Looking ahead to compulsory relationships and sex education from September, fertility pioneer Professor Simon Fishel says improved fertility education would allow young people to plan for their futures
Relationships and sex education (RSE) is finally having its moment. Overall teenage pregnancy rates are at their lowest since records began, comedy-drama Sex Education is trending on Netflix, and the subject becomes compulsory in English schools from September.
Yet, although RSE has been a huge success in preventing pregnancies, youngsters learn next to nothing about fertility. The government’s new requirements for secondary sex education include sexually transmitted infections (STIs), pregnancy, contraception and miscarriages. These requirements are to be welcomed, but contraception and conception are two sides of the same coin and teaching one without the other is failing our young people.
Now, as secondary schools develop their curricula for the autumn term, is the time to include long-overdue fertility education in the RSE curriculum. Individuals should have the liberty and respect to make informed choices, but we seem content to leave reproduction in the providence of the divine, to view it as somehow different from other medical conditions.
Many go on to assume fertility is a constant unwavering state from puberty to menopause and that having a baby is a matter of timetabling. They see celebrities having children in their late thirties and early forties and believe they will be able to do the same, unaware that many of them have had fertility treatment, often with donor eggs.
For some, by the time they visit their GP or approach a specialist, it may already be too late to conceive without the help of fertility treatment, while others may find they are no longer able to conceive at all.
Many young people are also unaware that lifestyle factors including drugs and alcohol consumption, obesity and STIs can all have effects on short- or long-term fertility. Fertility in both men and women can also be affected by environment and pollution.
What is cultural capital if not the ability to take control over one’s life?
And while women’s biological clock has long since been reduced to a stereotype, men have one too. In many ways it is more insidious as it relates to issues of the health of the child and miscarriage. In many Western nations sperm counts are declining, and approximately half of all fertility problems are due to problems with sperm. This needs to be taught.
In effect, there can be no knowledge-rich RSE curriculum that leaves out fertility and the biology of reproduction, to focus solely on STIs and avoiding unprotected sex. What is cultural capital, after all, if not the ability to take control over one’s life, to look to the future and to plan for it?
Having children earlier often impacts career development, financial security and housing stability, but waiting increases the risks of complications and life-changing outcomes for mother and child. Such moral dilemmas should not be left to be discovered unprepared.
And the development of technologies in the field presents as many new ethical questions as it does solutions. Options are already available to address some issues with later-life pregnancies, but while fertility issues may be overcome with IVF, the technique also controversially allows screening procedures to reduce the incidence of chromosomal abnormalities.
Meanwhile, cryo-preservation of ovarian tissue is also likely to become increasingly available. But although egg-freezing is sometimes touted as the solution to the working woman’s dilemma – allowing her to schedule childbirth at a convenient moment in her career – it ultimately relies on costly IVF. Does this undo the potential gains of pursuing a career in the first place? Is the ability to afford a procedure an equitable way to determine access to treatment?
Young people may not even know if they eventually wish to have children, but fertility education would give them a greater understanding of their reproductive biology, inform them in choosing the life they want, and give them a greater chance of conceiving should they choose to do so later. Importantly, it would also empower them to engage in the thorny political decisions facing society as they mature into fully fledged citizens.
In the meantime, as the adults in the room, we ought to be asking for a better RSE curriculum for their sakes.
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