HPV vaccination - the debate isn't over yet
St Monica's in Manchester does not want girls vaccinated against HPV on school grounds. Kit Roskelly argues that all schools have a responsibility to protect their pupils' health
All girls aged 12 and 13 will be provided with vaccinations against the Human Papilloma Virus, the UK government decided, in October last year. Because the vaccination must be given to girls before they become sexually active to be most effective in preventing cervical cancer, parents and schools can consent to the young women in their charge receiving this jab. St Monica's School in Greater Manchester announced recently that it was not prepared to allow the vaccinations to be given on school premises. The governors of the school, which is a Roman Catholic institution, wrote to parents raising concerns about possible side-effects of the immunisation, and informing them that they did not feel that the school was the appropriate place for it to be administered.
Schools have played a central part in vaccination programmes over many years. Immunisations against measles, mumps, rubella, diphtheria, TB, meningitis and a number of other diseases have been provided in British schools for decades, with incalculable benefits to the health of individuals and whole communities. This sudden change of heart on the part of St Monica's School is unexpected, to say the least.
The wider issue here is the attitude of right-wing Christians to women. This is more clearly a problem in the United States, but the effects are also felt closer to home. The proposal last year to provide this jab nationwide provoked a debate about the possibility that it would "encourage promiscuity". Groups such as The Christian Institute argued in favour of telling young women not to have underage sex, rather than providing them with the vaccination. This attitude is irresponsible and harmful.
The older generation may or may not approve of young women's choices, but nevertheless owes it to them to protect their health in whatever way they can
The link between promiscuity and HPV is tenuous. If a woman has unprotected sex with more partners, she is at more risk of contracting HPV, but with 80% of the population affected by the virus at some point, it is unlikely that following the Roman Catholic Church's teachings on sexual morality can prevent someone from catching it. The belief that 'good girls' don't get HPV, and only those who ignore the teachings of the Church are at risk, perpetuates the damaging idea that sexually transmitted infections are a punishment for those who do not follow the teachings of the Church. Whether a woman has one or many sexual partners, whether she remains faithful to a long-term partner or not, she does not 'deserve' to suffer from a preventable form of cancer.
In the 1980s, when the first outbreaks of HIV came to public attention, there was clear division made in public perceptions between the 'innocent victims' - those who had contracted the virus through blood transfusions - and those who had contracted the virus through intravenous drug use or through sexual contact with an infected person. This is an inhumane and repellent belief. No one, whatever their sexual or moral actions, 'deserves' to suffer from HIV and AIDS, and no woman, whatever her sexual or moral actions, 'deserves' to suffer from cervical cancer.
I am entirely in favour of all religious groups being free to teach and practice their own tradition, but within reasonable boundaries. In allowing religious belief to be placed before health, we undermine the wider freedoms of the society we live in, and in encouraging this, the conservative wing of the Roman Catholic Church damages its credibility as a Christian institution.
This addition to an already expensive set of immunisations and mandatory health checks places another obstacle in the way of women wishing to enter the US as citizens. It also raises questions about the United States government's attitude to women and health
The Roman Catholic church has a difficult record on issues of women's sexuality. A male, celibate hierarchy teaches on matters such as abortion and contraception - not, one might think, people in the best position to make constructive choices on women's sexual health. While in many areas of the church, discussion of these issues is welcome and change is beginning to occur, right-wing Christians are still trying to impose a moral standard which is increasingly irrelevant, negative and frequently misogynistic. Given the preoccupation of right-wing elements of the Church with the prevention of pre-marital sex, the refusal of St Monica's school to administer this vaccination looks like a part of a wider campaign to impose their sexual morality on young people by means of fear and guilt.
If this attitude were limited to one school in Greater Manchester, it would be less worrying, but the rise of abstinence-only education is a related and alarming trend. Religious institutions teach children that sex before marriage, homosexual acts and sex for purposes other than procreation is morally wrong. This approach does not work. It is widely acknowledged that young people will experiment with sex, and that abstinence-only education does not discourage sexual activity, but renders it more likely to be harmful by not providing the essential facts young people need to protect themselves from STIs or from unwanted pregnancy.
The policy of the United States on this issue bears consideration. Religious opposition has prevented the widespread use of the HPV vaccination in every state except Virginia, but the vaccination is required for all female immigrant between the ages of 11 and 26 before they can obtain a Green Card. This addition to an already expensive set of immunisations and mandatory health checks places another obstacle in the way of women wishing to enter the US as citizens. It also raises questions about the United States government's attitude to women and health. The government tacitly supports the vaccination's use, but is unable to do so among the voting public, whose opposition could jeopardise the results of the next election. So, by an underhanded tactic, it is trying to increase the immunity of the population by requiring the jab for immigrants.
Abstinence-only education ensures that young people do precisely what they would have done anyway, with an unnecessary burden of guilt and without the resources to do so safely and responsibly
In imposing this regulation upon women entering the country, the US places the onus on the voteless to 'earn' their citizenship. They can safely apply pressure, knowing that they are offering a very powerful incentive. In this way, the US government can be seen to support the vaccination and pay nothing for the privilege, since the cost of immunisation is paid by the woman who receives it. The people who vote for them are not concerned if foreign women are protected or not - they are more worried over their daughters' moral health and unblemished 'chastity'.
The imposition is also implicitly xenophobic, implying that immigrant women are responsible for the spread of this disease, while women who are currently citizens are not. The sexual health of US teenagers is believed or hoped or fiercely encouraged to be good, due to the insistence of its adults on imposing fear, guilt and ignorance on sexual activity. Meanwhile, the government expects its new arrivals to pay for the privilege of doing their work for them. The United States demands that its poor and unrepresented immigrant women improve the health of a nation too rife with religious extremism to do so itself.
The vaccination programme, if it protects any group of women from infection, is a good thing, but vaccinating immigrants victimises an underclass with no access to representation, and ignores those within the country who could equally benefit from the immunisation. Coupled with the abstinence-only education being taught in over a third of schools in the US, this approach is ignoring the health of most young women in the US.
Given this wider context, the stance of St Monica's school is clearly worrying. We are not as far distanced from the US as we would perhaps hope, but most of the young women in Britain will be able to receive this jab, precisely because our society places health above religious dogmatism. The UK also places unfair burdens on people immigrating here, treats young people's education and health as pawns on a political chessboard and gets sex education wrong. This needs to be addressed, particularly given the increasing likelihood of a Conservative win at the next General Election. Our attitude to young people needs to change.
No human society has found a way to enforce its adult standards on teenage behaviour. Between the ages of 13 and 19, young people develop their independence, test the limits of authority and make their own decisions about the adult world they must live in. Every generation of teenagers will experiment with alcohol, with drugs, with sex, with ideas, with music whose appeal mystifies their parents. Abstinence-only education ensures that young people do precisely what they would have done anyway, with an unnecessary burden of guilt and without the resources to do so safely and responsibly.
Western society has difficulty letting go of its young people. Parents and schools think of young people as children until they are 16 or 18, while their peers, magazines and the mass media impose an early, often confusing, maturity, and an equally confusing awareness of sexuality. Young women receive conflicting messages about what is expected of them, at a period of their lives which is already emotionally difficult. It is no wonder that our culture has trouble treating adolescents consistently. Abstinence-only education adds to this confusion and, in promoting ignorance to further a narrow view of sexual morality, it does harm instead of good. It cannot be allowable to let young people face the most life-changing few years of their lives, with inadequate information, just as it is not allowable to leave girls at risk from cervical cancer out of misplaced morality.
In the case of the HPV vaccination, St Monica's school and the Christian Institute persist in treating teenage girls like children, while the government has rightly acknowledged their approaching adulthood. The year eight students of St Monica's will, in five or six years, be making their own decisions on what to wear, what to study, what parties to go to, whether to have sex and with whom. They may stay committed to the Roman Catholic tradition in which they were brought up, or they may rebel against it and everything it stands for. The older generation may or may not approve of their choices, but nevertheless owes it to them to protect their health in whatever way they can.
The number of lives that will be saved by this jab in Britain - around 400 daughters, wives, sisters, mothers and grandmothers each year - is in itself a good enough reason for it to be offered by every school in the country, and the fact that the government has provided the vaccination programme is a cause for celebration. The right-wing backlash is not over, but attitudes are changing, and women's lives are being saved.