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.