand their attitude. It seems today that many of the clergy, particularly the Anglicans, are frightened of speaking out and of saying anything that might antagonise teenagers. And so, some of them have, it seems, been trying to bend the Scriptures to suit their 485 purposes—arguing, for example, that Christ's teachings on sexual matters were basically tolerant. One also hears the argument from churchmen and others that St. Paul's forthright denunciations of sexual misbehaviour should be seen in the light of his own physical infirmity, his "thorn in the flesh". This is a speech and not a sermon, but I cannot refrain from quoting from St. Paul's First Epistle to the Thessalonians, chapter 4, verse 4:Every one of you should know how to possess his vessel in sanctification and honour".How many clergy would be prepared to preach on that text today?
So much for the Churches. What about that most important area of all, the parents, which I have deliberately left until last? I am of course largely groping in the dark, but random conversations I have had with parents indicate that, all too often, their attitude is based on indifference and ignorance, and sometimes on ambivalance. One frequently hears it said, "Oh well, let them enjoy the freedom that was denied to us when we were young. Provided that they take proper precautions, they can come to no harm". Then there are those who will say, as a prominent QC at the criminal bar said to me only the other day, "I tell my children that below the age of 16, sex is illegal—but over that age, there are no holds barred".
Surely it must be accepted that children develop at different rates and that, even at 16, many are far too immature, both physically and emotionally, for such activity. Another argument one hears from parents is that sexual activity among young people is normal, natural and even necessary. But surely most doctors would agree that self-restraint is not all that harmful and that it can strengthen one's personality. All I can say here is that teenagers of my generation led a happier, healthier and more wholesome life than they do today.
Having lived abroad for the greater part of my adult life, I find the new attitudes to sexual behaviour all the harder to understand. For many young people today, hopping into bed with anyone, at any time, is just as normal as turning on a tap. I have met youngsters who were amazed when I suggested that youthful sex could be wrong. One hears of the most amazing behaviour that seems to be accepted almost as commonplace. Only the other day, at a reception in your Lordships' House for educationalists, I was told of groups of schoolchildren who had set up what was virtually a brothel with 14 year-old and 15 year-old girls charging their schoolboy friends 50p a time. We are indeed paying a terrible price for our failure to give children proper guidance.
What is the solution? I do not believe that the pill is the universal panacea, although I realise of course the necessity for contraception. I would not venture to describe the harmful effects of the pill, particularly on young people, in the presence of the two distinguished doctors who have spoken, but they would surely agree with me that children make poor candidates for the regular, daily, self-administration of contraceptives and that the contraceptive failure rate among teenagers is high.
More significant still, let me quote Dr. Judith Bury of the Edinburgh Brook advisory centre:There is overwhelming evidence that, contrary to what you might expect, the availability of contraceptives leads to an increase in the abortion rate".486 That is indeed a significant statement—coming, as it does, from an organisation that has been persistently pumping contraceptives into children.
I do not wish to discuss the Law Lords' ruling in the Gillick case, except to say that, basically, I support Victoria Gillick—for whom I have boundless admiration. With great respect to my noble and learned friend Lord Scarman, I believe that his judgment was misguided. I say so although I realise, as noble Lords have said, that there are many parents who will not or cannot give proper guidance to their children.
Nevertheless—and it is a very important point—this ruling has apparently created in the minds of many teenagers the erroneous impression that there is now no need for them to hold back, and that, however young they may be, they can misbehave as much as they like and the doctor will help them by providing contraceptives. A very interesting and important fact in this connection is that during the period between the ruling of the Court of Appeal and the judgment of the Law Lords last October—in other words, while the law was supporting Gillick—the abortion rate for underage girls actually fell for the first time from 2,040 for the March and June quarters of 1984, to 1,910 for the same quarters of 1985, which is a fall of 6.4 per cent.
Surely the solution to it all lies very largely in the restoration of traditional family standards. Only the other day a doctor told me that a strong, united family can withstand every shock and setback. We cannot put the clock back. It appears that we can hardly introduce that old-fashioned morality which is now almost totally rejected by the young. How I wish we could! But can we not argue that conduct which is condemned as morally wrong yesterday cannot become right today? We should take a lesson here from the Moslems and the Jews, to whom right is right and wrong is wrong, and whose standards of family life for the most part put ours to shame. In the realm of sexual morality we no longer think in terms of black and white but in hazy half-tones, muddy browns, and dingy greys. It is the children themselves who are clamouring for such a distinction. How often do you hear them saying, "Mummy, do tell me whether this is wrong". But Mummy does not know.
In conclusion, I am among the first to realise that the promotion of family unity and the building-up of moral standards within the family is a task so daunting as to deter all but the most deeply committed; and yet we must attempt it if we are to arrest the moral decline which is so rapidly eroding the fabric of our society.
§ 9.2 p.m.
§ Baroness Lockwood
My Lords, I am sure we are all grateful to the noble Lord, Lord Winstanley, for putting this Question this evening. I am particularly grateful to him for the way in which he introduced his Question, putting it in the context of the wider problem of teenagers generally and not the narrow and very controversial problem of the under-15s.
I think that the concern behind his Question can be illustrated by an article in The Times of 22nd January. If I may, I should like to quote one paragraph:Despite an undoubted rise in sexual activity the teenage conception rate has been declining since 1974. This trend demonstrates an increased consciousness about contraception. Nevertheless, still too many sexually active teenagers are not using 487 contraception and almost a third of all abortions are performed on teenagers. One in 10 of teenagers turning 15 this year will have an abortion before the age of 20. Yet only the same proportion of teenagers attend family planning clinics now as 10 years ago".My noble friend Lord Rea has referred to the early maturing of girls. I think that no matter how we try to fight against it, it is a fact that there is a rise in sexual activity among teenagers. Therefore, I suggest that our problem is to see what best can be done to help teenagers in this very difficult period of their lives.
There is one encouraging trend referred to in that paragraph which is borne out by the OPCS Population Trends 42, which shows that the number of teenagers conceiving outside marriage has dropped from 56 per thousand of unmarried women under 20 in 1973 to 47 per thousand in 1983. Of course, 47 per thousand is far too high a figure but I think we would all agree that abortion is not the answer to this problem. I say that as one who supports the Abortion Act and feels that it provides a very useful social and medical net in our system which is of great value as a last resort in cases of unwanted pregnancy. But so far as concerns teenagers, in the long run abortion is certainly not the answer and we have to look at other means of helping them. Hence, I welcome the approach of the noble Lord, Lord Winstanley, which is a positive approach, seeking to avoid unwelcome pregnancies and any subsequent abortions.
It is regrettable that, as we are told, only 50 per cent. of health authorities provide a designated youth advisory session for young people. I should like to underline the Question to the Minister on this point. Is anything being done to encourage other health authorities to provide such a service? All the studies point to the difficulties experienced in getting teenagers to take advantage of family planning clinics in the general sense. Teenagers need special provision—clinics and sessions which are geared to their needs and which provide an atmosphere which is sympathetic to their outlook and lifestyle.
Studies also indicate that there is a need to expand the number and scope of services available. Yet from what we have heard this evening, through a lack of funding we are moving towards a contraction of the services, with the threat of closure. I am very concerned indeed to think that the Brook Centre in Tottenham Court Road might be under threat because of lack of funds. That centre has pioneered family planning services, in particular for teenagers. It would be tragic if through lack of adequate funding it were to close. Can the Minister give us an assurance that the Government will give every possible assistance to prevent that?
Reference was made by the noble Lord, Lord Winstanley, and by my noble friend Lord Rea to the research undertaken in America by the Guttmacher Institute. That was comparative research relating, first, to 36 countries other than the United States, and then in a more detailed and specific way to five other countries and the United States. The concern of the United States was that its teenage pregnancy, abortion and childbearing rates were higher than those in most other industrial countries, and certainly higher than the five comparison countries. It was the only country where teenage pregnancy was on the increase.
488 It is important for us in this country to bear in mind the message of the research, and it is apposite to our debate. I refer to four points that came out of it of which we might take note. One was that teenagers in countries other than the United States are not too immature to use contraceptives effectively. The second was that the availability of welfare benefits and services (which were more generous in the other five countries than in the United States) does not act as an inducement to teenagers to have babies. Thirdly, low teenage birth rates in those countries were not achieved by greater recourse to abortion; on the contrary, they all have a much lower rate than the United States. Fourthly, teenage pregnancy rates are lower in countries with a greater availability of birth control and sex education. My noble friend Lord Rea referred to the latter point and in particular to the experience of Sweden, which is far in advance of ourselves in that respect.
In this country we have the basis of an adequate service. It needs building upon and expanding. I think the Minister will agree that it is better to have more sex education and counselling services for teenagers than more pregnancies and abortions. Certainly it is much more cost-effective to ensure that we do not have a greater number of pregnancies and abortions. We need to look carefully at sex education within the education and training system. YTS, for instance, where young people are brought together, could be used as a possible starting point for education. We need better consultancy services.
We need to emphasise the importance of including boys in the educational and consulting service. Boys increasingly are put at risk from sexually transferable diseases. Even without that danger, boys and young men should be aware of and understand their sexuality and be aware of, understand and respect the reproductive process. In that way we can bring about a greater understanding by boys and girls of the problems that they face as teenagers, and we may help them to approach the problems in a more sensitive and responsible fashion.
§ 9.14 p.m.
§ Lord Robertson of Oakridge
My Lords, I should like first to express my gratitude to the noble Lord, Lord Winstanley, for raising this Question. We are not here to debate the merits or the demerits of abortion, the 1967 Act or the way it is used and misused. All of us would, however, agree, I believe, that anything that could reduce the number of abortions is to be encouraged. I should like to touch upon the guidelines for the provision of contraceptives to under-16s. There is one particular point among others that worries me and that I would wish to draw to your Lordships' attention. I have seen it suggested that if a doctor other than the girl's family doctor prescribes the pill, then he should contact the child's GP. I wonder whether this is a strong enough injunction, particularly because the pill can clash with other medical conditions and with other medication. I wonder therefore whether there are other areas of medicine where a doctor other than the child's GP would make a prescription and then not tell the child's GP. Not to do so seems to be a little irresponsible.
My aim tonight is to draw attention to the work done by those voluntary organisations that already 489 provide counselling and other support to women who find themselves pregnant in difficult circumstances—circumstances where, otherwise, abortion would seem the only answer. In this respect I should declare an interest. I am connected with both Care Trust and Lifeline working in this field. I should like to give two examples of their work. The first is a girl who ran away from home to London. There, after a series of casual relationships with men, she found herself inevitably pregnant. Her boyfriend's only reaction was to tell her to have an abortion. In desperation, she prayed to God for help. Her prayers were answered when Care Trust found her a family who took her into their home. Since making her home with this family, her life has been transformed.
My other example concerns a single girl who approached Lifeline when she was nearly five months pregnant. She had had no medical attention and her boy friend wanted nothing to do with her or her child. Lifeline put her in touch with a GP who cared for her throughout her pregnancy and also, in accordance with her wishes, made initial contact with an adoption agency for her. She and her family were very relieved to have these contacts made and were supported throughout the pregnancy, the delivery of a healthy son and his subsequent adoption.
In each of these cases, the woman concerned was fortunate enough to find people who cared for her and for the child inside her. In each instance, the baby was saved and the woman herself did not have its killing on her conscience. I believe that organisations which do this work merit more support than they are getting from society in general and from Her Majesty's Government in particular. Some of these organisations feel—they are, I believe, justified in so feeling—that support is much more readily given to organisations which are little more than abortion agencies. I would therefore ask the Minister, as a step towards improved counselling and other alternatives to abortion, to give priority to supporting those organisations which do the positive kind of work of which I have given examples.
§ 9.18 p.m.
§ Lord Ennals
My Lords, I should like, as other noble Lords, have clone, to thank the noble Lord, Lord Winstanley, for introducing this timely debate and for the manner in which he did so. It is, indeed, timely, as other noble Lords have noted, following the recent ruling of the Law Lords on the Victoria Gillick challenge to the legality of the DHSS guidance to doctors on family planning and advice and treatment of girls of 16 and under. It also follows upon the new guidance issued to doctors by the general council of the GMC and the pleas by the BMA and the Family Planning Association to the GMC to revise those guidelines. I want to say how much I welcome the DHSS circular of 7th March, particularly in so far as it gives absolute clarity concerning confidentiality. I wish that it had had more to say about the main subject of our debate this evening, but I shall come to that.
I should at this stage say that this is in no way a party matter. The fact that I am standing at this Dispatch Box does not mean that I am speaking for anyone but myself. The facts have been brought forward by the noble Lord. I wish to add only one more. It comes 490 from the OPCS survey. It was published in The Times on 4th December. The OPCS said that 17 per cent. of all conceptions end in abortion. The top figure is 57 per cent. for girls under 16 and 47 per cent. for women aged 40 and over. One can understand the second, but the thought that 57 per cent. of girls under 16 are heading for abortions is a very frightening figure indeed, and emphasises all that has been said by noble Lords in all parts of the House on the urgency of having advisory centres.
As I have said on the question of the doctor's right to retain confidentiality, I think that the situation has now been made absolutely clear by the DHSS circular, and I hope that the GMC will revise its own. But we are concerned in this debate about the nature of counselling and its availability. I do not think anyone doubts the importance of counselling, although different points of view have been expressed as to what we would call counselling. Some appear to be very critical of the sort of advice that might be given by the Brook advisory centres and other bodies. All right—they are doing a job which some may feel the Government ought to be doing. They are trying to do it to the best of their ability and often to step in for the failure of parents—and I want to come on to that in a moment or two.
It is a sad fact, as the noble Lord, Lord Winstanley, said, that only half of the NHS health authorities provide specialised youth advisory services and sessions. There is a compelling need for such a service to be available to all young people.
In introducing the debate, the noble Lord referred to this.The DHSS's first Memo of Guidance published in 1974 faced the need for contraception and advice to be available to all, irrespective of age. It told local health authorities that sessions for young people would be useful. They should be separate from general health counselling, preferably in an informal setting.Perhaps I may quote a little more, as my noble friend Lord Rea did:'Whatever place is chosen, an informal and friendly atmosphere is desirable, as is the choice of staff with whom the young find it easy to communicate and who are sympathetic to their problems.' But these valuable clauses in the 1974 circular were lost when, in 1980, a second memorandum was issued. Its section on the young concentrated on the under-16s and talked only about good medical practice during individual consultations.I believe that what we are talking about is something very much more positive than simply medical advice. The thought that general practitioners have the time—let alone, in some cases, the personal ability—to provide the understanding which young people seek is, I think, absurd.
I draw some conclusions from a variety of sources, including the Brook advisory centre. Young people are receptive to the media, and local clinics should take advantage of this to advertise their opening hours, preferably to be outside school and working hours. Sessions on Saturday mornings and at lunchtime are welcomed when young people are likely to be available and when they would be perhaps more likely to go into an advisory centre when it would not be so obvious that they were doing so or when they were not taking time off work. Time in each session should be reserved for young people who turn up at the last minute for post coital contraception, a pregnancy test or because it was their first appointment and they are late, or they 491 did not make an appointment or they lost their pills, or arrived on the wrong day. All these things will happen with youngsters who have probably very unwisely and often unknowingly allowed themselves to get into a situation in which they desperately need help. The advisory centres must be available not only to counsel youngsters in general, but also to deal with emergency situations which may arise.
Counselling itself should be available. A young woman who turns up for a third time, for the morning-after pill, insisting that she is not really having a sexual relationship, needs help to understand her sexuality. Encouraging a sense of self-esteem will inevitably improve the efficiency of contraceptive use and help some who wish to say, "No".
Like the noble Baroness, Lady Faithfull, and the noble Viscount, Lord Buckmaster, I wish to turn for a moment to the responsibility of parents. I speak as a parent of four youngsters. One of the most difficult things that any of us ever has to face is the adjustment of the relationship between the stern father and mother and the little child, through the child's development to a relationship between two adults. It is a very difficult period and it has to be dealt with with great care and thought by the parent. It is a challenge to parents and one which I am sorry to say most of them seem unable to fulfil. It may be that they do not try or it may be that no one has advised them how to do it.
Certainly youngsters themselves need to be given courage and confidence to be in control of their own bodies. I guess that it is often quite difficult for a young girl to say no. It may be that she wants to say yes or it may be that she wants to say no, but the done thing is to go along with what is suggested to her. If she does that, she is not in control of her own body. She needs to learn that she may gain much more respect from the boy who wants to have a relationship with her, if she says, no and waits until a later occasion.
I find it quite extraordinary when one thinks of our educational system—and I shall not go back to the Second Reading debate on the Education Bill—that the most difficult task that most young people have to face within a few years of leaving school is that of being parents, and they get precious little advice in school about how to go about being a good parent and how they should explain a child's growing sexuality to the child in language that can be clearly understood. That applies to the advice that needs to be given to boys as well as to the advice that should be given to girls. Above all, it is based on the actual relationship. So many girls and boys would not think of asking their parents about these difficult issues. I fear that so many parents would not think of talking to their children and would not know how to talk to their children about this matter.
I wish that in our schools there was a greater degree of what I would call "preparing youngsters for parenthood". In my view, much more can be done than is being done at present. However, it is because it is not being done by parents that it is essential that the advisory services be available in some form or another and preferably in the informal way to which I have referred. I very much agreed with the noble Baroness, Lady Lockwood, that young men should be welcome 492 at these advisory centres as well as their girlfriends. They should be invited, if the partner wishes, to take part in the consultation. They should also be encouraged to come along as young boys if they wish for counselling and contraceptive supplies.
It is the informality that is important. It is the personal relationship that is important. But above all, I say to the Minister, what is important is that these services should exist. Unless the noble Baroness can give us some other figures, the facts we know of are that half the health authorities in the country do not provide this sort of advisory counselling service which they were called on to do in the circular in 1974. I hope that the noble Baroness will accept—even if she cannot say, "Yes, we are going to do this in two years"—that this needs an ongoing programme and commitment by the Government. It is not enough to leave half the country—which means half the young people—not able to take advantage of what the health service can provide.
If it is not provided, then all that can happen is that they go to the doctor, and the whole question of confidentiality is a great fear for the child. I know it is now clear as a result of the circular from the Minister, but whether it is clear to the youngsters themselves that they are not going to be reported to their Mums and Dads may take a lot of education to achieve. The Government have a great responsibility in this matter—a responsibility which they share with the schools and which they must share with the parents themselves.
§ 9.32 p.m.
§ Baroness Trumpington
My Lords, I think that we are all very much indebted to the noble Lord, Lord Winstanley, who has brought this difficult problem before your Lordships tonight. I am sorry that my noble friend Lord Molson had to withdraw from the debate because, as the noble Lord said, he is not feeling very well. I am sure we would all hope that this is a temporary malaise.
I do so agree with the noble Lord, Lord Ennals, on the difficult role of being a parent. So often it is the case that I am a good counsellor with other people's children and hopeless with my own, and this is quite a general aspect of things. I have listened with great interest to the views of noble Lords. I share the concern that so many abortions are still considered necessary, particularly where young people are involved. Abortion is always a cause of considerable distress and difficulty, and involves a risk to health. I share the view of the noble Lord, Lord Winstanley, that family planning advice is infinitely more desirable than abortion.
I am sure we all agree that the best possible situation would be for young people, boys and girls, not to embark on sexual relationships until they are mature enough, and capable of understanding a loving sexual relationship and able fully to appreciate the consequence of their actions. I agree with the noble Lord, Lord Robertson, that of course every effort must be made to increase young people's awareness about these matters, and to educate them about personal relationships and the responsibilities involved. As many noble Lords have said, this is primarily a task for parents, though programmes of sex education in 493 schools certainly have a part to play; and we regard sex education, taught within a moral framework, as an essential element of the curriculum and a necessary preparation for responsible adulthood. I like to think that the Churches also have their part to play in counselling the young.
The noble Lord, Lord Rea, spoke about the need to improve health education. The Government recognise the importance of health education in the matter of avoiding unwanted pregnancies. The Health Education Council recognises this too, and this year over a quarter of a million pounds is being spent from HEC monies on the family planning information service which is jointly run by the HEC and the Family Planning Association, and provides a comprehensive information system for all age groups on matters relating to contraception. But despite the best efforts of parents, schools and others who come into contact with young people we all know that young people embark on sexual relationships before they have sufficient maturity and understanding and thereby girls incur the risk of unwanted pregnancies and possibly disease, as the noble Baroness, Lady Masham, pointed out.
We must therefore consider what action is being taken in a less than ideal world. First, we must ensure that these young people who are engaged in sexual activity, or who are likely to be so, have access to proper advice and support. I firmly believe that a free family planning service is an essential preventative measure which contributes to the avoidance of unwanted pregnancies. Authorities have always been encouraged to provide separate facilities for young people where appropriate so that they are not discouraged from seeking help. Specialist clinics such as those run by the Brook advisory centres on behalf of health authorities have done a great deal to develop a model service sensitive to young people's needs.
As several of your Lordships have mentioned, voluntary organisations have a tremendous contribution to make in giving support, advice and help to young women who are in trouble. Sometimes they are better suited to do so. We give grant support to specialist organisations such as the FPA and the Brook advisory centre. It is interesting that research by Isobel Allen, who has already been mentioned, commissioned by the DHSS, reveals that many women prefer counselling outside the DHSS through voluntary organisations. As I understand it, no final decision has yet been taken about the Tottenham Court Road Brook advisory centre. I note the concern of your Lordships and I certainly recognise the valuable work that the Brook advisory centres do generally, but the final decision on this must be for the Bloomsbury Health Authority, taking account of all local factors. I shall draw the views of your Lordships to the notice of that authority.
The need for counselling was mentioned and the committee on the working of the Abortion Act, the Lane Committee, expressed the view that every woman seeking abortion should have the opportunity to obtain adequate counselling before an abortion decision is taken. The department fully recognises the need for counselling, and the guidance issued in 1977 gave detailed advice. The DHSS recognises that it is undertaken in the majority of cases where abortion is 494 under consideration. The voluntary organisations, including religious organisations, have an important contribution to make provided that non-professional volunteers are carefully selected and trained.
The noble Lord, Lord Winstanley, asked whether the DHSS consulted about improving education following the RCOG report on late abortions. My department liaises closely with the Department of Education and Science on matters concerned with health education in schools. In taking forward any ideas for improving good practice in this area we shall clearly need to consult the Department of Education and Science.
I am aware of the substantial ethical and social problems surrounding the question of contraception and the young, particularly those under 16. This House delivered important judgments on this issue last October, and your Lordships are aware that my department last week issued guidance on the circumstances in which doctors may give contraceptive advice and treatment, without parental consent or knowledge, to a young person under 16. This aimed closely to reflect the decision reached by your Lordships and stressed that it would be most unusual for a doctor to proceed with parental involvement. Although this issue is of the greatest importance, it has been very thoroughly aired and discussed in recent months. I hope your Lordships will understand if I do not enter into the details of the various arguments in this debate. My central point is that help and support should always be available to young people so that they have the fullest possible understanding of what is involved, of any risk they might face and of the possible consequences of their action.
The noble Lord, Lord Winstanley, asked what the department are doing to maintain counselling in the National Health Service. It is for local health authorities to determine this kind of provision. However, in our guidance on contraceptive services for the young we have said that health authorities may find it helpful to provide separate, less formal facilities for young people. It is worth noting, too, that between 1981 and 1984 the number of attendances at family planning clinics by young people under 20 has increased from 12.6 per cent. to 13.8 per cent. in the relevant female age group.
When I say "young people" I say emphatically, both sexes. I think the noble Lord, Lord Ennals, brought out that point. I much welcome in that context the Family Planning Association's current "Men Too" campaign, which aims to encourage men, particularly young men, to increase their sense of responsibility in caring involvement in sexual relationships. I agree with my noble friend Lady Faithfull that abortion should not be seen by some girls as a permanent escape from unwanted pregnancies. Again, despite the best efforts of those offering help, support and information, there are still many—far too many—unintended pregnancies among the young.
The noble Lord, Lord Rea, asked whether I agree with my right honourable friend the Paymaster General who said when he was Minister of State for Health last year that prevention is cheaper than unintended pregnancy. Yes, I think this must surely be so but I am also concerned at the negative emotional 495 and social effect of unintended pregnancies. To set all these remarks in context it is worth noting that the conception rate among older teenagers, that is, 17 and above, has been declining for some years and that the rate for younger teenagers declined too until 1980 but rose again between 1980 and 1983, which are our latest figures.
The proportion of teenagers with an unplanned pregnancy whose pregnancy is terminated has also increased. The number of abortions to women under 25 rose from 35,000 in 1981 to 37,500 in 1984. The noble Lord, Lord Winstanley, said that I must not forget older teenagers. I quite agree with the noble Lord, we should not overlook the needs of teenagers as a whole. Recent interest has concentrated on those under 16 but the abortion rate among the 16 to 19 year-olds is rising again too and it is clearly important that they have proper support.
In its revised guidance on contraceptive services, the department has advised authorities that they might find it helpful to make separate, less formal facilities. The noble Viscount, Lord Buckmaster, said the abortion rate fell in two quarters following the Law Lords' judgment. Perhaps I may refer the noble Viscount to the Answer in another place on 7th March 1986 arising from a parliamentary Question put by the honourable Member for Solihull. The rate is certainly lower for the first two quarters as compared with last year, and this must be welcomed. However, I should like to see a full year's figures and indeed to see the figure for the overall number of conceptions in these age groups—neither is yet available—before attempting to place any interpretation on the figures.
So far as abortion itself is concerned, your Lordships will be well aware that the Government have traditionally adopted a neutral stance. People have strong views, sincerely held and often widely differing, about abortion. Parliament has decided that abortions may lawfully be carried out in the circumstances specified in the Abortion Act. It is therefore the Government's duty to ensure that its provisions are properly applied. The operation of the Act in the private sector is monitored by the department's medical and lay investigating staff through the vetting of applications for approval and unannounced visits of inspection.
Against that background I should like to make two points. First, whatever the eventual outcome may be, it is important that facilities are readily available to give prompt confirmation of pregnancy and an early uptake of care. This was recommended in the first report of the Maternity Services Advisory Committee, which also stressed the need for each woman to be able to discuss thoroughly with those who will be responsible for her care any medical and social factors which might affect the course of her pregnancy and agree a suitable pattern of care. We have commended this report to the health authorities for their consideration as to the action which could and should be taken locally to improve services.
My second point is that if a pregnancy is to be terminated it is safer and less traumatic if it is done earlier rather than later. I should stress that so far as young people under 20 are concerned, roughly 80 per cent. of all abortions are provided in the first 12 weeks of pregnancy. Nevertheless, that means that one-fifth 496 or so occur later in pregnancy. Our concern about the problem of late abortions generally led to a request by my department that the Royal College of Obstetricians and Gynaecologists should undertake a review of late abortion practice. Their report was published early in 1984, and we have been considering how best to follow up a number of its recommendations.
In particular, the report found that there is avoidable delay in a significant proportion of late abortions either before referral or between assessment and admission. Young single women are at the greatest risk. We are aware that there are wide regional variations in the number of resident women having abortions in the NHS. It is of course for local health authorities to decide the level and scope of the services they provide in the light of local need and available resources. However, we have drawn the report to the attention of the health authorities and have discussed our concern about late abortions with them.
We have also asked them to consider in their own local context the extent of the problem and any developments as regards improving administrative procedures in the handling of abortion cases in the NHS. We are following up these actions with authorities and are continuing to monitor the situation.
The noble Lord, Lord Winstanley, quoted from research undertaken by Isobel Allen. Let me mention another aspect of her research, which was published by the Policy Studies Institute last year and funded by my department. That also revealed concern about late abortions, pointing out that as many as a third of under 16 year-olds and a fifth of 16 to 19 year-olds in their sample did not even go to a doctor until they were 10 weeks pregnant. One of the recommendations in the report was that pilot projects should be set up in the NHS, partly with the aim so far as abortion was concerned of seeing how delays could be avoided and more effective counselling offered. The department recognises the importance of promoting good practice in this area, and it is something which the department is actively considering.
My noble friend Lady Faithfull suggested that counsellors should be attached to general practices. Health visitors, practice nurses and domiciliary midwives are all already attached to practices, and all have training in family planning and counselling. Social workers are also sometimes attached to practices, as she will of course know. My noble friend asked about the grant to the British Association of Counselling. I am afraid that I have no news as yet to report on the grant application made by the British Association of Counselling but it will of course be given the sympathetic consideration shown to all grant applications.
I hope that I have been able to show that the Government share the concern expressed about the importance of counselling and other services for young people to combat the increase in the number of abortions and about the need to reduce the number of late abortions. Education, advice and support are being provided to help discourage young people, especially young girls, from entering upon sexual experience before they are mature enough to cope. For those who, for whatever reason, do not or cannot respond, sympathetic, constructive and supportive help and advice are available.
497 As my noble friend Lady Faithfull said, we do not live in a golden, perfect world. We live in an imperfect one in which we must look at the realities. We should acknowledge the improvements that have been made over the years and give credit to the nurses and the doctors who care for patients in what I know are very difficult and depressing circumstances. Successive governments have worked to improve matters. One good result of our efforts is that the back-street abortionist is a thing of the past. However, I assure the noble Lord, Lord Rea, and other noble Lords that the Government readily acknowledge that there is more to be done. I have attempted to show the various options we are pursuing to that end.
§ Lord Houghton of Sowerby
My Lords, may I ask the noble Baroness, before she sits down, when the Government will counsel those rampaging, randy stags about having unlawful sexual intercourse with girls under the age of 16? It is a criminal offence. The whole bias of the debate and her remarks has been that it is girls who are to blame and that they are the people whom we must counsel all the time. The sexual drive of young men is responsible for the whole situation. When will we hear more about that? We have heard nothing about restraining men's sexual drive.
§ Baroness Trumpington
My Lords, I mentioned particularly that I welcomed the "Men Too" campaign which the Family Planning Association has recently carried out. I said in my early remarks that I emphatically meant both sexes. If the noble Lord cares to read my speech tomorrow he will see that. I agree with him that, as I said, both sexes need to be counselled. I am sure that the noble Baroness, Lady Lockwood, will agree with me that this is the only matter in which there are not equal opportunities for both sexes; it is only females who become pregnant.
My Lords, may I correct a small point? I said that according to statistics I had the abortion rate for under-age girls fell between the appeal court ruling and the Law Lords' decision; that is to say, it fell during the period in which the law was supporting Mrs. Gillick.
§ House adjourned at six minutes before ten o'clock.