Not in front of the parents
By Jennie Bristow
May 19, 2004

Imagine that your 14-year-old daughter had an abortion without your knowledge - while her school not only helped to arrange the abortion, but colluded in keeping it secret from you. Imagine that you found out about this from your mother, who had found out from the elder sister of one of your daughter's friends. Imagine that, when you did talk to her about it, your daughter changed her mind about the abortion halfway through the course of drugs, only to find out that it was too late. How would you feel?

'I am absolutely outraged', said Maureen Smith, mother of the girl at the centre of this real-life drama (1). Outraged and, understandably, very upset. As more details have emerged about this story, the more awful it seems.

The Daily Mail's version runs like this: upon finding herself pregnant, 14-year-old Melissa went to the family planning clinic for a pregnancy test. When she said she did not want her parents to know, she was referred to a 21-year-old 'outreach health worker', part of the school's Community Child Health Service, which aims to reduce unwanted pregnancies. The outreach worker referred her to hospital, where arrangements were made for an early medical abortion, using the 'abortion pill', which is taken in two stages (2). During this time Melissa's school apparently telephoned her mother to demand why her daughter was not at school - before phoning back to say that she was at school, when in fact they knew she was arranging the abortion (3).

Accompanied by a school-friend, Melissa underwent the first stage of the abortion. Then her mother found out, confronted her daughter, and Melissa apparently changed her mind. By then, however, the drug had started working; and Melissa had to take the second lot of pills to complete the abortion, or wait for the inevitable miscarriage.

Reading the interviews with Maureen, Melissa and Melissa's boyfriend, 14-year-old Dwain, paints a picture of two deeply upset families, for whom all of this is just a mess. But the way that this personal tragedy - an extreme, rare case, about which it is impossible to know all the facts - has been picked up and spun as a moral fable on the evils of youth family planning policy is less than helpful. The issue is less, as certain tabloid headlines have put it, how the law could let this happen - for some years, the law has allowed for minors to access abortions without parental consent. What has changed are the broader cultural assumptions about the relationship between professionals, parents and teenagers.

Much commentary has focused on how it can be legal for a 14-year-old girl to have an abortion without her parents' consent, when parental consent is required for other medical procedures - for example, appendectomies. Unfortunately, however, abortion in the UK is never treated just like any other medical procedure - always requiring two doctors to make the decision that it is right to abort, rather than the pregnant woman. This means that it is not such a leap for doctors to take their own decision, as they appear to have done in this case, that a teenager is competent enough to consent to an abortion, rather than automatically referring to the parents.

When it comes to teenagers, things are complicated by the obvious tension between young people's need for sexual health services that they can access independently, and the fact that legally - and, in so many ways, in reality - they are still children, dependent upon their parents. When the outcome is, as in this case, such a stark undermining of parental support and decision-making, while leaving a young girl apparently barely supported in an upsetting situation, it does seem that sexual health policy has got this balance very wrong. You have to sympathise with Maureen Smith's attitude to her daughter's young outreach worker: 'How can a 21-year-old think she knows my child better than I do?' (4)

But this same story can also be read as an example of why teenagers do need independent, confidential access to contraceptive and abortion services. Maureen Smith has described how her attempts to talk to her daughter about sex were rebuffed - Melissa cannot be the only teenager keen to hide her sexual activity from her mum. From the girl's own account, as told to the Mail, it seems that she was given several opportunities to change her mind about having an abortion and about involving her mother - at every stage, she refused, and she apparently subsequently decided not to have an abortion only after her mother found out.

The alternative to a situation in which teenagers cannot legally access contraceptive or abortion services without their parents' knowledge is not one where girls like Melissa have a better abortion experience with the addition of support from their mother. It is one where they are, if anything, more likely to go through with an unwanted pregnancy, because they shy away from telling their parents until it is too late. Fourteen years old is indeed horribly young to undergo an abortion on your own, but it is also horribly young to be lumbered with the responsibility of an unwanted child. And it is worth bearing in mind that newspapers like the Daily Mail, so keen to express their horror at this girl's abortion, are equally keen to express their horror about young teenagers who go on to become mothers.

In these ways, this 'secret abortion' scandal looks like a re-run of the tensions and controversies that have beset teenage sexual health services in the UK for the past two decades. But it has revealed a new, and deeply worrying, tendency. The law already allows minors in desperate circumstances to have abortions without their parents' consent. What is new is the assumption that they are likely to want an abortion without their parents' knowledge.

In reality, as Ann Furedi of the abortion and advice charity bpas explains, the scenario in the Melissa Smith case is rare. The vast majority of under-16s who seek abortions are accompanied by their mothers or another 'significant adult', such as their aunt or their boyfriend's mum. They do not seek protection from their families by professionals - they know that their parents care deeply about them, and that they need their support. Furthermore, those who choose to keep their abortion a secret often do so for well-considered, responsible reasons - for example, one girl decided not to tell her mother because the mother had recently miscarried her own baby, and the girl didn't want to upset her. How members of a family relate to one another, particularly around such issues as underage sex and abortion, is dependent upon a number of factors, and a sensitive sexual health service should allow for that.

But while it cannot be presumed that every girl will benefit from her parents' knowledge of her abortion, it is bizarre to presume that girls will automatically want to keep something like this a secret. And it is this presumption that seems to be creeping into sexual health policy. The official, high-profile obsession with reducing teenage pregnancy rates has led to increasing involvement by family planning agencies, youth organisations, and, above all, schools, in monitoring and advising upon teenagers' sexual behaviour.

From pouring increasing energy into sex and relationships education to initiatives providing contraception and emergency contraception through the school nurse, the thrust of sexual health policy is to make it easier for teenagers to avoid the consequences of sexual activity. A pragmatic, even laudable policy perhaps - except that the upshot is a greater professionalisation of teenage life advice, and an implicit attack on parents.

It is one thing for teenagers to want to conduct their sex lives without full disclosure to their parents, and to have recourse to practical help when things go wrong. Indeed, it would be a strange kind of society where doting mums and dads became intimately acquainted with their teenagers' sex lives. But it is another thing entirely for teenagers to be fed the message, on continuous loop, that their parents might cause them grief, and so the first port of call in an emergency should be the school, the outreach worker, the mentor or the counsellor. This is not a recognition that it is dangerous to interfere into young people's attempts at sexual experimentation - it is encouraging them to hold their sex lives up for surveillance, not to their parents, but to trendier professionals who are assumed to know best.

The number of professionals in this case who apparently colluded, not only in providing Melissa Smith with an abortion, but in keeping it from her family, indicates that there is more going on here than simply providing a confidential service for teenagers in a difficult situation. There is an implicit assumption that parental involvement will need to be leap-frogged in order to encourage pregnant teenagers to make the 'right' decisions about contraception and abortion. The notion that it is somehow easier for teenagers to confide in their schools than their families, and that the kind of professional support that they receive is somehow better, is a disturbing example of the tendency to sideline parents in dealing with young people's personal issues, in favour of more and more intimate professional intervention.

This sits uneasily with the trend to make parents more responsible - in the sense of being directly punishable - for their children's bad behaviour. As Maureen Smith put it, 'If my daughter had been truanting from school or causing trouble in the classroom I would have been informed' (5). And it has serious consequences for the way in which young people are encouraged to view their relationships with their schools and their families. As schools seek to offload their own responsibilities, for education, discipline and attendance in class, on to parents, they are usurping parents' responsibilities for the emotional wellbeing of their children - encouraging the exchange of confidences about sex, home life and everything else, and promoting what seems to be a more informal relationship with the pupils in their charge.

Whether this helps young people is doubtful - the fact that it confuses them seems inevitable. And the parents? Increasingly, it seems, nobody even pays them a second thought.

(2) 'Abortion advice from girl of 21', Daily Mail, 14 May 2004

(3) Mother angry at secret abortion, BBC News, 13 May 2004

(4) 'Abortion advice from girl of 21', Daily Mail, 14 May 2004

(5) 'School fixes a secret abortion for girl of 14', Daily Mail, 13 May 2004