Teenage Pregnancy Unit ~ GUIDANCE FOR DEVELOPING BON TRACEPTION AND peal HEALTH ADVICE BeoeRVICES [TO REACH BOYS AND YOUNG MEN a 22503488927 Guidance for developing contraception and sexual health advice services to reach boys and young men INTRODUCTION | As the Social Exclusion Unit Teenage Pregnancy Report points out, half of the solution to Britain’s high rate of teenage pregnancy depends on increasing the involvement of boys and young men in decisions about relationships, contraception, sexual health and pregnancy. Improving boys and young men’s uptake of contraceptive and sexual health services is a key strand of the overall strategy. Although the number of men attending contraceptive clinics in England has more than quadrupled since 1975, they still form a tiny percentage of the overall attendance. With the Teenage Pregnancy national media campaign actively encouraging boys and young men to access local contraception and sexual health services, it is important that welcoming services are in place to meet the anticipated increased demand. How does this guidance fit into the teenage pregnancy strategy? The Best Practice Guidance on the Provision of Effective Contraceptive and Advice Services for Young People was issued by the Teenage Pregnancy Unit in December 2000. This sets out the criteria against which services for young people should be commissioned and developed to make them more accessible to teenagers. This guidance provides supplementary and more detailed advice for reviewing and developing services to meet the needs of boys and young men. It draws on existing research with boys and young men, and from consultation with practitioners, to identify the practical steps that can be taken to improve mainstream services and to develop targeted initiatives. Teenage Pregnancy It is intended for use by teenage pregnancy co-ordinators with their local teenage pregnancy/sexual health partnerships, to help ensure: ° that the needs of boys and young men are included in service development plans : that local targets are developed on increasing service uptake by boys and young men Visit the TPU website at: www.teenagepregnancyunit.gov.uk ~ WELLCOME a DERARY: CONTENT page The guidance is divided into five sections: i The context in which boys and young men access contraception and sexual health advice. > Z: Improving services: making contraception and sexual health advice services accessible and acceptable to boys and young men. 7 =F Partnerships and potential funding for services for boys and young men. 17 4, Examples of interesting practice. pA 5. Background reading and resource packs for working with boys and young men. 45 Useful organisations. 48 Visit the TPU website at: www.teenagepregnancyunit.gov.uk THHELGONTEAT: acl Boys learn from a very early age the behaviour that is expected of them. They learn the ‘right’ toys to play with and messages such as ‘boys don’t cry’. They often miss out on sex education in the family while school sex education has historically focused on biological aspects of reproduction and does not explore the impact of masculinity on attitudes and behaviour. Their main source of information is friends, but this information is often factually wrong while discussion tends to be limited to ‘performance stories’ of sexual conquests, real or imagined and doesn’t touch on emotions or relationships. ie Despite this lack of sex and relationship education, boys are expected to know about sex and experience pressure to have sex at an early age. They are not seen as needing help and support. Consequently, seeking help may be perceived as a weakness. Contraceptive and sexual health advice services therefore need to make special efforts to increase the uptake by boys and young men. Contraception and the changing social climate 13 During the last few years there has been an important cultural shift in attitudes towards contraception and sexual health. Traditionally, responsibility for both using contraception and dealing with any consequent problems has been seen as “women’s business”. Sex and relationship education in schools and from parents and carers has focused on protecting women from the consequences of sexual activity; contraceptive services have been provided almost exclusively by and for women; and women and men themselves have viewed men as peripheral to preventing unwanted pregnancy. The importance of boys and young men protecting their own, as well as their partner’s sexual health, has not been a priority. 1.4 There is however a new understanding of boys and men which looks to the social and cultural influences that make young men behave the way they do. In order to develop accessible services for boys and young men, it is essential to understand the impact of models of masculinity on their lives and to see where attitudes to contraception and sexual behaviour originate. Visit the TPU website at: www.teenagepregnancyunit.gov.uk “Public v Private” young men and masculinity i The picture which emerges from workers in the field is of young men under enormous pressure to live up to cultural norms. In certain contexts these bring obvious benefits of economic power, independence, and freedom of choice. But they may also inhibit the forming of successful, equitable sexual and emotional relationships, responsibility for sexual health issues and the playing of a full and rounded role as a parent. 1.6 Young men do not always feel comfortable, for example, playing the role of ‘stud’. Many find it hard to say no to peer pressure and feel the need to be seen as being sexually active and sexually ‘successful’. Many young men feel compelled to indulge in high levels of risk taking in order to ‘prove’ their manhood and this manifests itself as much in sexual behaviour as it does in crime or drink and drug abuse. Ly This ‘public’ world of young men, reinforced by the media and often policed by peer pressure, may often be in conflict with their ‘private’ world where they may feel less confident, less knowledgeable and more vulnerable. Homophobia , risk-taking and self esteem ‘Wea, The pressure to conform leads to high levels of homophobia directed at other young men seen as ‘different’, ‘weak’ or ‘feminine’. This not only contributes to risk taking behaviour and to bullying but also contributes to poor use of services. Asking for help is seen as a weakness that many young men find impossible to publicly refute. Many boys end up with low self-esteem because they have no one and no support service with whom to share their feelings and anxieties. The impact of racism, culture, religion and social class can further undermine self esteem and increase risk taking. NY, The recent social changes in attitudes to gender roles, which are undoubtedly of benefit to women, have left many young men in a ‘no man’s land’. Old models of behaviour have rightly been questioned, yet new models and role models are still unformed. This feeds into the limited responses many young men exhibit in their attitudes and behaviour around sexual and emotional relationships. Research with young men shows their desire for change around these issues. Services that have successfully engaged with boys and young men have also reported their willingness to disclose and discuss sexual health issues and personal anxieties. Yet young men often express the view that mainstream contraceptive services are not for them. For those already disaffected and marginalised, mainstream health focused services will seem even less relevant. Staff, whose training usually focuses on young women, also report feeling uncomfortable working with boys and young men and can view their attendance as a problem. The challenge is to take a positive approach to recognising the needs of boys and young men and providing services they trust and use. Visit the TPU website at: www.teenagepregnancyunit.gov.uk 2. IMPROVING SERVICES: Making contraception and sexual health advice services accessible and acceptable to boys and young men 2.1. The headings in this section correspond to the headings of the Best Practice Guidancfeo r the Provision of Effective Contraception and Advice Services for Young People, issued by the Teenage Pregnancy Unit in 2000. This guidance draws on research with boys and young men to give additional suggestions for providing quality services in both mainstream and targeted settings. 2.2 Action 2.2.1 The first step is to put the needs of boys and young men firmly on the agenda of the local teenage pregnancy/sexual health partnerships. It may be helpful to set up a sub-group to take the work forward. This might involve a ‘task force’ of a group of boys and young men from a local youth group or school to ensure the work remains focused on the needs of the potential users. Other potential sources include local youth fora and councils. 2.2.2. Local co-ordinators should work with commissioners, Primary Care Groups/Trusts, other NHS Trusts, local authorities, health authorities and non- statutory agencies to: e Map existing provision of services providing condoms and sexual health advice to young men, together with data on client numbers. e Review services against this guidance. ° Action an on-going programme of service development, which involves boys and young men to ensure implementation of this guidance. ° Establish links with other statutory, voluntary and community based organisations already working with boys and young men to explore working in partnership around sexual health. 2.2.3. Health authorities should monitor the performance of those delivering services against this guidance under their Health Improvement Programmes as one of the key actions to achieve the local teenage conception targets. \ 2.3 Involving young men and needs assessment ~ 2.3.1. The involvement of boys and young men is crucial to any service development plan to meet their needs. Visit the TPU website on: www.teenagepregnancyunit.gov.uk 2.3.2 However, boys and young men are no more homogenous than girls and young women. Consultation and involvement need to recognise diversity and seek the views of a wide range of potential service users. It is particularly important to find those who feel the most marginalised from services. Local data on teenage conceptions will help to identify those at highest risk. Data on sexually transmitted infections will also provide an indication of trends. Careful consultation can then be carried out to ensure that service planning meets the needs of the most reluctant service user. NN es aN To avoid duplication of effort, it is important to check whether colleagues in other settings have undertaken any recent consultation with boys and young men. If the work is relevant, it may provide both the beginnings of a needs analysis and access to young men who may wish to be involved in service development. ie, Not only should young men be consulted as part of setting up a service but i) also in the ongoing review and evaluation of services. Consultation groups with clearly defined remits could give young men a voice for feedback and an influence in future developments. Some services have young men involved on advisory/management boards or delivering peer education and support. However, less assured and assertive boys and young men will need to develop the skills and confidence to take part. Boys and young men’s views and feedback on services can also be used in N ON training exercises with staff. Managed carefully, the sharing of perceptions between professionals and clients, can be an effective way of enhancing understanding and improving consultations. The Teenage Pregnancy Unit has issued guidance on how to involve young people that includes examples of successful practice. The guidance was disseminated to co-ordinators through a series of seminars in April and May 2001 and is available on the TPU website. Age specific service The Best Practice Guidance recommends an upper age limit of 25 in services designated for young people. Local consultation will help to determine whether separate sessions for specific age groups would better tailor the service to different interests and needs. Younger boys for example may use the service as a safe place to check out myths and misinformation and discuss concerns about the emotional and physical changes of puberty. Older boys who are more likely to be sexually active, may use the service primarily for free condom supplies. Confidentiality Confidentiality of sexual health services is important to all young people, including boys and young men. Visit the TPU website on: www.teenagepregnancyunit.gov.uk