Malta 'burying head in sand' on sexual health

Malta is burying its head in the sand on sexual health, according to a World Health Organisation adviser who is concerned about soaring teenage pregnancies and the lack of proper sex education.

John Richens, whose recent visit to Malta was not publicised even though he was invited by the health authorities, seemed baffled that he did not manage to see a copy of the National Sexual Health Policy.

"I requested it but it was withheld from me. There was a reluctance to share the document. I don't know what the reasons for this were," he told The Sunday Times, when contacted at his office in the UK.

Dr Richens, a clinical specialist in sexually transmitted infections and HIV at the University College London who was invited to help Malta set up a sexually transmitted infection (STI) prevention programme, said a national sexual health strategy "was a matter of urgency".

His visit came just weeks after the third and latest draft of the National Sexual Health Policy - which would cost €1.5 million to implement - was withdrawn from the 2010 Budget, snuffing out the possibility it would see the light of day after 10 years in the making.

Dr Richens's report on Malta, which this newspaper obtained, points out that STI prevention and control appear to be low on the political agenda as there is no published national strategy, no defined budget and a small response team.

The report also observes the "strong negative influence of the Catholic Church" to have comprehensive sexual health promotion in schools, which it says was a constant theme raised by Maltese health professionals and politicians.

Dr Richens said Malta stood out because of the large number of births to teenagers, and reports from the GU Clinic indicating condoms and contraception were being used by very few people.

According to the latest European Perinatal Health Report, Malta has one of the highest rates of teenage pregnancy in the EU - 5.5 to 6.6 per cent of all pregnancies in females under 20 in the years 1999 to 2008. GU Clinic figures consistently point to a high rate of casual sex with 70 per cent of those who visit the clinic admitting to never using a condom.

Dr Richens, who is working with WHO to roll out a global strategy for the prevention and control of STIs, said: "It's shocking that Malta has been trying to get it (the sexual health policy) published for 10 years... That's a concern."

He is also worried about the lack of cooperation from Church schools' in connection with surveys of health behaviour of schoolchildren (HBSC).

Three years ago the Curia's education secretariat had instructed Church schools not to distribute WHO's HBSC survey to Form I, III and V pupils because it disapproved of the nature of the questions about sexual relations.

While in Malta, Dr Richens met Archbishop Paul Cremona to gauge whether it would be possible to get more information about teenage sexual activity through surveys in Church schools, but he did not get far.

"He was very charming but very firm. He acknowledged it was important to have the information, but he was reluctant to say the Church would cooperate with those surveys. He accepts the problem, but does not want to get involved in finding a solution," he said.

Dr Richens believed the way forward was to provide teenagers with accessible comprehensive information that presented all the methods available to prevent infection and pregnancy.

When it was pointed out that in Malta many favoured promoting abstinence rather than safe sex, Dr Richens said this type of programme, advocated by the Church, had been used in the US, but scientific studies suggested it was not as successful in reducing teenage pregnancies.

"The comprehensive approach is what is espoused in the Netherlands and delivers excellent results. The country has the lowest teenage pregnancy rate in Europe and they have a very good programme of sex education in schools," he said.

The report's findings and recommendations

• The report highlights the failure to investigate sex workers operating from massage parlours, gentlemen's clubs and hotel bars. There is no outreach health promotion or sexual health services for these people.

• There is also no specialist health services catering specifically for the sexual health needs of young people and access to contraception for females under 18 is difficult, because it requires a parent's consent.

• A national sexual strategy for Malta is a matter of urgency.

• Funding from the government or the EU should be secured to implement the strategy.

• Laws that work against sexual health objectives, such as age of consent, and laws governing provision of contraception, have to be reviewed.

• A programme of regular surveillance of sexual behaviour and STIs among the young and high-risk groups has to be developed.

• Sexually active 16- to 18-year-olds should have improved access to long-acting removable contraception (LARC), such as the contraceptive jab or the coil.

• At least one non-Church based family planning clinic able to offer a full range of modern methods, including long-lasting birth control should be set up.