Teenage pregnancy: the government's dilemma.

Introduction.

The phenomenon of teenage pregnancy has recently eclipsed lone parenthood as a focus of media and state concern, and of moral outrage. Although these two terms are often used interchangeably in politics and the media, Government policy has focused on tackling the 'problem' of teenage pregnancy. The latest case of a twelve year old pregnant girl, who claimed not to know who was the father of her baby, echoed earlier cases which had precipitated intense moral panic. Two years ago the news of a twelve year old Rotherham girl giving birth in the bathroom, coupled with the news of another pregnant twelve year old in Sheffield, prompted much press hysteria and a horrified Tony Blair to call for a 'new moral purpose' in Britain (Daily Express 30-8-1999). The recent hype is, in many ways, misleading because the actual rates have not in fact changed significantly since the 1970s, including the rates for under-sixteen year olds. Teenage pregnancy rates in other European counties have, however, fallen during the same pe riod. It is this fall that 'New Labour' has decided to attempt to emulate.

The Labour Government has significantly raised the political profile of teenage sexual behaviour. Teenage sexual health was prioritised in Our Healthier Nation (Department of Health 1998). This was followed by the Social Exclusion Unit's Teenage Pregnancy report, described as the first stage in a mission 'to develop an integrated strategy to cut rates of teenage parenthood...and propose better solutions to combat the risk of social exclusion for vulnerable teenage parents and their children' (SEU 1999: 2). Since then a 'national campaign' has been launched, the Teenage Pregnancy Unit established, local coordinators for the national campaign appointed, new guidance on sex education in schools introduced and new support packages for young parents issued. The most recent figures show that between 1998 and 1999 the teenage conception rate fell from 64.9 to 62.8 conceptions per thousand women aged 15-19 (ONS 2001: 86). It is clearly too early to judge whether this is the start of a downward tend.

Blair's 'moral purpose' is now being addressed, but the issue is far from straightforward. Continuous conflict and controversy surrounds debate on teenage pregnancy and teenage sexual behaviour generally. This debate is dominated by attempts to claim the moral high ground. The Labour Government's decision to allow pharmacists to supply women with emergency contraceptive pills without the need to see a doctor--a move designed to help young people avoid unplanned pregnancies--has been consistently attacked by conservative forces (including papers such as the Daily Mail) as a move against family values. At the beginning of May 2001 an anti-abortion organisation, the Society for the Protection of the Unborn Child (SPUC) launched an unsuccessful legal challenge to that provision arguing that the pills assist in the 'procurement of miscarriage' and provision is therefore illegal under the 1861 Offences Against the Person Act. Their argument that emergency contraception constitutes an abortion, is now heard at scho ols around the country as some parents try and prevent school nurses issuing emergency contraceptive pills.

Conservative middle England, outraged both at the phenomenon of teenage pregnancy but also at policy measures introduced to try and reduce the teenage conception rate, continues to resist attempts to provide young people with the sexual information, resources and knowledge they need to negotiate sexual relations. This was particularly evident in the consultation period for revised guidelines on sex and relationships education. The Government responded to the family rights lobby by ensuring a framework stressing the importance of marriage, family life, love and stable relationships in bringing up children, whilst David Blunkett declared that sex education must be taught 'within a moral context' (Daily Express 30-8-1999).

This debate, and government policy, around teenage pregnancy is politically important for socialists and for feminists. The whole issue is shot through with class differences, often disguised through talk of 'social exclusion'. Indeed, tackling teenage pregnancy and tackling social exclusion are often conflated, with obvious implications for the social control of 'unfit' (young working class/ethnic minority) mothers. For feminists, there are clear connections to issues of long-standing importance in feminist politics: reproductive choice and sexual freedom. This article aims to form a part of a socialist and feminist critique of New Labour's policy on teenage pregnancy. This critique has two targets: first, the Government's reluctance to challenge the right wing moral agenda on sexuality; second, its unwillingness to tackle the social inequalities central to teenage sexual behaviour and decision-making. These are the two themes running through this article. I will argue that both are important in first, expla ining why the relatively high rates of teenage conception in this country are resistant to change, and second, questioning whether New Labour's approach, as it stands, is likely to succeed in substantially reducing that conception rate.

These two themes are developed by examining the social, political and historical context of the current debate on teenage pregnancy. The historical context focuses on debate and conflict connected with sexual behaviour and sexual morality. This conflict involves the attempted regulation of sexuality by the state, and church, and has evolved as a highly politicised debate between those with conservative and progressive views on sexuality. The long-standing domination of this debate by conservative Christian morality, expressing concerns about the sanctity of family life, has played a large part in ensuring that young people are poorly prepared to meet the sexual realities of adolescence and adulthood. The 'moral' agenda of the conservative camp has a lot to answer for. It does not, however, go unchallenged. For those with more progressive views, the current debate around teenage pregnancy has provided an opportunity to press for improved sexual health services, improving sex education and better access to a fu ll range of reproductive health services, including abortion. It has also provided another platform for those critical of the Labour Government's poor record on tackling social inequalities.

Is teenage pregnancy a problem?

Whilst it is true that within Western Europe, the UK stands out as having the highest rate of teenage births it is not immediately clear why this should be viewed as a social problem. A headline which proclaimed 'Britain ages as pregnancies fall' (The Guardian 23-3-2001) might indicate a need for a sharp increase in the birth rate for all ages. Why then is there such a determined drive to cut the rates of teenage pregnancies? The Government's answer lies in the effects on teenagers themselves. According to the Social Exclusion Unit, giving birth as a teenager is associated with a high risk of adverse personal outcomes including (by their early 30s); a greater likelihood of having no qualifications, of being in receipt of non-universal state benefits and having a substantially lower income than any other group. The children are more likely to be brought up in a lone parent family and for witness the separation of their parents. They are also at higher risk of living in poverty, in sub-standard housing and a po or diet. The daughters of teenage parents are more likely than other teenage girls to become teenage mothers themselves (SEU 1999). These are all clearly related to social inequalities.

Leaving aside, for the time being, prescriptive assumptions about the desirability of the 'traditional' nuclear family, there is a danger in claiming causation for the pregnancy itself (Phoenix 1991). There is a clear association between socioeconomic deprivation and teenage pregnancy. Teenage parenthood is more common in areas of deprivation and for those who have grown up in poverty or those with poor educational achievement. There are differences in rates according to race and ethnicity but there is a lack of research into these differences. In particular, there is nothing available on differential rates, along class lines, within different ethnic minorities. Given that ethnic minorities are over-represented in low-income groups, predominantly working class areas which have higher rates of teenage pregnancy would also often include a higher than average population from ethnic minorities. The adverse outcomes outlined by the Social Exclusion Unit could also be attributable to the economic and social context rather than to the pregnancy itself (Jewell et al 2000). Socialists and feminists should highlight other issues.

There is little doubt that becoming a parent does severely limit many young people's future lives. Many feminists have long opposed women's confinement to the role of wife and mother, and such confinement is, at last, no longer generally expected. Early motherhood can close down opportunities for future education, training and employment. This is recognised by the young women themselves: those who are likely to enter higher education, for example, are less likely to become pregnant as teenagers, and (if they do become pregnant) more likely to have an abortion, than those who feel they have little to lose, and possibly much to gain, by having a child. But, just because some young people feel they have no opportunities does not mean that teenage pregnancy is not a problem, rather it identifies a further, deeper problem: the lack of opportunities and hopes for the future of many working class people. This is clearly an issue of some importance for the Left, but conspicuously lacking in the Labour Party's vision of the future.

There is a further way in which teenage pregnancy can be characterised as problematic that is particularly relevant for feminists: research evidence suggests that the majority of these pregnancies are unintended. A three month study of teenage pregnancy in a Staffordshire hospital, for example, found that of 113 teenage girls giving birth only one third claimed they had intended to become pregnant. The same study found that only one of the 57 teenage girls having an abortion had intended to become pregnant (Chambers and Milsom 1995). Tabberer et al (2000) reported that many of the young women in their sample had not planned their pregnancies. Anecdotal evidence from Childline suggests that one of the most frequent calls is a distraught teenage girl claiming to be unintentionally pregnant. On the basis of a number of research reports, the Social Exclusion Unit estimates the figure to be as high as 75% (SEU 1999:55). The statistics used by the Government are likely to be an over- estimation. One problem with th is data is that definitions of 'intended' and 'unintended' rely on self-reports. It is notoriously difficult to draw a line between pregnancies that are planned/intended and those that are unplanned/unintended (Furedi 1996). Whilst this is the case for all women it is likely to be more so for teenage girls. In particular, there is likely to be a reluctance to admit becoming intentionally pregnant given that the current negative social and political climate surrounding teenage motherhood. Nevertheless, given teenagers poor knowledge of, and access to, a full range of contraception it is clear that teenage girls are exercising less than perfect reproductive control.

Generations of feminists have campaigned for improved reproductive control for women, for women's control over their own bodies, and yet we now have a situation in which a significant number of young women appear to be becoming unintentionally pregnant. This is clearly problematic for advocates of women's reproductive choice.

Why are so many young women becoming pregnant?

Sexual behaviour and sexual decision-making do not exist in a vacuum. Decisions that individual young people make about their sexual behaviour and about their futures are made in particular social contexts. There is considerable debate around possible reasons for the high rate of teenage pregnancy in the UK. Three factors are particularly significant: first, patterns of social deprivation affecting young people; second, changing family structures; third, general attitudes towards sexual relationships. It is the complex interaction of all three factors that provides a full explanation.

It is not possible, however, to discuss each of these factors in great detail here. As mentioned above, the connection between teenage pregnancy and social deprivation is not straightforward. It would be a difficult task to establish why there is such a strong relationship in the UK, whereas social deprivation in other European countries does not lead to equally high rates of teenage pregnancy. What seems to be unique to the UK is the combination of social deprivation with conservative attitudes towards sexuality and anxiety about the decline in the 'traditional' family.

Much contemporary debate on the family shows concern about the decline of marriage, particularly with relation to extra-marital births (Wasoff and Dey 2000). The role of marriage and its importance as 'the surest foundation' for family life was emphasised in Labour's Supporting Families (Home Office 1998). Changing family structures, characterised by a diversity of family forms and a situation in which nearly 50% of marriages end in divorce, have, however, clearly contributed towards a situation where there is often little social stigma attached to unmarried motherhood, particularly in working class communities. Live births outside marriage have risen dramatically from 8.2% in 1971 to 38.7% in 1999 (ONS 2001). In European countries where the nuclear family form remains strong, such as Greece, the rate of live births outside marriage is extremely low, as is teenage motherhood. Recent research has shown that in some British working class communities there is more social stigma attached to abortion than to teena ge motherhood (Tabberer et al 2000).

Whilst social deprivation and diverse family structures are two important explanations as to, first, why some young women intentionally become pregnant, and, second, why others faced with unintended pregnancy are likely to opt for motherhood, these do not in themselves explain the high rate of unintended pregnancies in young women. The third factor, general societal attitudes towards sexual relationships, is important here, and will be discussed in more detail.

There is a widespread recognition, evident amongst sexual health professionals, that the most important explanation of relatively high rates of teenage pregnancy in the UK is poor use of contraception, rather than high rates of sexual activity. Although the teenage birth rate is twice as high as in Germany, seven times as high as in. France, and six times as high as in the Netherlands, the average age at first sexual encounter is not markedly out of line with these and other European countries. What is striking is the low use of contraception by sexually active teenagers compared with other European countries (SEU 1999: 29). Effective use of contraception amongst young people is associated with: good quality information and education about sexual matters; the quality of available sexual health services; and, significantly, the degree of openness about sexuality and the extent to which teenage sexuality is accepted by adults (Chambers et al 2001). Unprotected sexual behaviour means young people may also be vul nerable to sexually transmitted infections (STI's). Extensive feminist research into teenage sexuality and contraceptive use at the height of the 'AIDS scare' highlighted the point that young women struggled to negotiate sexual safety in unequal sexual relationships. The contexts within which young women learn about sex rarely offer positive models of female sexuality and they do not have the confidence to make their own sexual choices. This was a common finding in research on young women's experience of sexual encounters and relationships across different ethnic minority groups (Holland et al 1992; Holland 1993).

Young people learn about sex in a variety of different contexts. These include schools, families, friends, sexual health services and the media. These contexts are structured by social inequalities. Although there is a shortage of national research on the relationship between socio-economic deprivation and young people's knowledge about contraception and sex, some recent research projects indicate clear class differences. In a comparison of teenage girls from 'advantaged' and 'disadvantaged' socioeconomic backgrounds, for example, Jewell et al (2000) found that the disadvantaged teenagers had less knowledge about contraception, were more likely to be dissatisfied with sex education in schools and were less likely to use emergency contraception, than the 'advantaged' group.

Although it is widely acknowledged that young British people are poorly informed about sex, contraception, sexual health and reproduction, attempts to improve their knowledge have always been controversial (Hawkes 1995; West 1999). There is a widespread, ill-informed, view that more knowledge will simply result in more sexual activity. Such sexual puritanism does little to challenge a conservative view of sex as dangerous and undesirable, one of the 'forbidden' pleasures of adolescence, but it does contribute towards teenagers unwillingness to seek information and advice which might minimise the risks of pregnancy and STI's (Burack 2000).

The idea that teenagers under the age of sixteen may by sexually active regularly provokes moral indignation. The Prime Minister himself declared in his preface to the Teenage Pregnancy report 'Let me make one point perfectly clear. I don't believe young people should have sex before they are 16. I have strong views on this. But I also know that no matter how much we might disapprove, some do. We shouldn't condone their actions. But we should be ready to help them avoid the very real risks that under-age sex brings'. This belief would be echoed throughout the country but a more widespread response has been to try and ensure that teenagers remain sexually ignorant. Sexuality remains a deeply controversial subject. Conservative Christian morality views teenage pregnancy as one part of a much larger problem--the decline of the family. However, ironically, it is precisely the failure of successive governments to challenge such a moral framework that has contributed towards the persistence of high teenage concepti on rates. The tensions between an undeniable decline in the traditional nuclear family on the one hand, and continued promotion of family values by sections of the government and state, on the other hand, has contributed towards young people's lack of knowledge and confidence about their sexuality. The conservative Christian morality that bears such a major part of the responsibility for the ignorance, secrecy and shame surrounding sexuality today has deep historical roots.

An historical legacy

Sex has long been a difficult and controversial subject, in the UK, capable of prompting intense political struggle. Whilst there have been significant policy changes over the years, what has remained constant is a determined conservative resistance to feminist demands for policy based upon women's reproductive choice. Sexuality and contraception might be viewed as private and personal but religion and the state have been centrally involved in trying to exercise control. The state's concern with the regulation of sexuality dates from nineteenth century Victorian Britain (Weeks 1981). Birth control became a public issue with prohibitions on methods of control existing alongside attempts by individuals and organisations to promote birth control. Historically, feminists have been in the forefront of campaigns against the state regulation of sex and in favour of contraception and abortion rights. Throughout the nineteenth and into the twentieth century, such campaigns were confronted by a stubborn conservative re sistance, dominated by a Christian morality, which tried to maintain a model of sex as illegitimate except within the confines of marriage and for the purposes of procreation. Although this model has long broken down, strong elements of the ideology are with us still, as are some of the consequences of the decades of conservative resistance. Developing policy and practice on sex education, contraception and abortion has always been controversial and therefore often resulted in unhappy compromises.

The development of family planning is a case in point. In the 1920s, campaigns for birth control information were mounted by a number of organisations and individuals, Marie Stopes perhaps being the most prominent. Feminists and socialists were active in a movement that was strongly opposed by the Church and the state. Opposition was focused on the perceived moral danger of breaking the link between sex and procreation and the threat to the sanctity of the family. Successive governments resisted campaigners' demands on the grounds that sex was a private matter and not a public issue (Hoggart 1996). The controversial nature of the campaign had two results: first, in their desire to remain as respectable as possible, campaigners consciously disassociated themselves from advocates of more liberal abortion legislation; second, the policy outcome was that birth control advice would be limited to married women who were already mothers and for whom 'further pregnancy would be detrimental to health' (Memorandum 153/M CW, PRO/MH 55/289). A prescriptive model of sex within marriage, and reproductive control for the purposes of family planning, was established and legitimised, as was a damaging split between the politics of contraception and of abortion. The drive for respectability, which characterised the further development of the Family Planning Association, contributed greatly towards a policy of family planning for married women, rather than a policy based on women's rights, and abortion being viewed as an illegitimate form of reproductive control. These assumptions were not challenged until the 1960s and 1970s.

In October 1963 a 'scandalous' story broke in the press: Helen Brook had started secret sessions for unmarried women whilst working at a Marie Stopes clinic. At that time both the Marie Stopes Board and the FPA Executive, although they had condoned these sessions, decided it would be politically expedient for Helen Brook to leave and form a separate centre (the Brook Advisory Centre). It was not until 1967 that the Family Planning Association deleted the mention of married women from its aims, and not until 1970 that clinics were told they could provide contraception for any woman, married or unmarried. In 1974, the Department of Health and Social Services advised doctors that they could prescribe contraceptives for under-16s and respect their confidentiality, although they should consult parents if possible (Lewis 1992). These moves, taken against a backdrop of anxiety about the high rate of teenage pregnancy in the 1970s, have remained controversial and, accordingly, until very recently semi-secret. The leg al controversy sparked by Victoria Gillick's 1982 action against her local health authority over whether doctors should give contraceptive advice to under-16s without parental consent showed the extent of the controversy. Concern was centred upon defence of the traditional family and, in this case, upon the rights of young people as opposed to those of their parents. The debate revealed widespread anxieties focused on the view that easily available contraception encourages sexual promiscuity in young people (Hawkes 1995). It is still the case that teenagers are afraid that doctors will not respect confidentiality (West 1999), and that doctors would prefer parents to know they have been consulted about contraception by anyone under sixteen (Garside et al 2000).

A further consequence of the strength of conservative morality is the inadequacy of sex education. Conservative opposition to progressive sex education has focused on perceived threats to the traditional family. This was vividly illustrated in activity around Clause 28 in the 1988 Local Government Act which prohibited the 'promotion' of homosexuality by local authorities. Introduced after widespread moral panic about a library book called Jenny lives with Eric and Martin, an educational children's book which showed gay men as parents (Lovenduski and Randall 1993), Clause 28 still effectively prevents many schools discussing sexual difference and variations in family forms. The Government's recent attempt to repeal Clause 28 prompted a repeat moral panic.

Despite extensive research, prompted by HIV and AIDS, indicating that British teenagers were woefully ignorant and lacking in confidence about sex and contraception (Holland et al 1992; Thomson and Scott 1991) little changed. Too little, too late, is the overwhelming verdict of numerous studies, an assessment endorsed by the Teenage Pregnancy report. One irony is that the dominant model of sex education has been based on biological reproduction and one of the consequences of this narrow focus has been an inability to negotiate unprotected sexual activity that has undoubtedly contributed towards relatively high rates of reproduction in this age group. This model is in striking contrast to much of Europe where formal sex education lessons and programmes are the norm. One of the reasons for success in other European countries, such as the Netherlands, is that families and society are much more open in talking about sex with children from an early age. There is also a greater acceptance of teenage sexuality (Cham bers et al 2001).

Over the years the bitterest political struggles have been over abortion rights. These struggles have shown the strength of resistance to women's demands for reproductive choice--'A Woman's Right to Choose'--both from a minority completely opposed to abortion on any grounds, but also from those who support limited abortion rights controlled by the medical profession. The 1967 Abortion Act liberalised abortion law but throughout the 1970s and into the 1980s it was constantly attacked. A vociferous minority sought to repeal women's hard-fought (though strictly limited) abortion rights. The majority of those supporting the Act in 1967, and later, saw abortion as a means of maintaining a stable family. Greenwood and Young (1976) argued that many of these reformers were aiming at particular categories of women: the medically unfit; those who were psychologically disturbed; women from 'deprived' or 'demoralised' social backgrounds; those with abnormally large families and young girls. The Act'[c]ontains a strong mo ral element, distinguishing between categories of deserving and undeserving 'victims' of unwanted pregnancy' (Sheldon 1997: 46). Abortion often did appear to be aimed at 'unfit' mothers, an issue that became highlighted by black feminists activists who pointed out that ethnic minority women were often subject to racist pressure to 'choose' abortion (Amos et al 1984; Bhavnani and Coulson 1986). 'The demand for "The Right to Choose" and to assert control over our own bodies can unite women--including those who may be defined as infertile. "The Right to Abortion" has often succeeded in dividing women--rights for white women have meant the abuse of black women' (Bhavnani and Coulson 1986: 90).

In the 1970s and 1980s, a substantial section of the women's movement, whilst defending the Act against unwelcome attempts to restrict abortion still further, criticised the Act on the grounds that it had given doctors, rather than women, the 'right to choose'. Socialist feminists pointed out that any restrictive legislation would fall hardest on working class women who could not afford 'Harley Street' abortions, and would be forced back towards 'backstreet' illegal abortions. The bitterness of the struggles around successive amending Bills, in which abortion was politicised as an issue of competing rights between the foetus and the woman, effectively reinforced the historical division between abortion and contraception. Considering that at some point in their lives over a quarter of British women will have an abortion, it is still far too much of a socially stigmatised and taboo choice.

These three areas--sex education, contraceptive services and abortion--all remain problematic in terms of access and provision. They have been hotly contested issues over the decades in which conservative resistance to pressure for progressive reform has ensured inadequate provision and the dominance of a sexual morality in which sex is seen as dangerous and undesirable. The secrecy and shame surrounding sexuality affect three decision points in young people's lives: the negotiation of 'safe' sex; accessing emergency contraception; terminating a pregnancy. Choices made at these points help determine whether teenage sexual activity leads to pregnancy, and then to motherhood. The choices are, however, not free choices, but strongly influenced by social and cultural contexts. Class differences are particularly relevant. At each stage young people from lower socioeconomic groups are more likely to make decisions that lead towards teenage parenthood. A combination of social inequalities and conservative resistance to progressive sex education and sexual health policy, has made the high rate of teenage pregnancy resistant to change. The question is whether New Labour can change this situation.

Can New Labour make a difference?

The Blair Government claims to be serious about tackling teenage pregnancy and has announced a number of targets. There are two aims to the national campaign: first, to halve the rate of teenage conception within ten years; second, to support young mothers in order to lessen their chances of suffering social exclusion. The Government's policy and strategy on social exclusion is beyond the scope of this article and little research has been undertaken as yet to assess the relationship between this strategy and its teenage pregnancy strategy in which the focus is very much on efforts to change teenage sexual behaviour, rather than the broader social and cultural context which moulds behaviour. So what is the government doing to cut the rate of unplanned teenage conception?

sex education and 'safe' sex

The Teenage Pregnancy report recognised that: 'sex education here often does not equip teenagers with the facts or with the ability to resist pressures ...Young people need to be given the facts: the risks of pregnancy and STI's and the consequences of early pregnancy. The messages to young people should be simple and should not preach' (SEU: 90). Schools have been given new Sex and Relationship Guidance (DfEE 2000). Primary schools are required to consult with parents and draw up a school policy on sex and relationships education, which should cover, as a minimum, bodily changes related to puberty (such as periods), and how a baby is born. In secondary schools (again in consultation with parents) the emphasis is on preparing young people for adulthood. The starting point is developing a moral framework that will guide young people's decisions, judgements and behaviour. The Guidance covers communication skills, understanding of the arguments for delaying sexual activity, reasons for having protected sex; info rmation about contraception and how it can be accessed; confidence and skills to negotiate relationships; and how to avoid being pressured into unwanted or unprotected sex. Both categories of schools are required to set sex education within a broader base of self-esteem and responsibility for the consequences of one's actions (DfEE 2000).

Within this guidance there is considerable room for manoeuvre for individual schools, and some schools do go beyond the formal curriculum. Some primary schools, for example, include teaching on intercourse, conception and contraception although this is not part of the curriculum. For many schools there will be an improvement in sex education. The statutory obligation of schools to consult parents on their sex education policy will undoubtedly contribute towards unevenness. The potential for wide variations in sex education is clear from the debate and the conflict between family rights groups, which call for less education about explicit sex and more about morality, and promoters of progressive sex education, such as the FPA and the Sex Education Forum (which represents 44 groups). An FPA workbook for primary teachers that incorporated a glossary of terms children might ask about (including masturbation and oral sex) recently outraged family rights campaigners. By way of contrast, Valerie Riches, Director of Family and Youth Concern, stated that in primary schools all children need to know about is biological reproduction set in the context of marriage and that 'in secondary schools they should teach moral concepts of right and wrong and stress they don't have to have sex' (Guardian Education 149-1999: 3). In the light of the potential for controversy, any radical improvements are likely to take place by stealth. This is especially likely given the policy emphasis on developing local initiatives. A case in point is local funding for a pro-choice charity set up in 1992 to provide schools with resources and speakers on abortion: Education for Choice has recently received funding from the Teenage Pregnancy Unit to develop a speakers project in the North of England, and funding from the Nat ional Youth Agency to run a peer education project in Lambeth, Southwark and Lewisham. These should be national initiatives.

In addition, all schools will have to teach sex education within the family and relationships framework. The Labour government's teenage pregnancy strategy has always been strong on moral messages. The first health minister heading the strategy, Tessa Jowell, made a point of supporting Blair's 'moral purpose', arguing that one priority for the Labour Government was to help teenagers avoid being browbeaten by their peers into having sex too young. Blair's government has been consistently influenced by family rights lobbying and attempts to impose their own moral agenda. This was clear during the period of consultation of the revised National Curriculum (published September 1999) and the new Guidance. Following accusations (and near hysteria in the Daily Mail) that Ministers were failing to support traditional religious and family values, the Government announced that in the Personal and Social Health Education (PSHE) curriculum there would be a new emphasis on marriage (The Independent 10-9-1999). The Governme nt later went out of its way to stress that, for the first time, sex education would be set in a framework in which pupils would be taught about the importance of marriage and family life. It stuck to this approach despite teachers' unions pointing out that for significant numbers of children such 'traditional family values' are not the norm (The Independent 5-5-2000). The emphasis is on making young people aware of all the dangers that sex has to offer them. Sex is not fun but a danger to be avoided, something which might be acceptable in a stable, loving (preferably adult) heterosexual relationship.

Contraception

Local services (such as GPS and family planning clinics) have also been given a role in improving contraception and sexual health services for young people. The Teenage Pregnancy report anticipated that such services should be publicised, accessible to young people, open to all and also 'joined up' in the sense of making links between contraceptive issues, STI's, pregnancy testing, abortion and future contraception needs.

Improving access to emergency contraception, through allowing distribution at chemists, is one of the braver acts of the Labour Government. This had long been advocated by sexual health workers but vociferously opposed by the anti-abortion movement and the right wing press. There has been the backlash, mentioned above, about emergency contraception really being abortion. The other conservative response has been to claim that ready availability will encourage sexual promiscuity. It is too early to tell how successful this initiative has been. The government should go much further by responding positively to calls in favour of making emergency contraception available in all schools. Given its reluctance to take controversial decisions this is an unlikely move.

There are indications of clear class differences operating in young people's decisions to access emergency contraception with those from higher socio-economic backgrounds being far more likely to use emergency contraception following unprotected sexual intercourse than their peers. This is part of the class divide that runs through the whole issue of teenage pregnancy, and is also striking with respect to teenagers' decisions about unplanned pregnancies.

Abortion

The Government's policy on abortion is ambivalent. Tony Blair has always been opposed to liberal reform, and yet, very quietly, access is improving (Chambers et al 2001). In addition, the new guidance on sex and relationships education, for the first time, includes abortion (DfEE 2000). Access to NHS abortion services has long varied considerably from area to area with some health authorities funding over 90% and others less than 50% (Chambers et al 2001). Some health authorities are clearly influenced by moral judgment, rather than medical criteria, when deciding on their abortion policy. In many areas women may be admitted to general gynaecological wards, face uncertain waiting times and receive poor, often callous, treatment from medical staff. In 1997, the Abortion Law Reform Association (ALRA) revealed that a number of health authorities limited approval for NHS abortion according to their own list of restrictive criteria (ALRA 1997). There are some signs of improvement. ALRA recently revealed that some health authorities are removing such arbitrary criteria.

The Government has been working on a new sexual health strategy in which the plan is to further integrate abortion services into other sexual health services (as mentioned above). The launch of the strategy originally promised for summer 2000 was delayed due to the 2001 general election. Abortion rights activists have given the consultation document, eventually released in July 2001 (Department of Health 2001), a cautious welcome. The Abortion Law Reform Association, for example, has announced, '35 years after the 1967 Abortion Act, abortion is established as part of mainstream reproductive and sexual health care' (ALRA Members' letter, January 2002). The British Pregnancy Advisory Service, however, has warned that abortion services need a radical overhaul if government targets on service delivery are to be met (BPAS Press Release 13-9-01). Others, such as the National Abortion Campaign, have emphasised the restrictions that still exist. Access to abortion is still dependent upon two doctors' approval of ever y woman's reasons for wanting to terminate her pregnancy. This looks unlikely to change.

For pregnant teenagers, there is a clear trend to a higher rate of abortion in more prosperous areas. Young women who plan to enter higher education are more likely to have abortions than those without such plans, and students tend to have more abortions than non-students. While it is unacceptable politically to argue in favour of targeting abortion services towards lower socio-economic groups, the fact that terminating an unwanted pregnancy remains an act of shame and stigma is regrettable. Contraception is not infallible, even when used, and abortion should be seen as a necessary, and natural, part of all women's reproductive control. Targeting would not only collude with normative prescriptive views of the desirability of motherhood within the nuclear family, but could become aimed at young people from the ethnic minorities and working class. It would be all too easy to revert to one of the main justifications of the 1967 Abortion Act: to deal with 'problem' pregnancies and 'unfit' mothers. This sub-plot m eans that feminists need to make reproductive choice central to their analysis and political position. Although preventing, rather than terminating, unwanted pregnancies is preferable, it is clear that women are not able to exercise complete reproductive control by contraception alone. A recent survey of more than 2000 women requesting abortion at clinics run by the British Pregnancy Advisory Service found that almost 6o% claimed to have been using contraception at the time they became pregnant (www.prochoiceforum.org.uk). Abortion has to be normalised generally so that it is seen as an essential part of reproductive choice. Legislation was not based on women's rights to full control over their own bodies and that has left us with many limitations, including the social stigma attached to abortion as a method of reproductive control.

An assessment

The changes to sexual health policy proposed by the Labour Government are promising are far as they go. Its attempts to deal with teenage pregnancy are, however, limited in two important respects.

First, the national campaign on teenage pregnancy does not go far enough in breaking the secrecy and shame attached to anything sexual. Although many initiatives, supported by the Teenage Pregnancy Unit, are promoting a generally liberal attitude towards young people and sex and relationships, this does not amount to a national policy. Not only is the Government scared of a conservative backlash, but leading members, most notable the Prime Minister, share many of these conservative values. The clearest examples are the undesirability of underage sexual activity, promotion of the desirability of the nuclear family and continuing resistance to liberalising the law on abortion. All too often the government's priority appears to be 'no sex' rather than 'safe sex', and the idea that sex is dangerous and undesirable (in young people) pervades its policy. The efficacy of sex education in delaying sexual activity is much disputed, and yet arguments spelling out the dangers of sex and in favour of 'saying no' are an i mportant part of the government's guidance on sex and relationships education. Sex and reproductive control have to become less contentious issues. All the evidence suggests that increased confidence follows increased knowledge and that what is therefore required is promotion of more liberal and open attitudes towards sex and young people. It is open to question as to how far a government fearful of publishing its sexual health strategy in the run up to a general election, can achieve this.

The second limitation is more intractable. The Government's 'problem-solving' approach ensures a narrow focus on the issue itself without clearly acknowledging the centrality of class inequalities to teenage pregnancy. The targeting of areas with high rates may do something to change this but in the absence of a political drive towards greater equality the long term does not look hopeful. It is all too likely to be middle class schools, for example, which adopt more progressive sex education. The Labour Government has no commitment to overcoming social inequalities. Any government which believes that tackling inequalities in education can be solved by specialist schools (increased selection), and ensuring that a handful of working class children can go to Oxford or Cambridge, is not serious about equal educational, training and employment opportunities for young people. A transformation of the socioeconomic conditions within which teenage girls become pregnant is necessary for significant and lasting change.

Acknowledgment 

Many thanks to Costas Lapavitsas, Rosemary Sales and the two referees for their useful comments. The usual caveats apply.

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Lesley Hoggart is a senior lecturer in Social Policy and Social Science Research Methods at Middlesex University. She is currently researching around issues of reproductive choice for young people.