Legal Update: Access to sexual health services
Elizabeth Yarrow
Tuesday, March 4, 2014
Elizabeth Yarrow, senior researcher at Coram Children's Legal Centre, summarises recent research that explores the impact of the law on young people's access to sexual and reproductive health services.
Last year, Coram Children's Legal Centre (CCLC) conducted research into legal barriers to young people's access to sexual and reproductive health (SRH) services. The study, commissioned by the International Planned Parenthood Federation, took an innovative approach to exploring young people's access to SRH services; assessing the extent to which the law, as well as young people's and service providers' knowledge and perceptions of law, intersect with other factors, to restrict young people's choices and practices regarding SRH.
As part of a larger study, research was carried out in three locations across England and Wales: Greater London, Manchester and Cardiff. Young people aged 13 to 24, selected through schools, colleges and youth services, participated in the research. Researchers also interviewed SRH providers and practitioners.
The research revealed that laws have the potential to influence access to SRH services in several different ways, through the establishment of: direct legal barriers; indirect legal barriers; or, alternatively, through positively helping to facilitate young people's access to services.
Direct legal barriers include laws that restrict a young person's access to (certain types of) services, either absolutely, or where they are below a specified minimum age; or laws that require a young person to obtain the consent of their parents before accessing services. For example, common law in the UK provides that, where a child is under the age of 16 years, a service provider must assess their competency to (independently) consent to SRH treatment on the basis of a number of guiding principles ("Gillick Competency" or "The Fraser Guidelines"). Where children are deemed "not competent" they require consent from a person with parental authority. The research indicates that many young people are unaware of their legal right to independently access services under the age of 16, even though they are not often refused in practice. Furthermore, some service providers were found to be imposing restrictions on children's access to services based on their personal ideas, expectations and beliefs.
Indirect legal barriers are laws that do not explicitly restrict access to SRH services, but nonetheless may function in this way. For example, the law that criminalises sexual activity with young people under the age of 16 (the minimum "age of consent") may cause some sexually active young people under this age to be reluctant to access SRH services. While young people were not found to fear prosecution, they tended to conflate the age of sexual consent with other age-related restrictions, including consent to treatment, fearing that services will be denied to them, or confidentiality will be breached, if they attempt to access services under 16.
Facilitative laws empower young people to make informed decisions around sexual health, and safeguard their right to access a full range of services. These include: laws that provide for compulsory comprehensive sex and relationships education (SRE); equality laws; and laws that protect young people's confidentiality. Among other issues, the research found that a failure to make comprehensive, inclusive and value-neutral SRE a core compulsory subject taught from an early age has led to significant variation in the extent and quality of SRE in schools in the UK. Furthermore, the heteronormativity of SRE in many schools has caused lesbian, gay, bisexual, transgender and intersex young people to miss out on relevant information and feel stigmatised.
The full report is due to be published on CCLC's website in the coming months.The findings will be used to develop a series of recommendations for advocacy for legal and policy reform; as well as guidance and information for service providers on the implications of the research evidence for their work.
For more information on the development of these publications please contact Elizabeth.Yarrow@coramclc.org.uk