Midwives magazine: December 2005
Teenage pregnancy has, and continues to receive, much attention not only in health and social care policy and practice, but also in the media.
The government policies on teenage pregnancy and social exclusion (Teenage Pregnancy Unit, 1999; Social Exclusion Unit, 1999) that stemmed from Fullerton et al (1997) are widely embraced within midwifery, notably the establishment of a midwifery network within the Teenage Pregnancy Unit and dedicated roles for midwives. But within this policy context an aspect that has received much less consideration is that of confidentiality and the rights of young people. Everyone has the right to confidentiality, but for the young it is of paramount importance.
Young people need to feel safe, respected and valued so they can have confidence in health professionals, including midwives.While the government purports to be standing by its teenage pregnancy strategy that emphasises the importance of confidentiality (Teenage Pregnancy Unit, 1999), the fact remains that application in practice is very challenging and variations exist.
The charity Brook has declared it is concerned because it regularly hears from young people who say health workers have been obstructive, disrespectful or failed to recognise their right to confidentiality. Is this reflected in midwifery? Maybe we do not even know, so a fundamental question is: ‘How ethical is it that young people are unable to feel their right to confidentiality is adhered to and maintained?’ Younger teenagers, (under 16 years old) find it even harder to approach health professionals – this is in part bound up in their lack of faith in a professional’s ability to be confidential.
Young people regard confidentiality as the most important thing when seeking professional advice. Bearing in mind that social inequality has been implicated in teenage pregnancy, it is even more challenging to engage and establish a relationship with midwives. I argue that without confidentiality there can be no trust and without trust there can be no affinity. These are essential ingredients on which to base a sound midwife-woman relationship and every woman has the right to this. Too often though, pregnant teenagers and young mothers are stereotyped and as a consequence this interferes in the process of confidentiality and trust. Teenage pregnancy and sexual health stir up moral and provocative debates within society.
The midwifery profession is not exempt from the arguments over what young people should or should not be doing in terms of their rights and their sexuality as both are frequently scrutinised and judged. In conjunction with the teenage pregnancy strategy (Teenage Pregnancy Unit, 1999), how certain can we be, as midwives, that from an ethical perspective we are not transmitting a negative message about teenage pregnancy? In whose interest is it to reduce teenage parenthood? Are we not adding to young people’s sense of guilt and regret? Is it fair to view pregnant teenagers and young mothers as a problem and nuisance to health and social care services and more broadly to society? Is it ethical that confidentiality is not fully embraced? Is it ethical that some young people were excluded from the policy context in terms of access to care provision? For example, black minority ethnic groups and young fathers were not explicitly addressed in the original policies (Teenage Pregnancy Unit, 2002; Teenage Pregnancy Unit, 2005;Wiggins et al, 2005).
On one hand, it seems the notion of young people engaging in early parenthood is shameful and immoral. Yet on the other, the policy context of Sure Start Plus (Social Exclusion Unit, 1999) requires adherence to specific targets – health, social and emotional wellbeing, strengthening families and advances in learning, all intended to improve life chances. But is it simply rhetoric? Is it more about power and control, grounded on the desire to rule young people’s lives? Ethically, does it sit comfortably with the principles of respect for autonomy, benevolence, justice and preventing harm? I am not convinced we can answer ‘yes’ to these questions.
As young people are labelled and uncertain that their rights will be fully addressed and supported as autonomous people, many ethical questions arise for midwives to consider. Finally, consider this comment made by chief executive of Brook Jan Barlow and ponder on your own practice: ‘Any erosion of young people’s rights to confidential sexual health advice and services could lead to a massive increase in the number of unplanned pregnancies and sexually transmitted infections among teenagers’ (2005). How sure are you that you respect young people all the time, secure their rights and instil confidence in them to trust you with their information and be confidential?
Brook. (2005) News. See: www.brook.org.uk/content/ M7_2005_19_10.asp (accessed October 2005). Fullerton D, Dickson R, Eastwood AJ, Sheldon TA. (1997) Preventing unintended teenage pregnancies and reducing their adverse effects. Quality in Health Care 6(2): 102-8. Social Exclusion Unit. (1999) Teenage pregnancy. HMSO: London. Teenage Pregnancy Unit. (1999) Teenage pregnancy. Department for Education and Skills: London. Teenage Pregnancy Unit. (2002) Diverse communities: identity and teenage pregnancy – a resource for practitioners. Department for Education and Skills: London. Teenage Pregnancy Unit. (2005) Implementation of the teenage pregnancy strategy: progress report, March 2005. Department for Education and Skills: London. Wiggins M, Austerberry H, Rosato M, Sawtell M, Oliver S. (2005) Sure Start Plus national evaluation final report. Institute of Education: London.