Young lack sexual health education

Malta awaits a clear sexual and reproductive health policy, Frances Camilleri-Cassar Tells Ariadne Massa, arguing that it is time to move away from the silence and taboo attached to this debate.

Young people are being short-changed because they are not getting enough basic information on sexual and reproductive health as a result of the stronghold the Church still has on society, according to social scientist Frances Camilleri-Cassar.

"Young people have a right to basic information on sexuality and to sex education, while girls need to know their reproductive rights, something they're supposed to be getting in schools," said Dr Camilleri-Cassar, who will speak about this subject today at the SOS (Malta) seminar on Reproductive Health in the Fight Against Poverty: Networking and Building Partnerships, at the Commonwealth People's Forum in Valletta.

Pointing to a study carried out by the Health Promotion Department, Dr Camilleri-Cassar said the information young people were getting was sporadic and came from parents, friends or their peers, and very few were getting it formally through school.

"We always seem to be afraid of moving away from our strong attachment to the Church. The Church in Ireland held very strong beliefs about contraception but eventually the state had to take the crucial step of distancing itself to develop and progress," she said.

Political and religious impediments to accessing the necessary range of reproductive options, such as in-vitro fertilisation and the latest reproductive technology and contraception, presented one of the most serious health problems facing women and men, she insisted.

She pointed to the unavailability of comparative data on the incidence of sexual intercourse, mean age and use of contraception among young Maltese aged 11, 13 and 15, in the 2001/2002 World Health Organisation international report.

What's even worse is that the questionnaire "was modified by the authorities so as not to offend certain sentiments", and 11-year-olds and those attending special schools were left out of the survey, she claimed.

"In schools where scruples ran high, participation in the study was not allowed," she said.

Despite the lack of data from the WHO report, figures emerging from the latest Genito Urinary Clinic report indicate that casual sex among people below 25 years of age has shot up to 42 per cent in 2004 from 28 per cent in 2000.

The report points to alarming habits - 63 per cent of those visiting the GU clinic indulged in unprotected sex while just 25 per cent of young women who went to the clinic consistently used contraception. The most popular was the contraceptive pill (85 per cent), which does not protect against sexually transmitted diseases.

In parallel, respondents in Malta's first national health interview survey (which involved a random selection sample of 5,510 individuals aged 16 and over) in 2003 were asked whether they had used contraceptives to avoid getting pregnant, or as protection to avoid infections.

Responses suggest that while 34 per cent of those interviewed never used contraceptives, only seven per cent used them regularly. Comparative data drawn from the European Parliament report 1999-2004 suggests that the average EU rate of modern methods of contraceptive use is 65 per cent.

Apart from this, the number of single mothers is soaring, with a total of 4,848 babies born out of wedlock between January and August this year.

"Society points a finger at girls who are having children at a young age, but why don't we first ask what we're doing to help them out? Do they have access to quality education on safe reproductive health? Why are we constantly hiding the fact that we are at fault not to provide them with information about reproductive control simply because we feel inadequate to talk about it in a professional way?" Dr Camilleri-Cassar asked.

Another worrying issue is abortion. Precise statistics are hard to come by, especially since most of them take place clandestinely. However, figures released by the UK's Health Department show that 69 Maltese women sought an abortion in the UK in 2002, including one girl under 16 and four aged 16 or 17.

Abortion is illegal in Malta and being such a contentious issue, it is difficult for women who have had or are considering an abortion to speak out or seek non-judgmental advice.

"Instead of looking at abortion in isolation, why don't we talk about preventing unwanted pregnancies? We also need to emphasise that men should also be responsible for unwanted pregnancies," she said.

"We seem to be looking at the problem rather than trying to prevent it. Why don't we try to understand what is happening instead and then create policies to prevent the problem and avoid stigmatising people?"

Dr Camilleri-Cassar spoke on how a woman's right to choose in an informed way seemed inexistent in Malta, especially when it came to her sexual and reproductive health.

She complained that women were also pressured by society and the Church to have children, with newly married couples constantly being bombarded by questions on when they planned to start a family.

"The idea of motherhood is a social construct and it's not at all true that a woman needs to have children to feel fulfilled. Yet, in Malta, society and the Church emphasise it so much that women who don't have children, either because they are infertile or just because they do not wish to have them, are made to feel uncomfortable and inadequate."

In the light of all this what were women in Malta doing to have their rights recognised? Were they indifferent to their situation?

"Women are just apathetic about the situation. I have a feeling it's because they don't know any better. Are they being made aware of their rights in schools, for instance? To what extent are women taught to be assertive and stand up to sexual harassment and male oppression, for example? These issues are never mentioned," she said.

"Through my studies I have found that Maltese women are very passive; they let things happen and things are decided for them. Asked what they think of women's movements in Malta, they replied with another question: 'Do they exist? Who are they? What are they doing?' These women are not only unaware, but just not interested in entities which they cannot relate to," Dr Camilleri-Cassar pointed out.

Yet what were women's organisations doing to put women's reproductive health and rights at the forefront?

"The right to choose and control their fertility has been central to the women's movement worldwide, yet in Malta they're not doing anything to influence policies or the government's agenda. They tend to be cautious overall, and not radical. I think women's organisations try not to rock the boat too much and just go along with things.

"We need a forceful equal opportunities machinery and independent movements which give a voice to women and really make things happen. Muddling through just will not do," she argued.

Dr Camilleri-Cassar stressed the need to have reliable data and to move away from this silence and taboo.

"Malta's key challenge to sexual and reproductive health and rights is its tradition of involving religious, conservative views in its national reproductive health agenda," she pointed out.

"However, there is just no excuse! Young people have a right to information and prevention, and outreach services need to target high risk groups, among them non-school attendees, girls attending existing services for pregnancy testing and contraception, children of teenage parents, young people living in high risk areas, and young people in care."

Good access to all forms of contraception and quality basic education, she argued, would reduce unwanted pregnancies and sexually transmitted diseases.

Malta had to emphasise the use of condoms, as the proven best-practice preventive method for HIV and Aids.

"Reproductive control is central to women's health and autonomy, and where services are inadequate, costs in health, life and personal freedom are enormous," she stressed.

Malta was bound to draw up a Development Aid Policy by 2007, and it urgently had to understand the state of sexual and reproductive health and rights, and best practices for effective implementation of reproductive health policies.

Key data on the true prevalence of all sexually transmitted infections, including HIV, remained unknown. The GU clinic report argues that the present data available on STIs could be the tip of the iceberg, as many could unknowingly be carriers.

Rarely has it been emphasised that Malta still awaited a clear and separate sexual and reproductive health policy, which hung in the pipeline, she said.

On a related topic, sexual violence had a devastating impact on the sexuality and the reproductive health of women and teenage girls, yet the Domestic Violence Act had, for years too, hung in the pipeline.

"It is high time for action. Sexual and reproductive health and rights in Malta are still engulfed in silence and taboo. The key now is to address the issue with urgency and sustained action. Whether this opportunity will be used to the full remains to be seen. Which way are Maltese policy makers looking, now when it matters most?"

Dr Camilleri-Cassar is a social scientist and experienced researcher with special interests in welfare states and gender regimes and the implications of EU enlargement for Malta's labour market and its social policies.