Sexual education: good ideas, bad framework
L. Peremans, V. Verhoeven, H. Philips, P. Van Royen, J. Denekens
Department of General Practice, University of Antwerp,
Belgium
Introduction: Because of the increased figures for
abortions with adolescents the Belgian government decided in 2001 to give free
access to emergency contraception in the pharmacy. There is no evidence that
this strategy leads to a diminution of the abortion rate. In Belgium there was a
diminution in 2002 but it raised again in 2003 and especially in the age group
(20-24 years) from 3 692 in 2002 to 4 032 abortions in 2003.
Objectives: To evaluate which strategies can help
according to the view of Flemish health care providers en what their role can be
in preventing unintended pregnancies with adolescents.Method: In 2002-3 we
conducted twelve focus groups with pharmacists, general practitioners and school
physicians. A skilled moderator accompanied by an observer conducted the focus
groups using a semi – structured screenplay. The discussions were audio-taped
and analysed following the procedures of the grounded theory. Analysis was
partially manual and by the computer program QRS-Nudist.
Results: There is strong agreement about the role of the
school physicians, teachers and nurses. Class groups are not an ideal setting
because of a large difference in culture and personal development of the
adolescents. Small discussion groups and individual support would be more
convenient. Obstacles are: no long-term strategy and vision in spite of
well-formulated learning goals, no time and financial support. Not every school
physician feels good to talk about subjects as ‘the first time’,
masturbation, homosexuality. Young physicians have no opportunities to develop
experience. Collaboration with general practitioners is good, but financial
obstacles and fear regarding confidentiality and involvement of the parents are
obstacles. GPs ask also to be better informed about the campaigns in local
schools. These gave them the opportunity to discuss these issues in an
individual setting. School physicians would like to prepare adolescents to visit
their GP for contraceptive health and counselling about sexual transmitted
infections Over-the-counter sale of emergency contraception is not enough
because pharmacists have not enough opportunities to counsel women.
Conclusion: The government has to develop a better
framework with clear task definitions and financial recourses for school
physicians. Specific educational programs are necessary for physicians, nurses
and teachers. Adolescents have to be better informed about the professional
secret of GPs. A model of collective education focused on empowerment of
adolescents and collaboration between the different health care providers would
be ideal.