Researching teenagers andsex:ethics, issues and findingsSally BrownSchool of Medicine and HealthS.R.Brown@Durham.ac.uk
Researching teenagers andsex• Background to the research• Ethical issues• Recruitment issues• Study 1 – talking to young women about unintended conceptions ∂• Study 2 – talking to young men about sex and contraception• Where next?
Background• Government commitment to reducing unintended teen conceptions• However, the UK still has the highest rate of teenage pregnancy in Western Europe• Within the UK several “hotspots” exist, of which Hull is one• ∂ Although conception rates have continued to fall, there remains a need to understand why unintended conceptions still occur, despite widespread availability of contraception.• A series of qualitative research projects were commissioned in Hull to gain a deeper understanding of the issues.
Ethics and recruitment• Study 1 required NHS Ethics approval as we planned to recruit young women whilst they were patients on the day case unit: • Consent to be contacted after 2-3 weeks • Consent to be contacted after 2-3 days • Consent to be interviewed on the ward • “thinking time” ∂• Issues: • Sensitivity • Not doing harm
Ethics and recruitmentStudy 2 required University ethics, but not NHS ethicsRecruitment:• Teenage pregnancy and sexual health development worker• Boys and young men’s worker ∂• Teenage pregnancy advisor (young fathers)
Study 1• The first project involved: – In depth focussed interviews with young women aged between 16-20, who had either had, or were waiting for, a termination of pregnancy – 23 face-to-face interviews; 1 telephone interview; 24 in total – The face to face interviews were recorded (with the consent of the ∂ interviewees) and later fully transcribed – Notes were taken for the telephone interview – The interview transcripts were analysed using a grounded theory approach to build up categories using the constant comparative method and “in vivo” codes
Key Findings• Key findings centred on: – Knowledge about sexual health/contraception – Access to services – Use/non-use of contraception ∂• Findings are reported in: – Brown S. Guthrie K. Why don’t teenagers use contraception? A qualitative interview study, European Journal of Contraception and Reproductive Health Care 2010(15)3:197–204
Knowledge – sex education at school• Can’t really remember. They told us about STIs and stuff, and then showed us how to put condoms on. Not much really. (R6/16)• They only talk about the reproductive stuff, they don’t talk about how you’ll feel, or hormones or anything, and they should (R23/18) ∂• I don’t think it makes much difference, if somebody’s trying to talk to you seriously about sex when you’re in a classroom with all your mates, that’s all it’ll be, a giggle. (R5/20)
Access to servicesNot using the GP • Well, cos it’s the family doctor and I don’t really want my parents to find out (R11/18) ∂ • You could see one of your Mam’s friends or summat, and the nurse comes and shouts out your name and your number, and like your Mam’s friend could think, could say to your Mam, ‘oh, I seen your daughter at the clinic on Tuesday’. Mam says to me, ‘what were you at clinic for?’ (R16/18)
Use of contraceptionContraceptive failure: • The reason I think I got pregnant is because I wasn’t very well, and I had sickness, and I think because of that … (R5/20) ∂ • I’ve always used condoms, you see, unfortunate occasion it didn’t work, but I’ve always used condoms for protection (R8/17)
Non use of contraception “It won’t happen to me” • I just thought I won’t get pregnant, but I did (R6/16) Being “in the moment” ∂ • They just get caught in the moment and they daren’t say,” have you got a condom?” You just go on with it and think “oh, it’ll be alright,” then it’s not (R19/18)
Not using contraceptionLack of confidence: • like, sometimes, like during sex they don’t speak, so the girl is, like, scared to say “have you got a condom?”, and the boy, well, the boy will just like get on with it won’t he, really? He’ll just think, “forget about it, oh it doesn’t matter” (R19/18) ∂ • I think most of it you feel stupid, you know, but erm, a couple of times I was saying” shall we use a condom?”, cos obviously I don’t want to be getting pregnant, like in the situation I’m in now. And they’re just like basically, no. (R16/18)
Not using contraceptionMale reluctance/refusal • But they’re just lazy. They say it spoils the moment, but no, its not. It’ll spoil the moment when there’s a baby crying in the middle of it. (R14/18) ∂ • Mostly its lads, they think it’s all up to the girls all the time (R9/16) • Cos they’re not the one who’ll have … they’ll just think at the end of the day if they do get someone pregnant or whatever, at the end of the day its not really their problem. A lot of boys think that. (R18/16)
Influences on non-useAlcohol • I know it sounds silly but at the time you aren’t bothered, when you’re drunk. Well you are, but you just seem to think you haven’t got a condom,∂ doesn’t matter this time round, its I’ll be alright (R16/18)
Influences on non-use EHC as an alternative: • They just tell them to go and get the morning after pill. That’s what they all say. (R1/16) Termination as an alternative: ∂ • I’ve had that said to me, I mean, I’ve never been pregnant before, but I have had my ex boyfriend saying to me, before, “its alright, if anything happens you can just do this”, and I’m like, “well, no its not as easy as that, its horrible”, its not a nice thing to do either, but he’s like, “no its alright”, you know. (R7/16)
Assumptions• Yeah a lot of boys just assume, oh I thought you was on the pill, I thought you would’ve been. Well I’m not, (laughs) so… Yeah, a lot of them just assume, don’t they? (R14/18)• Its just like, hit puberty go on the pill. That’s what they’re thinking. Loads of lads I used to hang round with thought that. ∂ (R10/17) SB Do you think boys think it’s a girl’s responsibility to use contraception? R Yeah they blame the girls for everything, don’t they? Yeah SB Are the boys thinking that it’s the girls job to go on the pill? R Yeah. Cos my little girl’s dad, he used to think that. SB He thought you would be on the pill? R Yeah, but I wasn’t obviously (laughs) (R5/20)
Thinking• I think girls take [contraception] more seriously. To be honest (R15/16)• I think in a couple of cases they probably just think they’re on the pill. But that’s maybe if they just have ∂ night stands and things but if one you’re with somebody, they’re obviously gonna know whether you’re on the pill or not, so you’d both decide to use summat, wouldn’t you? (R8/19)
DiscussionLimitations of the study may affect the conclusions it is possible to draw: – This was a focussed study, looking at reasons for unintended conceptions amongst young women having a termination, therefore the young women interviewed may not have been typical of the wider population; ∂ – Social class and education levels may have influenced views; – Young women’s perceptions of young men’s attitudes may have been influenced by bad experiences; – There may be an element of “post hoc rationalisation” in terms of explanations about why a young woman became pregnant, and she may not wish to appear to be “to blame”.
Study 2• Having heard the views of young women regarding “what boys say”, the next project sought to explore what young men themselves say;• Focus groups were held with young men who were not fathers;• ∂ The topic guide took the issues arising from earlier interviews with young women as a starting point• Findings are reported in: – Brown S. Young men, sexual health and responsibility for contraception: a qualitative pilot study. Journal of Family Planning and Reproductive Health Care 2012;38:44-47
Sex educationSam: I treated as a joke, that’s what all lads do.Rob: They laugh if they see someone naked, like at 14.SB: Do girls take it more seriously than boys?Sam: Girls are more mature.Rob: Yeah, they are more mature. ∂Sam: The lads don’t care. They act like they think they know it all afterwards.
Using contraceptionSB: Do you think boys and girls think differently about contraception?Mike: Yes. No question.SB: In what way?Mike: Most boys are prepared not to use them, but girls generally are like, no you must use them.Joe: ∂ Yes, girls are very keen to use them.SB: Thinking about contraception, do you think there’s a difference between girls and boys in terms of who takes responsibility?Sam: In my experience, no. I think it’s shared really.Rob: It’s shared. You’re both going to do it.
Being preparedMike: What do you mean, carrying condoms? I think it’s always safe for a girl to carry them.Joe: Everyone should have them, boy or girl. ∂
But …Joe: To be honest, I’d think she was a slag.Mike: Yeah, if she came to a party with a condom.Joe: Yeah, it’s like she knows she’s going to have sex.SB: But what if she wasn’t planning to have sex, but thought she might want to? ∂Joe: Yeah but why would she carry one? Just for a laugh? I mean, if she goes to a party carrying a condom she knows she’s going to have sex. Definitely knows.Mike: I don’t know. I think if you go to a party and you know there’s going to be drinking, you might not initiate sex but if you think you might get drunk and you don’t know what you’re going to do, then I think it’s probably best to bring a condom.
ThinkingSB: Thinking about STIs, does that play a part in boys’ minds?Joe: I don’t think boys actually think about anything when it actually comes to it, if you know what I mean.Mike: No.Joe: ∂ They think about it when they can actually get something, but they never think about it before.SB: So the next day …Joe: …they think “oh my God, I could have that, and that, and that …”Mike: …if it’s with someone they don’t know.SB: But it’s not something that would stop them having sex?Mike: No.
Is it something about Hull?Family expectations:• Me mam had my older brother when she was 15, and me nana had me mam when she was 15, it sort of like runs in the family. (Emma,17) (had first baby at age ∂ 15)• Everyone knew, in my family, and they were all really excited, and wanted me to have the baby. So I did. And I know I shouldn’t say I regret it, with her out there, but I do. (Sophie,18) (had first baby at age 15)
Is it something about Hull?Sam: If your Mam had you when she was young, you’d say “well, it didn’t do me any harm” so they get brought up to think it’s OK to have a kid really young, and∂ think about having a kid when to you’re 30 is like another world. So I think it’s the education you get as part of your upbringing.
Where next?How to engage young men in researchResearch with families – multi-generation households ∂Your reputation or your health? Which would you risk?What makes teenage motherhood a success?Why is teenage parenting problematised?
Acknowledgements• Both studies have been funded by the Teenage Pregnancy Unit, Hull City Council• The first study was given ethical approval by the NHS Local Research Committee for Hull and East Riding• The second study was given ethical approval by the Ethics Committee of the School for Medicine and Health, University of Durham• • ∂ The author would like to thank the following people for help and advice: Ms Gail Teasdale, Service Development Manager for Teenage Pregnancy and Sexual Health, Hull City Council • Mr Neil Wade, Mr Simon King, and Ms Mel Clarke, Hull City Council • Dr Kate Guthrie, Hull and East Riding Sexual Health Partnership • Professor Hilary Graham, The University of York • Dr Karl Atkin, The University of York • Mrs Helen Thornton Jones, East Riding PCT • All the young people who took part in the studies