Tánaiste Mary Harney's comments about contraception for 11-year-olds puts the spotlight on underage sex in Ireland, writes Kate Holmquist
Children as young as 10 are engaging in full sexual intercourse, according to a study conducted at Trinity College Dublin, which found that the average age of starting full sex was 13. This research focused on a group of "at risk" early school-leavers in programmes for the disadvantaged.
"But it's not a good idea to assume that sexual activity is not happening in the leafy suburbs," warns Dr Stephanie O'Keeffe, research manager with the Crisis Pregnancy Agency (CPA).
The trend is worrying. Larger studies show that the age at which teenagers have their first experience of sexual intercourse has plummeted by three years in the past decade, from an average age of 19 for girls and 18 for boys, to an average age of 15-and-a-half today, with some starting kissing at 12, heavy petting at 13 and full sex at the age of 14.
Many teens see virginity as a stigma, research at UCD has found, yet girls who succumb to the pressure to have sex are labelled "sluts" while boys are regarded as "studs". The greatest influence on girls' sexuality is the attitude of boys who they desire to please.
This scenario is as predictable as any MTV rap or r 'n' b video, in which the boys declaim their macho sexuality as the girls dance in service to the boys' beat.
In this atmosphere of premature sexualisation and peer pressure, one in five teens aged 13-17 has had sexual intercourse. When 18 and 19-year-olds are added to the group, the figure rises to 30 per cent. But by university age, 70 per cent have not had sex, which is high by European standards. When combined with teen fertility and abortion rates, this puts Irish teenagers in the lower half of the European league on measures of teen sexual activity.
Whether or not sex is truly consensual for young teenagers, in particular, is a question that worries experts.
"Girls can't be seen to take the lead in sexual intimacy. They believe they must please boys rather than their own sexual desires. It's very depressing," says O'Keeffe.
Children having babies without fully understanding how those babies came to be made is a small, but worrying, phenomenon. In the past 10 years in the Republic, babies were born to one 12-year-old, seven 13-year-olds, 97 14-year-olds and 550 15-year-olds, while an estimated 500 girls in the 12 to 15-year-old age group had abortions.
WHEN MARY HARNEY offered her view this week that 11-year-olds should be entitled to prescriptions for the morning-after pill and the contraceptive pill, she ignited a debate which is long overdue and far more complex than the mere issue of contraception. While her remarks may have given the impression that the pill is unavailable to under-16-year-olds, the reality is that every day of the week sexually active girls aged 15 and younger are being prescribed the pill with or without their parents' knowledge.
According to the Irish College of General Practitioners (ICGP), nearly all GPs - a handful of conscientious objectors excepted - believe that they have a "duty of care" to prescribe oral contraception to young teenagers who request it and, furthermore, that they are legally justified in doing so under a UK precedent, known as Gillick Competence. In a celebrated case 20 years ago, Victoria Gillick challenged her UK local authority's right to prescribe contraceptives to teenage girls under the age of 16 without their parents' knowledge. She lost her case on the grounds that the degree of parental control varied according to the child's understanding and intelligence, and that parental rights only existed so long as they were needed to protect the property and person of the child.
This precedent has never been tested in Irish case law.
Dr Eamon Shanahan, speaking on behalf of the ICGP, says that demand for the contraceptive pill in underage girls comes mostly from those aged 14-and-a-half and upwards.
"These are very sound and sensible girls. GPs make pragmatic decisions on a case-by-case basis. We have a duty of care to do what is best for the patient irrespective of age. Technically, a girl under the age of 16 who has had sex has been raped and we have to ask about the age of the partner and consider that this may be a case of child sexual abuse. I think there may well be cases where 14 and 15-year-old girls are not in a position to give informed consent [ to sexual intercourse].
"We would actively encourage every girl to seek parental consent before we prescribe. If the girl refuses, the vast majority of GPs would prescribe the [ contraceptive] pill if, in their considered judgment, the girl is at greater health risk from pregnancy than she is from being prescribed the pill," he explains.
The same ethical and legal criteria are used when prescribing the morning-after pill to underage teenage girls, says Dr Fiona Graham, GP and academic at UCD. "Most GPs would prescribe the morning-after pill. If anything, the morning-after pill is easier to prescribe to an under-16-year-old without parental consent because it's a once-off prescription, rather than a long-term prospect. It's also an opportunity to provide health screening and health awareness for the patient, which is why I would not like to see the morning-after pill being made available over-the-counter. Dealing with these situations is always a nightmare, but you have to make the best of a difficult situation."
THE RAPE CRISIS Network of 16 centres gets many calls from 14-year-olds in distress after bad sexual experiences. Mothers working on the Dublin rape crisis hotline this week expressed the view that they would be "appalled and hurt" to learn that their underage daughters had got the contraceptive pill without their knowledge, because it would mean that their daughters feared discussing it with them.
Teenagers' number one fear concerning sex is not pregnancy or sexually transmitted disease - it's being found out by their parents, research has found. Yet teenagers want to receive their sexual information and advice from their parents, rather than from schools, it also found. If parents are not involved in discussing sexual choices with their children, then it is peer groups, not schools' programmes and legislation, that inform young people's choices.
"The age of consent, which is 17 for girls and 15 for boys, doesn't matter to young people," says Dr Sheila Jones of the Irish Family Planning Association (IFPA), where the youngest patients being prescribed the morning-after pill and contraception are aged 13. Dr Jones's study in the European Journal of Contraception, published last month, found that the average age of starting sex in the State is 16 - with the youngest age 13.
"Prescribing the morning-after pill to 13 and 14-year-olds [ she has never seen an 11-year-old in her clinics] is always difficult for doctors, because it puts them out on a limb, but the alternative is far worse," she says. "I would never prescribe the [ contraceptive] pill to an 11-year-old because she'd forget to take it."
Many mothers and daughters jointly decide when the best time is to start having sex - even if the girl is not yet 16.
"I see a number of mothers bringing their daughters in for contraception - either the pill or injection. Occasionally, the girl is not sexually active and does not want contraception and the Mum is so eager to protect her, that she is annoyed when her daughter refuses," Dr Jones says.
The more open parents are to discussing sex with their children, the more likely the children are to postpone having sex, says Caroline Spillane of the CPA.
"The debate should go in the direction of parental responsibility. We are saying to parents that there is an absolute necessity of instilling values around sexuality in children, starting gently and early. It's not enough just to have 'the chat'. Sexuality must be discussed on a number of occasions. Research shows that kids want their parents to be involved in their decision-making, but that, while kids know the biological aspects of sex, they find communication with their parents difficult," she says.
Because many Irish parents say they lack confidence in talking about sex with their children, the CPA has produced a DVD, You Can Talk to Me, which is available from the CPA on disc, in public libraries, or to download free from its website. Leaving it up to the school to educate your children about sex is unwise, since research shows that children want to learn about sex from their parents - no one else.
Not only are many parents reluctant to face the realities of teen sexuality, public policy too has avoided the topic, O'Keeffe believes.
"We need good, reliable statistical information in order to make decisions in policy and practice," she argues. In recent pan-European surveys of health behaviours in school-age children, the sex questions have been eliminated from the Irish version of the survey, which means that research among 10 and 11-year-olds is scanty.
On the other hand, swamping teens with implicitly judgmental sex information, as the UK government has done on a massive scale, may be counterproductive.
"Teens believe that this policy has given them the message that teens who have sex are bad people," says O'Keeffe.
Parents, and the public in general, need to understand that teen sexuality "is not just about 11-year-olds getting the [ contraceptive] pill. It's a hugely broader thing," she concludes.