Category: Sexual health

The Barbershop metaphor

Barber's shop pole

The story of when I was given sex-education has passed into our family’s folk-lore. I still remember it extremely well. I was in the fourth form, or Year 4 in today’s money, (aged 8 going on 9), when a letter came home from school, that we were going to be taught about the birds and the bees, by the headmaster, together with a note about the explanatory material.

In 1982 or it may have been 1983, (I can’t remember which precise term this took place, although I do remember it was most definitely Form 4, I can still recall the desk I was sitting at), this was a big thing. Especially in an independent preparatory school in the heart of a quiet ancient Essex market town. The school was a single-form entry, the ethos was that of muscular Christianity, the pupil intake consisted mainly of children of local wealthy farming families and the headmaster made liberal use of the slipper on naughty schoolboys.

The headmaster who despite being the proprietor of a decidedly middle-class private school and the son of peer of the realm, appeared to nurture progressive, left-wing views and suddenly out of the blue decided to take it upon himself to teach the fourth-form sex ed.

What do I remember from it? Horrible cross-section drawings of a man and a woman engaged in the marital act, together with diagrams of male and female reproductive parts, which I found to be boring and meaningless. In fact, I found the whole thing so dull, that I coloured in the A4 cross-section diagram of male reproductive parts, which was supposed to be labelled, in pink and green diagonal stripes, resembling the pattern of a barber’s pole!

Freud would have had a field day, but oh how my parents roared with laughter when I brought the booklet home, in order for them to be able to see the material we were covering for themselves and ‘support’ the curriculum. Instead of the embarrassing baby photographs, for the past 30 years they have regaled friends and family with the story of the time that Caroline coloured in the diagram of a man’s willy in garish barbershop stripes.

Parents like talking about these things, not to embarrass us, but because they like to wistfully recall the time before we had put away child-like things. They remember with fondness and no doubt, rose-tinted glasses, the innocence of our childhood. These stories are only embarrassing to those who are desperately trying to cultivate an image of sophistication or coolness and the story of that time that you stuck a pea up your nose which had to be removed by the GP (yep, me again) is a reminder of one’s base humanity and that like the rest of us, you were born, have bodily functions, and will one day die. Nobody seriously judges the adult on the basis of some barely remembered childhood escapades.

My parents like telling this tale because it is inherently funny. The 8 year old more interested in treating the picture of the male organ as a piece of colouring rather than deriving any educational benefit from it and who had no idea that colouring it in could be seen as inappropriate. I vaguely remember doing it as well. I think it was because I found the whole thing deadly boring.

The idea of men and women ‘doing it’ was utterly repellant, there was no way, thought my 8 year old self, would I entertain the idea of one of the boys in my class ever doing that, not even when I was grown up – it looked painful! And of course, no kind of context was provided, that the couple might be in love, would be married, that the love meant that they’d want to have a baby together, no, it was the sheer mechanics of the thing. Being the youngest child of two only children, I had no first cousins and very little experience of younger children or babies, wasn’t that fussed about them and certainly not enough to suddenly decide to do ‘that’ with a boy. It just seemed so cold and revolting.

At the same time as being taught about reproduction however, we were also taught the word ‘gay’. It meant, said our headmaster earnestly, that a man or a woman may sometimes fall in love with each other, instead of with the opposite sex. People who were gay ‘could not help it’, it was not funny, no laughing matter, they should not be mocked and should be treated the same way as everybody else.

That was something we took on board, along with the previous warning we’d had about the amount of trouble we would be in, if following episodes of Blue Peter, we were overheard calling anybody a ‘spastic, spas’ or ‘Joey’ in the playground with accompanying hand gestures. You’d be in very big trouble indeed!!

Now all this was fair enough, though from what I remember, outlawing specific terms of insults in the playground, just made them more exciting for the really naughty children (usually boys) who were trying to push boundaries. They’d still use the words, but in the wooded area behind the school hall, where the teachers didn’t bother to patrol, not because they wanted to be ‘able-ist’ or homophobic or whatever, but because they got a frisson out of being naughty. The only effect banning words had, was to encourage children to snitch on each other. Sometimes this would be genuine; you’d get the child who understood why the term ‘Joey’ was really wrong, but sometimes, one child would misreport another, just to get them into trouble. It’s been a feature of playgrounds since time immemorial.

I remember thinking that it was wrong to mock people because they fell in love with those of the same sex, but I thought that was primarily about adults. Aged 8, the word ‘gay’ wasn’t really milling around the playground as to the best of my knowledge, sex wasn’t something we were thinking about. Not even in 1982/3. The contents of the sex ed lesson were universally received with an ‘eurgh’ by a class who were too shocked to say much about it to each other. I’m not aware that we had any pupil (though we are culturally obliged to call even 4 year olds, the adult term, ‘students’ these days) who was gay, but neither did we have any pupils who were ‘going out’ with anyone either. Children being sexually interested in each other, just wasn’t a thing. Kiss-chase was something you did to wind the boys up, just as they would run after you with plastic spiders!

When we revisited sex ed in Year 6, aged 10-11 it was met with much hilarity, still due to embarrassment. My little friend Rebecca kept talking about the “scrotchum” instead of the ‘scrotum’ when labelling her diagram and we racked our brains as to what one of these was, still not fully understanding. We had ‘the period talk’ and for a while discussion about sanitary products prevailed and we wondered who had a mum who wouldn’t talk about these things, like the grim-faced snappily silent mother of the booklet, and breathed a sigh of relief that we’d still be able to go swimming and play netball.

Can I say that aside from knowing not to be unkind about people who were gay (or had cerebral palsy) that my primary school sex education was especially necessary or relevant? Did it help equip me ‘morally, culturally, spiritually and socially’? Does it stand as a shining example of why we so apparently need high quality sex-ed in primary schools today? Does it explain why pupils specifically need to be taught that some people are ‘born in the wrong body’ (a statement with no scientific evidence behind it) and why 4 year olds need to be encouraged to believe that changing your sex is as easy as deciding that you’d prefer to wear a dress and that being male and female is all about the toys you wish to play with and the various superheroes or children’s characters you like and dislike?

Does the fact that Savannah has two daddies or that Kacey-Eve only has a mum, mean that children need to be taught about adult sexuality in depth in order to be ‘safe’, or will a simple ‘be kind, be nice, be loving and respectful to everybody, including to those different to you’, no longer suffice?

My pink and green diagonally striped ‘barber’s pole’ is as sound a metaphor as any, when we’re talking about the usefulness of primary school sex ed.

NFA – the perfect example of Gradualism

I’ve been meaning to revisit the topic of NFP or, as I would prefer to call it, NFA and Joseph Shaw has provided me with the perfect opportunity, with a blogpost critiquing this rather natty little video, promoting the benefits of NFP, as opposed to conventional contraception.

First off, I think Catholics need to stop referring to NFP (Natural Family Planning) and instead refer to NFA – Natural Fertility Awareness. The semantics here are important: the former term implies a contraceptive mindset, validating the secular mindset that every family needs to be meticulously planned in terms of timing and number of children, whereas Natural Fertility Awareness is more accurate in terms of the (more often than not) Catholic mindset of those who adopt this attitude towards their sex lives.

Unlike the secular rigidity of the term Family Planning, favoured by our state health agencies, the phrase Natural Fertility Awareness conveys something of the fluidity and indeed flexibility, of the process. Moreover one does not need to be sexually active in order to monitor one’s own fertility and I’m a great advocate of young women (and indeed young men) being versed in the basic principles, before they may actually need to practice it.

There is nothing inherently immoral about teaching young women how to be aware of and chart their individual fertility – the process takes a few months to get to grips with and do so accurately. The engagement period tends to be a busy and frenetic time. observations can be missed or mistaken. It isn’t unreasonable for a married couple to wish for a short honeymoon period where they aren’t plunged straight into the trials and tribulations of pregnancy at a time when they may be attempting to consolidate financially, especially if they have not previously been cohabiting or sexually intimate.

Indeed if more young women were to monitor their fertility then arguably potential problems could be identified and treated more swiftly. Even, Sir Robert Winston, the IVF pioneer has argued that too many women are being automatically referred for IVF treatment after a failure to conceive, when cheaper and more effective treatments may be available. (Such as for example, the NaPro Centre in Ireland).

Natural Fertility Awareness is scorned by the vast majority of the medical profession, who do not understand it and believe it to be some sort of outdated rhythm method from 50 years ago as opposed to a rigorously scientific method, based on a woman’s own individual fertility, rather than the standardised version assumed by manufacturers of hormonal contraception. This leads to a passive attitude adopted by woman, who are taught to believe that their natural fertility is an out of control monster which needs to be medically  suppressed in order for them to stay healthy.

Last week my youngest daughter came up with an alarming looking rash, (it turned out to be some sort of pityriasis) which needed swift checking out by a medic. Unable to get a GP appointment within a few days, I took her instead to the walk-in centre in central Brighton so she could be seen swiftly. This particular centre also happened to be an anonymous walk-in sexual health and GUM clinic. I was particularly struck by the larger -than-life size posters advertising their sexual health and contraceptive services. Basically there was nowhere you could look without seeing adverts for sexual health prominently displayed. (Which is understandable when you consider Brighton’s considerable LGBT population and the location of the clinic, next to the railway station. You can pop in for an anonymous HIV test).

I was sat in front of an enormous six foot banner stand, which displayed a photograph of a clean-cut, wholesome-looking, causal but modestly dressed, pretty young blond woman, advertising “reproductive health services.’ The image has stayed with me precisely because as I thought at the time, the model was obviously chosen for her ordinary look. The message was crystal clear, all young women will be having sex and therefore they need to ensure that they do not have an unwanted pregnancy or contract any sexually transmitted diseases.

It was precisely the sort of image that I identified with as a teenager or in my twenties, just a normal-looking young woman, probably a professional of some sort, living a normal adult life, in sexual relationships and needing to make sure that she was healthy. Sexual health being just one more adult responsibility that she had to deal with. Take the pill, use condoms with new partners, get checked from time to time to make sure you haven’t inadvertently picked up anything nasty – no big deal, all part of being an empowered grown up.

I had bought into that entire mindset which is why the poster really struck a chord with me.  I too was that ‘empowered’ young woman who believed that all romantic relationships ought to involve sex and that consensual one-night stands were no problem. Sex was  a fun and exciting thing to do and most people who had an unplanned pregnancy had been a bit stupid. (Until it happened to me). Everywhere young women go, they are subtly indoctrinated into a certain way of thinking about sex and their sex lives. The poster was deliberately designed to feature a bland image of an everyday, normal attractive woman, with whom most woman would identify. No doubt in other areas, the models used would vary according to demographics.

Which is why it is so important that women are introduced into another way of thinking about their fertility, namely monitoring their own individual cycles instead of being duped into a passive acceptance of long-term hormonal suppression as being the norm.

This is why I don’t have so much of a problem as Joseph Shaw does, in terms of the secular nature of the video, which is perhaps designed to reach beyond the Catholic faithful.

I’ve personally found NFA to be so enriching for my marriage, despite not always managing to avoid pregnancy, that I want to share it with others because it’s a great thing in and of itself, and as Dr Shaw notes, the fewer people pumping estrogen into atmosphere or suffering from potential side effects, the better. Sceptic readers could do worse than read Sweetening the Pill. In January 2014, Vanity Fair published a 10,000 word expose of the Nuvaring, which has been responsible for thousands of avoidable blood clots and hundreds of deaths, all suppressed by the manufacturers who are now facing lawsuits. Wanting to get women off this stuff is an act of charity and mercy.

Advocating NFA to non-Catholics is the perfect example of graduality – get women onto a more natural and healthier way of avoiding pregnancy and it may well prove a useful first stepping stone in terms of evangelisation. It also might do something to engender better attitudes to sex and the rejection of female instrumentalisation, which has to be in the interests of the common good. I cannot emphasise how much of an uphill battle it is to overturn the entrenched attitudes hammered into children by well-meaning but ultimately ideologically blind professionals, since pre-adolescence.

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Every secular priest ought to read this too. Ideally have a copy on hand to lend to couples.

For Catholics struggling with NFA, I strongly recommend Simcha Fisher’s Sinner’s Guide to Natural Family Planning, which is unashamedly written from a Catholic perspective. The book does not tell you how to chart, it does not give the pros and cons of NFA, it does not moralise, or tell you how many children you ought to have, but rather it acts as a spiritual accompaniement purely in terms of the sex and relationship issues related to NFP. If only it had been written two years ago when I was struggling with an unplanned pregnancy, in extremely challenging circumstances. Not only should married couples read it, but anyone involved in any sort of ministry involving engaged and married couples and yes priests, I mean you – it’s not a heavy theological tome, it’ll take a couple of days at most, but most definitely a decent use of your time.

Like Joseph, Simcha identifies the notion of being ‘baby-phobic’ but nonetheless she expclicity rejects the idea of the ‘contraceptive mentality’ that many Catholics using NFA have supposedly adopted. Certainly every Catholic I know who uses NFP, does so with a prayerful mentality and to accept NFA is also to accept that sex could always result in a baby, something that our experience has taught us.

In the aftermath of the Synod, there is a troubling narrative doing the rounds, namely that Catholics who avoid children must have a critical reason for doing so. As I said last year, this is explicitly, not the case, and to get hung up on the ‘grave and serious’ reasons for avoiding conceptions, ignores the actual teaching of Humanae Vitae.

What I said in August 2013, still seems pertinent.

Ultimately if a faithful Catholic couple is using NFP then they are still accepting and participating in God’s plan for creation. NFP/NFA accepts that no method of pregnancy avoidance, bar total abstinence is 100%. It is hugely unlikely that such a couple would then opt for abortion or reject an unplanned pregnancy. Practicing NFP constantly reminds one that this is always a possibility which is why NFP encourages spouses to care for and take responsibility for each other.

We should not berate those who use it in good conscience, procreation is one of the missions of marriage but not the sole mission, there are other ways of building the kingdom, the church does not treat children as a moral good to be pursued at the expense of all other moral goods. Gaudium et Spes 50 suggests that having a large family would be the generous thing to do, but also states that it is up to couples to decide.

But berating those for using NFP to avoid in good conscience, or discouraging discussion of using NFP to plan a family responsibly, is not the way to go, particularly for those encountering these concepts for the first time, which sadly seems to be a not insignificant proportion of the faithful.

To be clear, Joe Shaw did not advocate that everyone should have 10 children, nor did he insist that the reasons for avoiding children ought to be life-threatening, but he was stating that the vocation of marriage must include openness to children. The challenge is how to communicate this beyond the Catholic faithful.

Postscript for the sake of transparency

I am extremely happy to go on record as saying that following the birth of our fifth (God willing, living) child in March, I am no longer open to pregnancy.

I should not need to justify this to the Catholic faithful and it speaks volumes that I immediately feel defensive about this decision. Couples ought to be trusted to prayerfully discern what is right for them in their particular circumstances without having to defend themselves to random shouty online strangers.

For those wishing to ‘judge’ my Catholicity, the reasons are as follows:

  1. As I age, pregnancy is exacting an increasing toll on my body physically. This is in turn having an impact on the rest of the family as I am constantly exhausted and unable to function at full capacity. Due to the transient nature of our living circumstances over the past few years, there are no family or friends close by to help pick up the slack. While pregnancy is only a temporary stage, this recent piece from First Things notes that Catholics should not shy away from accepting and validating its difficulties. I am one of those women for whom pregnancy is a form of the Passion.
  2. I am facing my fourth cesarian section. While I know of women who have had as many as seven, 4 is considered the upper limit for this to be performed safely by most surgeons. During the birth of our youngest daughter there were some difficulties in terms of scar tissue and a large amount of adhesions; this next procedure is expected to be complicated and may well result in some damage to surrounding organs or emergency hysterectomy. A recent ante-natal appointment resulted not in discussion of the wellbeing of my unborn baby, but my being exhorted to accept sterilisation while I was on the table. An option which I have declined.

So no doubt in being very clear that we wish to avoid pregnancy – we fall into the scandalous contraceptive mindset. Perhaps the difference is that it’s not that we reject the idea of further children, but of further pregnancies?

However if the Catholic Church really wishes to throw off her image of misogynistic judgementalism, perhaps advocates of the vocation of marriage, ought to embrace the positive instead of loudly critiquing what they believe to be the motivations of the imaginary minority. I don’t need some shouty man imagining that he can persuade the world to tell me how I need to put my health and family at risk if I wish to save my soul or trying to engage me in online discussion about how married couples need to be open to life 100% of the time. Actually this is one issue where the feminists have a point, there is something particularly grating about a man who does not ever experience the physical tribulations of pregnancy and childbirth telling women how they ought to feel about the subject, no matter how logical, rational or theologically correct he may be.

Using NFA requires trust and a whole new way of thinking. Let’s encourage people to do that without telling them exactly what their decisions should be or implying that they ought to have fifty children until their uterus drops out.

UK 2013 abortion statistics: few reasons to be cheerful

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It’s that time of year again  – the UK abortion stats have been released for 2013, which will be carefully crafted into a positive press release by agencies with a commercial interest and so we can expect to see cheerful headlines about the increase in early abortion and the declining abortion rate in women aged 15-44.

The real story is rather more complicated. The rate of women aged 15-44 having an abortion has declined to 15.9 per 1,000 and is indeed at its lowest for 16 years. But the overall total of abortions performed in the UK in 2013 has slightly increased from last years figure and is 2.3% higher than 10 years ago. The amount of women choosing to have an abortion might be in decline, but all is not lost for the private clinics – those who do have an abortion are likely to be repeat customers. In any event we shouldn’t forget that despite being at its lowest level for some time, in 2013 the rate of women having an abortion was double that of 1970.

The pro-choice, pro lots of lovely sex ed and contraception lobby find themselves in something of a bind. There is the very welcome news that abortion rate for the under-16s and the under 18s shows a steady decline, in common with teen pregnancies. “See, hooray look, lots of education and access to contraception in schools is the answer” they will cry, with collective pats on the back, affirming blogposts and accompanying PR about ‘evidence-based’ choice. Indeed the rate of abortions performed on those under the age of 22 is declining. Fewer young people going through the agony of abortion is something that folk on all sides of the debate will applaud.

But here’s the rub: the numbers of those aged 22 and above having an abortion remains static from 2012. Which means that either people are suddenly forgetting what teacher told them about the banana and the condom and the handy over-the-counter pill back in 4B, or that they are taking more risks, or as is most likely to be the case, that this is the age where regular sexual activity is the norm. A 22 year old is far more likely to be cohabiting or having sex on a more frequent basis than a 16 year old whose sex life will probably consist of sporadic chaotic fumbles. By the time you’ve got to 22, most young women will have imbibed the mantras of Cosmpolitan and the like and be aiming for some sort of quality and consistency in their intimate life.

And why shouldn’t they, will be the riposte of the feminists. What’s the point of equality if you can’t have multiple orgasms and demand that a partner gives you 100% satisfaction, and obey your whims 100% of the time, just for the privilege of being with you?!

I digress, but what this cultural demand and expectation that women really ought to be demanding marvellous sex lives means (and I’m all for the latter, trust me, I just don’t believe that the vision women are being sold leads to anything other than narcissist, paranoid and ultimately frustrating intimate encounters) is that it makes women entirely reliant on contraception. If you know that pregnancy would spell a disaster then it’s the ‘responsible’ thing to use contraception because you know, swinging from the chandeliers and achieving orgasms in double figures is your birthright as a woman. If you’re not having lots of juicy sex ,then let’s face it you’re probably a freak, there’s something wrong with you and nobody would want to be with you anyway!

So all these emancipated young women are totally dependent on their contraception, which is a bit of a problem considering that no method is 100% effective! Which is where the kindly ‘abortions for only £700 a time charged directly to your local NHS trust’, BPAS come in, with their reassuring campaigns that you are not alone, 1 in 3 women will need an abortion in their lifetime and that around 66% of their clients have managed to conceive while using contraception. Still, once you’ve had an abortion the clinics will kindly advise you on future contraception to guarantee repeat custom, under the guise of altruism, selling the expectation that you won’t once again end up in that 66% bracket.

If you think I’m being just an itsy bitsy bit cynical, then it’s worth remembering that the 2013 abortion figures demonstrate that the number of abortions performed in private clinics which are paid for by the NHS are at an all-time high of 64%, up on 62% of the previous year.

The repeat abortion figures are in fact, astonishingly high, 44% of all women aged 25-29  ending their pregnancies in 2013 underwent a repeat abortion, a figure which rose to 47% in the 30-34 age bracket and then dipped to 45% in the over 35’s. It seems that once you have had one abortion, you are more than likely to have another.

With repeat abortions at 37% amongst all women in 2013, compared to 32% in 2012, it’s no wonder that the clinics describe it as a ‘need’. Almost 50,000 women who had an abortion last year, had already had one. Black or Black British women and those of mixed race were more likely to have had an abortion than white women and other groups. Interestingly Asian and Chinese women have the lowest preponderance of repeat abortions, despite the fact that Asian women are likely to be more affected by the issue of gendercide – perhaps this is indicative the rise of the professional Asian class in the UK.

At a time Catholics are being blamed for their attitudes towards sex and stigmatising of single mothers in twentieth century Ireland, not much has changed. Around 81% of abortions were performed in 2013 upon single women, a number which has risen slowly from 76%, ten years ago in 2003.

Another statistic to be vaunted will be the number of abortions carried out under 13 weeks,  comprising 91% of the total, same as last year, but that abortions under 10 weeks had risen to 79% compared with 77% in 2012 and 59% in 2003.

The subtext here is that the earlier an abortion the better, both for mother and child alike (although a dead baby is a dead baby at whatever stage it’s at) but the complication rates seem to have risen in that 11% of women having an abortion under 10 weeks needed a stay of at least 1 night in hospital. The rate of complications obviously rises the further progressed you are in pregnancy, 25% of abortions of 13-19 weeks required a hospital stay, rising to 57% of those more than 20 weeks or more. We shouldn’t forget that complications experienced once you have left the clinic premises are not recorded.

The rise in early abortions, and medical abortions indicate that women are making their decision earlier than ever before. This once again raises the contentious issue of counselling – if 64% of all abortions are being carried out in private clinics on behalf of the NHS, then it’s imperative that women are not rushed into making a decision due to the time limits of one particular method.

The high number of abortions being carried out by private providers using NHS funds highlights the need for accountability to the public by abortion clinics along with the organisations which they fund to go into schools. This week we’ve seen that well over half of the abortions carried out on the grounds that the baby had Downs Syndrome were not properly recorded, with most information being lost. Add in the fact that doctors caught pre-signing abortion forms without seeing a patient were neither prosecuted nor did they have to face a fitness to practice hearing, despite being in breach of the law, then one has to wonder at the wisdom of yet further liberalising the practice of abortion law.

The clinics have not yet shown that they can be trusted. It will be interesting to see if there is any variation in these figures now the government have clarified that the practice of gender selective abortion is illegal.

One final stat here. So often we hear that late stage abortions are a necessary option for those who discover that their baby has a terrible anomaly.

Leaving aside the arguments about whether or not we ought to impose our vision of what constitutes quality of life to justify depriving another of life, ‘feticide’ was the word which jumped out at me while looking at the table which outlined the methods used to abort the baby, admitting that direct action to end the life of the baby was performed prior to their forced evacuation from the womb.

Of those who aborted their babies between the ages of 20-24 weeks, 904 were on the grounds of fetal anomaly, which means 1,659 babies were aborted at a time when the mother was over-half way through her pregnancy, the baby was fully formed, waving, kicking, smiling and the mother would have felt the movements, simply because they were no longer wanted.

To put that figure in some kind of context, that’s more than the 1,491 live births to women aged 38-39 from 7,500 cycles of IVF. Or how about comparing the 8,500 abortions performed in 2013 on women in the over-40 age bracket with the 6,355 cycles of IVF resulting in 822 births in women in the age 40-42 cohort. What kind of a pickle have we got ourselves into?

When is society going to wake up to the screwy schizophrenia surrounding female fertility instead of patting ourselves on how well we are doing at educating people into a pattern of repeat abortions.

It’s not about regulating others’ sex lives or controlling their bodies but recognising that not only does this take the life of an unborn child but it also causes irreparable pain and suffering to so many women. I don’t which is more depressing. That nothing has changed, the lives lost to abortion in 2013 or that this time next year I’ll be saying exactly the same thing.

 

The knots of infertility

This morning, I was invited back on to breakfast television to reprise the argument I made on the programme last year regarding the NICE guidelines which recommended that infertile couples should be given 3 cycles of IVF on the NHS.

Since then it transpires that over three quarters of NHS trusts are disregarding the guidance, leading NICE to issue even stronger advice forcing Clinical Commissioning Groups to implement their IVF guidelines, to end the ‘postcode lottery’ system which produces massive inequality in terms of how qualifying couples are treated.

In this instance inequality is not an inappropriate description of the situation. The NHS should provide an equal standard of care across the country – if it has determined that infertile couples should be afforded 3 cycles of IVF treatment then that should apply to you regardless of whether you live within affluent city suburbs, in a remote part of the country or on a run-down council estate.

If IVF is an accepted medical treatment on a par with chemotherapy for example, then it should not be withheld from anyone because their local health trust has decided that they cannot afford it and their priorities lie elsewhere.

The trouble is, of course, that whilst IVF is a medical treatment, opinion is massively and legitimately divided as to whether or not this ought to be funded by the NHS, given that infertility in and of itself is not a fatal, life-threatening or even life-limiting condition, unless one extends the medical definition of life-limiting to encompass quality of life issues.

That’s not to downplay the devastating effects of infertility which can undoubtedly cause emotional ill-health, but simply to note that an inability to conceive won’t actually kill you neither is there any research to prove that it might shorten your lifespan.

This certainly seems to be the view that various CCGs have taken faced with increasing budget constraints and difficult decisions as to where to channel their funds, and its one with which many of us will have sympathy. If the choice is between paying for drugs to extend the lifespan of a cancer patient, a hip operation or heart bypass for an elderly patient and whether or not to fund a form of therapy which could lead to a couple having a much wanted child, then for most right-thinking people, the choice is clear. Our priority should be with assisting the already-living and vulnerable rather than ignoring them in favour of creating their replacements.

As I pointed out last year, NICE guidelines have a habit of becoming quasi-legislation and thus last week former health secretary Andrew Lansley (responsible for the stealthy and undemocratic liberalisation of abortion law) has said that CCGs have a responsibility to obey NICE rules despite the fact that they are not actual pieces of legislation. Spot the inconsistency. In the eyes of Mr Lansley, NICE comes before the letter and spirit of the law.

So slowly but surely, British law has introduced and supported the notion that a child is something that every single person or couple should have a right to and for which the state  should pay. Consider the language of Sarah Norcross, co-chairman of the National Infertility Awareness Campaign who says “it’s high time that patients were allowed to access the treatment that they were entitled to”.

The ethics of entitlement and so-called equality therefore override any other considerations. If you are entitled to medical treatment on the NHS, then you should be given it regardless of other factors. If not being able to have a child is automatically designated as being a medical issue, because it takes clinical measures to achieve one, then it’s some kind of ‘ist’ or phobic to deny the treatment to someone, taking into account their lifestyle or individual circumstances. The needs of the adult are paramount, the needs of the child secondary – all that’s needed is love and the desire to access costly and gruelling treatment is sufficient evidence of suitability and should overcome all other considerations.

Apologies for beating the same allegedly homphobic drum, but recent HFEA stats show that there was a 36% increase in lesbian couples using IVF between 2010 and 2012. No matter how much sympathy one may or may not have for two women deciding to disregard a child’s right to a father, it’s not bigoted to ask whether or not this is really the sort of thing Bevan had in mind when he put in place the founding principles of the NHS? Should a single man or woman have the same right to access this treatment as married opposite gender couple? If resources are scarce, and IVF is going to be an accepted treatment, is it really so heinous to prioritise the married couple in a stable relationship who have been trying to conceive over a number years and have suffered a number of miscarriages over other scenarios? Or does the defining zeitgeist of equality mean that all situations and circumstances have to be treated equally regardless of merit? To say that one person may be more deserving of another, whether that be in the field of IVF or the even more controversial field of welfare and benefits, is today’s unspeakable heresy. In our relativistic world no one set of circumstances must ever be judged as being better or worse than another.

Another unpalatable fact that no-one seems to want to discuss when discussing the ethics of IVF on the NHS is the ethics of IVF itself. So when I attempted to point out that for every live birth that comes about due to IVF, another 30 embryos are created and that of the 4 million embryos created since 1991, only a tiny proportion have made it through to birth – this point was brushed aside. The discussion has to centre around the ethics of the treatment being made available for free, regardless of whether the treatment is in itself ethical.

I don’t know what is more frustrating, the entitlement culture, the disregard for the welfare of children or the wilful short-sightedness. Any other expensive treatment costing around £3.5K to £5K a time which had a less than 25% chance of success would not see NICE attempting to impose it upon CCGs as a matter of routine, especially when the treatment itself is so physically and emotionally demanding. It would instead be allocated according to individual circumstances.

As I said on the programme, it seems that we’ve got ourselves in something of a pickle with regards to fertility. On the one hand there’s couples crying out for IVF and the opportunity for a biological child of their own, on the other almost 200,000 abortions take place in the UK every year. Added to which abortion rates amongst women in their ‘30s and ‘40s are rising as women believe that they are no longer fertile.

It’s time for some joined-up social policy thinking on this issue. We know that with a little bit of training women can be trained to monitor and track their monthly cycles and pinpoint with a high degree of accuracy the fertile periods every month.

Women are given so many mixed messages and conflicting signals about their own fertility it’s not surprising that so many of us fail to navigate successfully through the reproductive minefield. Instead of teaching young women how to avoid pregnancy and that sex can be devoid of consequences how about teaching girls (and boys for that matter) the specifics of how to track female fertility. Instead of teaching them that fertility is an obstacle which must be suppressed via chemical hormones and abortion a useful and necessary back-up, why not help them to empower themselves in terms of learning the ebbs and flows of their own unique monthly cycle.

Armed with that information, they can then make the decisions which they feel are most appropriate, especially during the window of peak fertility. Tracking monthly cycles has another advantage in that it enables abnormal cycles or potential issues and barriers to conception to be identified and treated.

If the NHS is serious about wanting to tackle infertility, then instead of chucking money at what is a not very effective sticking plaster, a more pragmatic and cost-effective solution is to enable both women and medical practitioners to become specialists in natural female fertility instead of attempting to artificially suppress it until such time as it might be needed and then attempting to employ a costly treatment with a 75% chance of failure.

Even more radical, instead of teaching young girls that pregnancy is to be avoided until an indeterminate date in the distant future, how about education that focuses their minds on real family planning and the pros and cons of early versus late motherhood? How about going a step further and implementing far better childcare and maternity solutions and options for university students. While we’re at it why not chuck in cheap starter homes for young couples and measures to make life more attractive and conducive for young families?

Unfortunately the genie is out of the bottle when it comes to IVF and it would take a heart of stone not to sympathise with women like Jessica Hepburn who was interviewed alongside me earlier. What I wouldn’t do to be able to wave a wand and give her a baby and find a method that was successful, devoid of harmful physical side-effects and didn’t involve the destruction of life. Disagreeing with the use of technology does not extend to blaming or shaming those who want to avail themselves of it.

Heartbreaking, unexplained and untreatable cases of infertility cannot be completely eliminated, but with a bit more joined up thinking, the need for both IVF and at the other end of the spectrum abortion, could be drastically reduced.

Catholics reading this might be aware that today marks the start of a novena to Mary, Undoer of Knots. Dedicating it to couples facing the pain of infertility seems a good place to start.

 

The taboo of behaviour change

Most people accept and acknowledge that behaviour is an important factor when it comes to matters of health. Although we cannot change our genetics, certain people are predisposed towards conditions such as cancer, there are things that we can do to mitigate risk and attempt to maintain optimum health. We know that smokers substantially increase their chances of contracting disorders affecting their pulmonary and circulatory systems, we accept that eating saturated fats and salt in large quantities increases our risk of heart attacks, we accept that obesity is linked to diabetes and that ideally we should eat at least five portions of fruit and vegetables a day as well as take regular exercise.

Very few people kick up a fuss when the benefits of adopting certain behaviours are suggested and promoted by the government, we know that excessive drinking is bad for us, we know that pregnant women shouldn’t smoke and various health authorities and advisors are playing around with the idea of financially incentivising or discouraging certain behaviours in the interest of public health. One health authority is trialling the idea of financially rewarding mothers who breastfeed with a voucher system, in order to reboot and kick start a culture of breastfeeding which, if the mother is able to do so (the overwhelming majority of women can breastfeed with the right advice and support) is best for the child. We’ve seen minimum alcohol pricing introduced in Scotland and mooted in the UK, along with taxes on fast food, dubbed the ‘fat tax’. There’s also talk of making vaccinations compulsory for children in order to qualify for child benefit.

So why  is it, when it comes to issues of sexual health, proposing certain behaviours should be adopted, such as abstinence until marriage and remaining faithful and monogamous to one sexual partner only, becomes the subject of immense vitriol and scorn?

Those who follow me on Twitter, would do well to have a look at an illuminating discussion held over the course of the last few days. Leaving aside the usual awfulness comprised of “you have bizarre morals, you’d rather your children got cancer than had sex, you are twisted, everyone hates you, oh look now you’re playing victim again, you’re only doing this for attention, you ought to get off Twitter, no one listens to you and thank God you are not like most Catholics” (requisite skin of a rhinoceros is yet to form, it is hard to repeatedly attract such unfounded abuse) what seemed to be causing unprecedented amounts of opprobrium was the idea that sexual behaviour is key in terms of maintaining optimal sexual health and avoiding the transmission of STDs.

The first issue being that of the HPV vaccine which it is recommended that girls receive in early adolescence before they commence sexual activity. In a misleading advertising campaign, the NHS suggests that once the girls receive the vaccine they are therefore “armed for life”. As this interview with one of the lead researchers responsible for the development of the vaccine used in the UK, Gardasil, makes clear, HPV vaccination has its disadvantages as well its advantages. Instead of being armed for life, as the NHS advert suggests, the vaccine has a limited effect, lasting up to 15 years maximum.

Armed for life, or 5-15 years? Armed against every strain, or just a few?
Armed for life, or 5-15 years? Armed against every strain, or just a few?

The vaccine is not an immunisation against cervical cancer, but rather the HPV virus, which is present in almost all forms  of cervical cancer and believed to be responsible for the condition. While considering whether or not one ought to allow one’s child to be vaccinated, one needs to weigh up all information available, such as efficacy and benefits versus the risks.

As with all vaccines, there are risks with Gardasil, including auto-immune disorders and even death, although these are rare. As Marcia Yerman points out, this vaccine does not protect women for life, they can still get other HPV infections which are not covered by the jab and they must not neglect regular cervical smear tests, which are vital in terms of discovering and treating pre-cancerous cells.

An immunisation may protect you from certain forms of HPV which could lead to cancer, however cervical cancer is as my gynaecologist once put it, “one of the must stupid cancers to die from” in that is is easily treatable if caught early. Regular pap smears detect abnormal or precancerous cells which are then promptly removed before they have a chance to develop into full-blown cancer.

The best way to avoid infection with HPV, which is a purely sexually transmitted disease, is to limit the number of sexual partners you have, the ideal being to have just one sexual partner and remain faithful them to the rest of your life. If your sexual partner has equally never had any sexual contact with anyone else then your risk of developing an HPV infection which could lead to cancer is negligible. Worringly, there seems to be an emergence of head and neck cancers related to HPV infection, contracted through oral sexual contact.

While HPV vaccination could prevent infection, aside from the small risks of an adverse reaction, the danger is not that it will encourage promiscuity, (and regardless of vaccine, promiscuous behaviour is risky) but that it will encourage the phenomenon of risk compensation, as experienced by Professor Edward Green, former Professor of HIV Prevention at Harvard. Believing that they have been immunised against cervical cancer, girls may be encouraged not to use barrier forms of contraception and/or engage in sexual behaviour that they would otherwise have avoided, under the illusion that they were safe and protected. Most concerning is that they may be discouraged from participating in the cervical screening programme, (most women approach their smear with reluctance, no-one relishes the experience, it is a necessary uncomfortable part of health care) believing that they are protected from cervical cancer. An HPV jab isn’t going to prevent the development of precancerous cells let alone treat them.

Pap smears have never killed anyone. Pap smears are an effective screening tool to prevent cervical cancer. Pap smears alone prevent more cervical cancers than vaccines. The argument is best summed up by Marcia Yerman thus:

Gardasil is associated with serious adverse events, including death. If Gardasil is given to 11 year olds, and the vaccine does not last at least fifteen years, then there is no benefit – and only risk – for the young girl. Vaccinating will not reduce the population incidence of cervical cancer if the woman continues to get Pap screening throughout her life.

If a woman is never going to get Pap screening, then a HPV vaccine could offer her a better chance of not developing cervical cancer, and this protection may be valued by the woman as worth the small but real risks of serious adverse events. On the other hand, the woman may not value the protection from Gardasil as being worth the risk knowing that 1) she is at low risk for a persistent HPV infection and 2) most precancers can be detected and treated successfully. It is entirely a personal value judgment.

What is left out is that 95% of all HPV infections are cleared spontaneously by the body’s immune system. The remaining 5% progress to cancer precursors. Cancer precursors, specifically CIN 3, progresses to invasive cancer in the following proportions: 20% of women with CIN 3 progress to invasive cervical cancer in five years; 40% progress to cervical cancer in thirty years. There is ample time to detect and treat the early precancers and early stage cancers for 100% cure.

So really there is no need for the “Lord spare us from ignorant Catholic houseswives putting out dangerous information” “your daughters will get cancer”, “Farrow is spreading dangerous lies”, “you are pro-cancer and pro-HIV” invective spewing across my timeline.

Problem is, in a society when personal autonomy and choices are gods, suggesting anything other than all choices are of equal value (moral relativism) is akin to judgemental bigotry. It might be extremely convenient for me that Catholic doctrine on sexual morality is  scientifically sound, natural law is entirely logical, but it’s a nightmare for sexual libertines, most of whom seem to be unhealthily preoccupied or obsessed with others’ approval. Advocating a certain course of action is automatically deemed ‘judgemental’ or ‘blaming’ of those who don’t take that course of action and allegedly stigmatises those who do suffer from adverse health, regardless of whether or not they have engaged in risky behaviour.

The idea of a society when people can have as much sex as they like, with as many people as like, consequence free and that we can protect people from STDs might well be a beguiling one, but it is highly irresponsible. HPV vaccines, condoms, birth control and abortion all add to this masquerade, which is why people become so angry when their lifestyle is challenged. It’s easy to dismiss moral concerns as being based upon religious grounds but pointing out irrefutably scientifically established health risks raises things another notch. It must be disconcerting to learn that the prejudiced bigots are right, better to attack their motivation, values or character, instead of the issue itself.

The whole canard of HIV prevention in Africa was once again raised, with all evidence being dismissed as biased, simply because of the fact that it was presented by me and supported Catholic doctrine. As has been demonstrated, the Emeritus Pope was entirely correct when he pointed out that condom promotion exacerbated the problem of the spread of HIV. Condoms have a typical use failure rate of 18%, the spontaneous nature of sexual urgency makes laboratory conditions of perfect use, extremely difficult to replicate. Problems are exacerbated in countries such as Malawi, which as aid workers testify, are flooded with condoms nearing their expiry date and which have been stored and shipped in conditions making them more susceptible to damage. People are making risky decisions on the false premise that they are protected.

I guess I’m rather nonplussed, it’s bizarre to see coherent evidence denied simply because it supports your worldview. The ‘debate’ veered from accusations of making stuff up, of putting out irresponsible information on internet that would cause deaths, to an admission that I hadn’t actually said anything factually incorrect, but was cherry-picking the evidence to suit my own purposes. Isn’t that what most people do, come to a conclusion based on the evidence available?

Sexual health is not the only area in which emotions are inflamed when suggestions are made of an unhealthy lifestyle as being a contributory factor to certain conditions, and the age of moral relativism means that all are equal. Hence the perennial wars on baby websites about breast versus bottle. Health decisions, especially for children always involve  heavy personal investment. I’ve taken decisions (such as miscarriage management) that may not have been advocated as the best course of action as others, but the difference is, I’m not going to get offended if someone suggests I should have done something else, in the same way, I couldn’t give two hoots if someone thinks my cesarian-sections were because I was too posh to push. I know a natural childbirth is ideal but just because life doesn’t always work out the way you’d hope, doesn’t mean that we shouldn’t aspire to the best.

Trying to discourage promiscuity, instead of relying upon the illusions and false promises of the pharmaceutical society, has to be a much more sustainable, long-term and ultimately cheaper solution. Pointing out that condoms don’t always work should not be an issue to cause such bad feeling. Why aren’t we asking why until the HPV jab was developed, that condom manufacturers and family planning officials were not widely publicising that they didn’t fully protect from HPV?

Evidently I’m still a naif, in that I’m still taken aback and surprised by the animus coming in my direction, for stating a medical fact. Stick to one sexual partner only (or remain celibate) if you want to seriously lessen your chances of contracting a sexually transmitted condition. It may not be the easiest, it may take willpower, but it’s no more impossible than say quitting smoking or cutting out the booze. You just have to want to do it. Stating the ideal does not blame the unlucky.

I may well get a t-shirt printed – Catholic teaching on sex corresponds with medical fact, get over it. What is more dangerous, giving an illusion of protection, or presenting the pure unadulterated facts as they stand?

While I should no longer be surprised, I still find myself taken aback nonetheless. Why are otherwise intelligent people so willfully blind when it comes to the consequences of sexual behaviour? Uncharitably, the only conclusion I can arrive at that is that it’s concrete proof that sin really does darken the intellect and make you stupid. People are too attached to a certain behaviour to want to admit that it could cause harm.