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Plenary, 14 Jan 2004

14 Jan 2004 · S2 · Plenary

Item of business

Sexual Health and <br />Relationship Strategy

Scanlon, Mary Con Highlands and Islands Watch on SPTV

I am delighted to speak in the debate and to be able to raise an issue about which I take every opportunity to speak—low fertility rates in Scotland. The registrar general has recently raised the issue, too, and research has been done on it by the University of Aberdeen.

I will concentrate on the relationship between chlamydia and fertility. There are many reasons why some couples choose to have no children and why others choose to have one child or small families. However, the problem of men and women being unable to conceive children is increasing.

I am pleased that the strategy acknowledges the increase in the incidence of sexually transmitted infections. Paragraph 1.3 states:

"Sexual wellbeing is not just about the absence of disease or unintended pregnancy."

Any sexual health strategy should be combined with a reproductive health strategy, as is outlined elsewhere in the document, including at page 51. However, the link is not strong enough.

The Minister for Health and Community Care commissioned the national sexual health strategy with particular reference to measures to reduce unintended pregnancies and sexually transmitted infections. I would like the strategy also to focus on intended pregnancies and the effect of chlamydia on infertility. As the minister suggested, rates of chlamydia increased by 41 per cent in 2000-01 and by 12 per cent in 2001-02, although some of that increase can be put down to better diagnoses. However, the increase among females under 16 is particularly marked. The infection is symptomless, so many people—men and women—go through their lives totally unaware that chlamydia will prevent them from having children in future.

We now have the morning-after pill, Levonelle, as well as condoms and peer pressure—the emphasis at the moment is on avoiding pregnancy. Many youngsters may be confident that, as long as they are not among the statistics for teenage pregnancy, they are all right; they may think that pregnancy is the main issue.

In addition to having a strategy on unwanted pregnancy, we must be more aware of fertility problems later in life, particularly given that people are marrying later—the average age at which people marry is now 28 to 30—and that many people are starting their families later in life. Naturally, couples often wait some time to build their home before thinking about a family. They may also wait some time before seeking help on fertility problems, which is not to mention the waiting time to see a consultant. There are more second and third marriages, so many people are 38 years old before fertility issues are wholly identified. I am sure that the minister, like me and many other members, has had people at his surgery asking why they cannot be funded for fertility treatment after 38. That simply is not allowed in the national health service.

For that and other reasons, although we have to talk about unwanted pregnancies and sexually transmitted diseases, we also have to tell young people that they should be aware that chlamydia is a symptomless infection. If they are not tested, they may not be able to have a child when they want one. For many people, by the time they ask for help, it is too late.

Often, men and women are reluctant to seek help on fertility issues. They carry the burden that they are letting their partner down. For many women and men, the issue is complex; they feel that they are not quite a complete male or female because they cannot reproduce. I ask the minister to be sensitive to those complex feelings and to include those issues in his strategy.

I raise those points because I would like the strategy to place more emphasis on intended pregnancies as well as on unintended pregnancies. There must be more emphasis on the fertility issues resulting from the increase in the incidence of sexually transmitted diseases, particularly chlamydia.

Box 8 of the strategy is entitled "Interim national clinical service targets for chlamydia". Out of nine targets, seven of them use the word "should". For example, the list of targets states:

"Each NHS Board should increase chlamydia testing … NAAT should be used … 90% of individuals diagnosed with chlamydia should be treated within four weeks".

However, only one of the nine targets uses the word "must". If the consultation is serious, I ask the minister to look again at those targets to ensure that they cover reproduction. The targets on chlamydia should also be firmed up to cover fertility issues.

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Plenary, 14 Jan 2004

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