I’ll like to discuss 2 major points that were omitted by The Sunday Times when they published our(AWARE’s) letter ( http://mathialee.wordpress.com/2008/12/17/aware_sex_education/ )regarding teenage sexuality. I suspect they omitted these points because they are really thorny issues, with no easy, non-controversial solutions. I see no easy way out as well, but still I think these issues should be brought out for discussion, in hope that someone reading might have good suggestions or a different angle to it. Definitely should not just sweep it under the carpet.
FACT: If you’re female, being MARRIED is your biggest risk factor for getting and STI or unwanted pregnancy.
There is a common misconception that unwanted pregnancies and sexually transmitted infections (STIs) are a problem of teenagers. The fact is that in Singapore, teenagers account for only about 5% of the STI cases and about 10% of the abortion cases. About 2/3 of 12,000 – 14,000 abortions here are performed on married women, and 2/3 of the female HIV patients here are faithful wives who contracted the infection from their husbands.
When over 10,000 married women find themselves in the position of having to consider an abortion, every year, in a country like Singapore, where the education system is supposedly one of the world’s best, where condoms are easily available at any supermarket, convenience store and pharmacy, where birth control pills are available for a mere $5 for a month’s supply at public clinics, we really have to reconsider our current sex education system.
Unlike many programs which focus on the teenage years of girls, AWARE’s program takes a lifelong approach. This makes sense to me, because what we learn in school is meant to see us through our entire lives. English, mathematics, science, health education, moral education – all these are as applicable to us today as they were when we were primary school students. Likewise with sex education, the overwhelming majority of people would have sex at some point in their lives, either when they get married, or before they do.
Preaching against premarital sex gives the impression that sex within marriage is somehow safe. Vocal objections in the media to teenage sex, and laws protecting girls below the age of 16, give the impression that sex is safer for older people. Sadly, the fact that the majority of abortion and STI patients are married, and are not teenagers, highlights the importance of equipping people with lifelong skills. The best age to start would be of course, at puberty, where schools provide the best platform and opportunity for giving our adults of tomorrow the information they need.
Taking a lifelong approach, we can see the limitations of the abstinence-only message. The abstinence message is only useful for teenagers. The abstinence message is unhelpful in preventing over 8000 married women from having unwanted pregnancies each year. The abstinence message is unhelpful for the older person who has decided to engage in sex and is looking for ways to practice it safely.
Telling people that being faithful would reduce their risk of getting STI infections is unhelpful for the faithful housewife who feels powerless to stand up to her philandering husband, whom she depends on financially. The abstinence and faithfulness messages are good messages, which are beneficial as a public health policy to reduce the total number of STI infections in the entire population, but they may not always be helpful at the individual’s level.
We need to tell people that unwanted pregnancies and STIs do happen to good, faithful, married people, that they happen to people with college degrees and well-paying jobs. We need to tell you that it could happen to you. We all need to know that the only contraceptive method that can protect us effectively is the condom.
That being said, I know how difficult and thorny this can be. Relationships are built on trust, not paranoia. Why would you be in a relationship with someone you can’t even trust to be faithful, and have to insist on a condom years after being married? As national policy makers, what kind of advice can you give to the faithful partner? There is no easy answer. At the end of the day, we are all human, all vulnerable to fall, and we do. After the forgiveness or divorce is through, the last thing we want to deal with is HIV. The only thing we can do, then, is to equip people with the raw hard facts, rather than give a false sense of assurance, and leave them to decide for themselves.
FACT : Making it a criminal offense of having sex with girls under 16 can harm the under-16 girls having sex.
In the course of conducting these workshops for these students, I have met girls under 16 who love their teenage boyfriends so much, that instead of risking their boyfriends going to jail, they risk their health and lives by sticking objects up their birth canal to do a DIY abortion at home. I have met teenage girls so terrified of authority, they will risk their safety going out with strangers met online while keeping their parents in the dark. I have met girls who come under so much peer pressure to have sex, or who are outright blackmailed – with compromising mobile phone videos and photos for example.
Again, there is no easy answer. The law is there to deter and prosecute malicious sex predators—who tend to be adults. But the law is a weak deterrent for teenage boys whose girlfriends have promised not to tell. Fortunately, it seems that the courts are a lot more lenient to these teenage boys – still, they get probation, simply for having sex. The law has resulted in under-16s going to the doctors only in the late stage of pregnancies or STIs, when it becomes a lot more complicated to treat. How do we get around this problem? I honestly don’t know. I tell teenagers that their health should be No.1 priority, and that no doctor can force them to reveal the identity of their boyfriend.
I understand that condoms can fail especially when used incorrectly. So I show teenagers how to use it correctly, and I make sure they practice using it correctly before leaving my workshop. I make sure they know that even if they do not go “all the way”, STIs can still spread through oral sex or heavy petting, and pregnancies can still happen even if their boyfriends “pull out” in time. I understand that even with practice, people can still fail to use condoms properly or fail to use it at all. So I introduce teenagers to the Morning-after-pill, which is the second and last chance at preventing an unwanted pregnancy.
I understand that we can be pressured into having sex at times, and we can mistake sex for love at times. So I teach teenagers how to negotiate effectively for what they want – whether it is abstinence or sex with condom use. I go through with them what makes a relationship healthy or not, and how to move the relationship towards a healthier direction, or how to get out of it if that cannot be done.
We need go beyond the simplistic view that STIs and unwanted pregnancies are the problems of unruly promiscuous teenagers, and take a closer look at what reality is. We will then see that simply telling them to abstain, will not help the ones who truly need help, and will not help the adults that our teenagers would eventually become.
Profile of women presenting for abortions in Singapore at the National University Hospital
Kuldip Singh*, Y.F. Fong, S.Y. Loh Contraception 66
Rising Trends of STIs and HIV Infection in Singapore – A Review of Epidemiology Over the last 10 Years (1994 to 2003)
Priya Sen, , Hiok-Hee Tan, Roy KW Chan, Ann Acad Med Singapore