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School Health Services - Well schooled in teenage sexual health matters.

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Viv Crouch, RGN.

School Nurse based at Bath and North East Somerset Primary Care Trust and a Nurse Adviser to the Teenage Pregnancy Strategy Group.

Does the availability of emergency contraception from the school nurse encourage teenagers to have unprotected sex?

Does the availability of emergency contraception from the school nurse encourage teenagers to have unprotected sex?

While some people will assert this is the case, in my experience as a school nurse, unprotected sex is often the result of too much alcohol, rather than the knowledge that the consequences will be easy to sort out at school the following day.

Some people also feel that such provision takes away the rights of parents and raises the question of whether school the right place to deal with young people's sexual health needs.

While the debate continues, the consequences of unprotected sex can be serious. Research for the Teenage Pregnancy Unit shows that:

- Teenage mothers are less likely to complete their education and to find a good job

- Their children are more likely to be brought up in poverty and experience ongoing poor health

- Half the conceptions in under-16s end in abortions

- Many sexually active young people do not have the knowledge and confidence to obtain or use contraception.

Young people, including those under 16, have a legal entitlement to a full range of health services in their own right, but this can be difficult in rural areas or poorly serviced inner-city estates.

School-based sexual health services that offer contraception alongside broader education about health, relationships, sex, drugs and alcohol can help overcome such problems and help young people to make informed, responsible choices.

Under a patient group direction, school nurses can now issue Levonelle-2, but no nurse should be forced to issue contraception if she/he does not feel it is right or does not feel competent to do so.

The decision to offer contraceptive services within the role of the school nurse must be made by each school's governing body. The initiative must be made explicit in the school's sex-and-relationship education policy, which should be developed together with parents.

Anxiety, confusion and embarrassment mean that young people often do things they may not be ready for. School-based services offer the chance to help them develop a sense of pride in their bodies, boost their self-esteem and respect for themselves and others.

Young people will value the chance to talk about sex and relationships, and some will require more individual advice - or simply time to talk in depth about problems affecting their ability to concentrate and learn.

Much of the impetus for schools and sexual-health services to forge constructive relationships has come from the government's drive to reduce teenage pregnancy. To achieve this, the aim is to offer young people a choice as to where they get help and support.

Health professionals working on school sites must remember to follow legal and policy guidelines. Provision of sexual health services to young people under 16, including pregnancy tests, must be made in line with the Fraser guidelines:

- Is the young person likely to understand the advice given?

- Is the young person likely to start having or to continue having sex without contraception?

- If the person does not receive the advice, are their physical and/

or mental health likely to suffer?

- If they cannot be persuaded to involve their parents, the advice and/or contraception offered by the health professional is in their best interests.

Competent young people are entitled to confidentiality in their dealings with health professionals, subject to exception where child protection issues may be involved.

Many school nurses combine the role of teaching as part of their school's sex and relationships education programme with providing confidential advice and support.

I see this service as an extension of the traditional school nurse role. It is not easy for a young person to admit they have had unprotected sex, and school nurses are : well placed to talk about sexual health issues and offer teenagers help and encouragement.

Further information: www.dfes.gov.uk/teenagepregnancy

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