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Not a path to promiscuity, but to sanity
In the entire history of the world, the greatest freedom women have been given — greater than equal legal status, greater than property rights, greater than the vote — is safe, reliable contraception.
Before that, biology was indeed destiny; women found themselves chained (as they still are in much of the world) to a hormonal rollercoaster of pregnancy, miscarriage, childbirth and breast feeding, followed by another, often unwanted, pregnancy; what is extraordinary, given this upheaval, is not how little women achieved but how much.
It is strange to think that this astonishing freedom is new and appeared only recently, easily within living memory, at the beginning of the second half of the 20th century. Perhaps it is hardly surprising that many people haven’t quite caught up with the idea or adjusted their thoughts and feelings to it and find themselves still resisting the idea of contraception, often in terms of a confused moral disgust.
“Charter for promiscuity” was the front-page headline in one newspaper last week; that was the predictable response of self-appointed family groups, so-called pro-life groups and religious spokesmen to the news that the National Institute for Health and Clinical Excellence (Nice) is recommending that all girls over 16 should be offered long-lasting contraceptives on the National Health Service.
The guidelines now say doctors should suggest alternatives to the pill, such as injections and implants, which last for many weeks, or intrauterine devices, which last for several years. These alternatives, known rather endearingly as larcs (long-acting reversible contraceptives), are cheap, reasonably safe, easy to insert and hugely more effective than pills, if only because a woman doesn’t have to keep remembering not to forget about them — she can happily forget about them. What larks indeed.
You might think this would be seen as a great blessing. Nice estimates that 400,000 pregnancies a year are unplanned. The abortion rate in this country is high and rising. About half of women rely on pills or condoms, although not as heavily as they should; one in five women under 25 forgets to take her pill at least once month. It is hardly surprising that a recent study suggests that if just 8% of women taking the pill switched to a larc, unplanned pregnancies could be cut by 70,000 a year.
I do wonder how anyone arrives at such figures: women are far from frank about contraception or contraceptive “accidents” or about what they really want at all. But it stands to reason that more larcs would mean fewer abortions and fewer unwanted babies and fewer miserable, neglected children, not to mention huge savings for the National Health Service and social services.
So why the outrage from the usual suspects? Why is better contraception somehow worse? They ought to be against unwanted babies and against abortions but what they seem to be against is sex. For reasons I cannot understand they are convinced that larcs will lead to all too many more larks or what they tend to call “experimentation”.
They are wrong. These days there is no inhibition, which larcs might be imagined to remove, standing in the way of having as much sex as one wants or can get, with or without contraception, with or without the prospect of abortion. That revolution has happened. Larcs will make no difference.
I would be surprised, too, if larcs make any difference to sexually transmitted diseases — as the usual suspects are also claiming. A man sleeping with a woman who has an IUD or three-monthly injections might be tempted to forget about condoms, but that same argument (and same risk) applies to people who rely on the pill.
The truth is that it depends on the individuals. Just as people know perfectly well how not to get pregnant, they also know how not to get nasty venereal diseases; what they do depends on how sensible they are, just as it always has, time out of mind. It has nothing to do with the refinements of contraceptive technology such as larcs — people used to take those sexual risks, or avoid them, long before there was any contraceptive technology.
What the contraceptive revolution offered from the first, for all its minor side effects and risks and with refinements ever since, such as larcs, was freedom. Contraception offers freedom from the risk of doing something wrong — bringing an unwanted child into the world. It offers freedom from all the risks and distress — some would say the evil — of abortion. And it offers freedom to women to have a sexual life without sacrificing every other kind of life.
But freedom, like justice, is indivisible. Sexual freedom for one is sexual freedom for all. Some people abuse it — in fact when one stops to think of the confessions and betrayals in the tabloid newspapers and on the airwaves of the bonking-mad love rats and their slaggy chavettes, of last week’s 16-year-old mother of triplets and her deeply depressing daily round and so on, one begins to think that a great many people abuse it — but that is the price of freedom.
As moralists warned when the original contraceptive pill broke the necessary link between sex and conception, there were bound to be social consequences. There certainly have been, as with the bonking-mad love rats, slaggy chavettes and wraparound tumescent TV. But there has also been a moral change.
Traditional sexuality morality — meaning sexual restraint, particularly for women — was based on that connection between sex and conception: it evolved to protect paternity and patrimony. Now the connection has all but disappeared, as has patrimony, and the less connection, the less restraint and the more empty the morality.
For this reason Christian moralists and others are doomed to failure with their quixotic hopes of getting people to say no to sex or to save themselves for married monogamy; they might as well try to put a genie back in his lamp. Because higamous, hogamous we are mostly not monogamous, and we no longer have any reproductive reason even to try to pretend that we are.
For better and for worse, contraception changed sexual morality. But it is surely for the best that long-term contraception will now make it less likely that unwanted babies will be born to unwilling or unthinking mothers. That is a great emancipation by any standards.
The Sunday Times | Sunday, October 30, 2005 | Comments (0)
Improving schools is as easy as c-a-t
Education, education, education. How those words ought to haunt Tony Blair. Perhaps it would be naive to imagine the prime minister lost sleep over last week’s Ofsted annual report on the nation’s education. But he should have.
One in four schools in England, according to the chief inspector, offers nothing better than mediocrity. One in five children does not reach the expected level for English at 11, and about 30% fail to reach the expected level in both English and maths. Admittedly the Ofsted report is not all negative; 70% of schools were judged good or better.
But the inspectors found that the government’s secondary school strategy had not brought the promised “substantial transformation” in half of them. Children in greatest need of help were “too frequently” left with untrained classroom assistants and the expensive key stage 3 national strategy was said to be inadequate in one in five secondary schools.
Something else emerged last week that ought to have disturbed the prime minister’s sleep. A little cloud descended on the government’s claims about GCSE successes. It has become clear, largely thanks to a persistent BBC investigation into unpublished figures, using the Freedom of Information Act, that the “record breaking” improvement in school league tables over the past five years is not what it seems. The figures are inflated. They hide a decline in key subjects.
A school’s position in the league tables depends on how many of its pupils pass any five GCSEs at grades A*-C. So the government can and did truly claim that the proportion of children achieving that standard this year jumped by two percentage points to 55.7%, the highest rise for a decade. But bean-counting all depends on which beans you count and why. The GCSE beans have been very oddly counted.
The five beans that each child needs for league table success do not, strangely, have to include English and maths GCSEs. It is difficult to think of a good reason, since it’s obvious that English and maths are the gold standard of basic educational attainment at GCSE. Even more strangely, the vocational GNVQ qualification is now counted as equivalent to four GCSEs, no matter what the subject or grade. It is impossible to think of a good reason for that; it looks like the most manipulative egalitarianism.
Vocational courses are valuable and plenty of children should be doing them. But they are easier academically than GCSEs, they have a high pass rate and are simply not comparable. It is striking, too, that the GNVQ grades make no difference. One way and another, it makes perfect sense for head teachers to put as many children as possible down for them to inflate their league table figures. I don’t suppose the prime minister will lose any sleep about that, however, as according to Chris Woodhead, the former chief schools inspector, he knew about it at least four years ago.
When you count the beans scrupulously, things don’t look so good. When English and maths GSCEs at A*-C are included in the tables, the proportion of successful children drops from 55.7% to 44.1%.
According to last week’s BBC investigation, although 300 mainstream schools went up the league tables, their results in English and maths GCSE went down. And some schools at the top of the league table are getting only a third of their pupils through English and maths.
What is more, the percentage of children getting five or more GSCEs and the percentage getting English and maths have both been flatlining since about 2001. What on earth happened to all the extra millions that the government started spending at that time? And what on earth can Blair do, in the short time that remains to him, and on his own terms, about education? Given the forces of conservatism in the left-liberal teaching establishment, which have resisted most of what he has tried, the answer may be little. But if he is prepared for one last heave he should forget bold new initiatives and concentrate on what’s essential — the simplest standards. He should concentrate on literacy teaching and mixed ability teaching, which are more to blame than anything else for today’s low standards.
He should revisit the national literacy strategy. It was a good idea but it was undermined by educationists who don’t accept “synthetic” phonics (the good old-fashioned way of sounding out words, as in c-a-t makes cat), paid lip service to it but insisted on a dog’s dinner of conflicting methods, which doesn’t work. Unadulterated synthetic phonics does. The evidence is irrefutable.
The prime minister should drop the strategy in favour of a much more basic, universal, teacher-proof synthetic phonics method to be compulsory in all schools. Among other things it would mean teaching children to read with others at their own level, regardless of age.
All the evidence shows that, contrary to 40 years of dogma, careful setting and streaming are best for every child. Mixed ability teaching has been largely responsible for the collapse of English education and the extreme stress that many teachers now suffer, not to mention their pupils. Ruth Kelly, the education secretary, seems to accept this. In yet another education white paper this week (Labour’s wearisome 12th) she will make Labour party history by calling for more grouping by ability and “personalised” teaching.
However, an aide said that “setting is something we would want to encourage but not force on schools”. How feeble. It is high time that it was forced on all schools. Many teachers and educationists are still deeply opposed and will resist “encouragement”. And all schools are thoroughly sick of being bullied by Blair and his years of box-ticking.
He could offer a constructive deal. In exchange for accepting compulsory setting, streaming and synthetic phonics, Blair could agree to set schools free from huge amounts of unnecessary targets and paperwork and self-assessment. That would be a powerful sweetener; it would save schools a huge amount of time and money and misery.
Blair’s tragic error with education is not that he has imposed too much on schools, although he has, but that he has imposed the wrong things. Now is the time to impose the three right things.
The Sunday Times | Sunday, October 23, 2005 | Comments (0)
Dense clouds of drug-induced hypocrisy
“We know of no spectacle so ridiculous,” Lord Macaulay famously said, “as the British public in one of its periodical fits of morality.” We seem to be in the middle of a particularly absurd one right now. Although there are many hugely important questions in public life generally, and even a few in the Conservative leadership struggle, what obsesses the media is the attempt to force David Cameron into some sort of confession about drugs. It is ludicrous and shameful.
Cameron has said quite enough about this to satisfy anyone with a proper interest in his past and quite as much as any public figure could be expected to disclose, yet he has been hounded for days. Goaded yet again on Thursday on BBC1’s Question Time, he admitted that like many people he had done things in his youth that he should not have done.
“I’m allowed to have had a private life before politics, in which we make mistakes and do things we should not,” he said. And then he went on to make a perfectly reasonable distinction between his life before politics and his responsibilities now. To any fair-minded person, that should be that. It’s perfectly clear what he means.
To insist that he ought to say more — and I am astonished by the number of liberal and libertarian types who cry out that he must — is in itself rather dishonest. In fact what we’re seeing is not so much a periodic fit of morality as an even more common fit of hypocrisy.
Cameron’s adversaries are hypocritically trying to whip up an anxious moral frisson about drugs to make him look unelectable. I think they are making a mistake. It won’t. Public attitudes to drugs have changed greatly and if the Conservatives are smart they will recognise that.
Almost everybody in this country who is under 40 has been ceaselessly exposed to illegal drugs — at school, at college, in clubs and pubs, at parties and even at work — and there can be hardly any of them who haven’t at least had a tiny puff. People who never have are either unconventional or else older and belong, like David Davis and Ken Clarke if not quite Liam Fox, to the generation in which drugs were still tried only by a tiny avant-garde minority. These days anyone who knows nothing personally of drugs must seem like a total dinosaur to the younger generation; the Conservative party’s problem is not that it’s nasty or stupid, but that it’s extremely middle-aged.
One thing that young people all think is that most middle-aged people, who have no close up and personal experience of drugs, don’t know what they’re talking about. If middle-aged politicians boast publicly of their inexperience of the drug-taking scene as if that were some sign of moral superiority, they make themselves look foolish as well as ignorant. There might well be some interesting blowback in this moralistic attack on Cameron.
Taking recreational drugs is not in itself a moral matter. It has always been one of the greatest pleasures and greatest consolations of humankind, found in all civilisations. Plenty of recreational drugs are legal in Britain, despite their real risks.
It’s true that since some recreational drugs are illegal here it is by definition a crime to take them, and for that reason responsible public figures certainly should not do so. But that does not mean it is necessarily immoral to do so and most younger people don’t think it is. Drug taking is illegal not because it is wicked, but because it can be dangerous.
For many years I did not appreciate how dangerous drugs could be or would become; my generation used to think cannabis was harmless and I have known plenty of people who’ve played around for years with cocaine or with even more alarming drugs without becoming addicts. Fashionable London is said to be thickly sprinkled with the devil’s dandruff. People joke that the lavatories in bars and clubs are crowded with queues of people desperate for a line and we hear lurid tales about celebrity coke heads, but given the millions of times that people take drugs, it is surprising how few addicts there are.
It always seemed to me that the few who drifted towards addiction were driven there by other problems — some by their own addictive personalities, others by the poverty of their lives or their expectations. It is one of life’s many injustices that the people most likely to get into serious trouble with drugs are those who are already in some other serious trouble, and the law does not seem to protect them.
That is why for years I used to be firmly in favour of decriminalising drugs; I thought that despite the increased risk involved — possibly, to some — it put an end to drug pushing, to habit-supporting crime, to contaminated drugs and to the vast evil empire of the illegal narcotics trade.
All the same, as my children have been growing up I have gradually realised that drugs seem to be getting nastier and evidence of the long-term damage they can do has been mounting. Even contemporary cannabis, grown hydroponically, is several times stronger than the gentle weed of the 1960s and 1970s, and skunk can quickly trigger psychotic episodes in a small minority of susceptible people. It even has a name — skunk psychosis. I’ve seen it in someone close to me. It is terrifying and it has made me suddenly much less sure about decriminalisation. With the democratisation of drugs, the privileged trips of the 1960s have turned into a dead-end highway.
The question of what to do becomes more pressing. The law as it stands does not seem to protect the vulnerable, rather the reverse. Yet nobody seems to know and perhaps there is no way of guesstimating whether decriminalising drugs would make things better or worse. Understandably nobody is willing to make the experiment. All one can say is that ignorance and moralising merely obscure the problem.
Last Friday it emerged that a close relation of Cameron’s has been receiving treatment for heroin addiction; some commentators may claim that this, too, will somehow count against him in the leadership contest. On the contrary, compared with the professed ignorance of his three rivals, his more youthful knowledge and experience so far from being a mark against him should be a mark in his favour. Hypocrisy doesn’t always prevail.
The Sunday Times | Sunday, October 16, 2005 | Comments (0)
Mother care, muddle care and don't care
A woman’s place is in the wrong, according to the old joke and indeed according to the book of Genesis. In fact, and it is no joke, it is a mother’s place that is in the wrong. That is one of the nastier, more immutable facts of life.
Mothers have been blamed at one time or another for almost everything. If they are too close they smother, they infantilise, they emasculate, they drive. If they are too distant then they neglect, they understimulate, they undermine.
Either way, mothers have been held responsible for almost all the ills that flesh is heir to: from mental illness to sexual dysfunction, from schizophrenia to cross dressing and underachievement, overachievement, attention deficit disorder, obesity and football hooliganism.
So it is hardly surprising that mothers are hypersensitive to criticism. And it is hardly surprising there were howls of anguish last week from working mothers — or at least from vociferous media mothers — in response to news that an academic childcare study by Penelope Leach and others suggests that a mother’s care is best for very young children.
The Families, Children and Childcare study for Oxford and London universities, which followed 1,200 children from three months until age four, concluded that those looked after by their mothers do significantly better in social and emotional development than those looked after by others, who are “definitely less good”.
A kind of pecking order emerged, with stay-at-home mothers on top, followed by nannies and childminders in a homely situation, then grandparents and other relatives, with day nurseries at the bottom as the least good. Young children in nursery daycare, the study found, tended to show higher levels of aggression or were inclined to become more withdrawn, compliant and sad.
Since 450,000 British children under three are in nursery care, and since, according to the chief executive of the National Day Nurseries’ Association, 78% of working mothers say a nursery is their ideal form of childcare, huge numbers of British mothers appear to be firmly in the wrong yet again. It puts the government clearly in the wrong as well because of its plans for a massive and hugely expensive explosion of free nursery care places for the very young, and for its enthusiasm for “wraparound educare” generally.
Evidence along these lines has been appearing for years, much though people try to ignore it. Leach herself has said similar things before.
In the mid-1990s a study by the National Children’s Bureau into nursery care for children under three found an alarming lack of personal contact between staff and children, which meant the child’s need for attachment was not being met. Toddlers were often frightened, neglected and withdrawn, as well they might be when put on the pot by one woman, wiped by another and dressed by a third, most of them underpaid, undertrained and inclined to disappear.
That’s still true 10 years on. Last month it emerged that a study done in Berlin by Professor Michael Lamb of Cambridge University and others showed that toddlers starting at daycare nurseries experienced high levels of stress in the first weeks after separating from their mothers, and showed continuing mild stress for as long as five months. Their levels of the stress hormone cortisol doubled during the first nine days, though they appeared to have settled after five months.
Jill Kirby produced a ground-breaking pamphlet for the Centre for Policy Studies two years ago. She cited earlier research into non-maternal care by the Joseph Rowntree Foundation that showed children whose mothers were employed full-time when the child was under five had reduced chances of obtaining qualifications, and were more likely to be unemployed and suffer psychological distress in early adulthood. So this kind of evidence has been around for quite a while to dismay the working mother, especially the poorer working mother.
I don’t say all this, in some spirit of censorious maternalist triumphalism. I am not trying to monster working mothers. I am a working mother myself, though part-time and from home.
But mothers are faced with a tragic conflict of interest that no amount of wishful thinking or social engineering or wilful blindness can resolve. A woman wants and needs to work and a baby wants and needs its mother. Whatever happens, sacrifices will have to be made one way or the other. If mothers are to work they will have to abandon their children, more or less. They will have to hand them over to someone else to bring up, and that upbringing may not be much good.
I don’t think there are any easy or universal solutions to these problems. Leach herself is irritated with people who think her study is proof that a woman’s place is in the home. What she advocates is greater choice and more childminding. That might be possible with a radical reform of tax and tax relief to give mothers and fathers a choice of how to spend their money, but that is hardly a new Labour approach.
All one can conclude from this research is that Labour’s childcare plans are not only hugely expensive and impracticable, but have demonstrated that — over this at least — the government’s place is in the wrong.
The Sunday Times | Sunday, October 09, 2005 | Comments (2)
Be compassionate, let doctors speed death
We know not the day and we know not the hour. Death has many terrors, even for the most stoical and the most pious: we don’t know how it will come, either. If I am to die from a drawn-out and painful illness then I hope that I will have to look after me a doctor I can trust to protect me from that particular terror.
I hope I will have a doctor who will help me to decide how much pain or distress I can bear and — if necessary — who will be prepared to give me enough of the right drugs to ease my departure from this world, and even to hasten it. I want my doctor to give me some control over my death or, if necessary, to take it over for me. I know that the people I love most feel the same and I have many friends who are discreetly grateful to courageous doctors who have done this for their dying mothers and fathers or for their friends and lovers.
Yet this extraordinarily compassionate service is a serious crime in this country. Euthanasia is widely regarded with horror. Last week a retired doctor was severely punished by the General Medical Council for planning to help an old friend to die. Michael Irwin was struck off the medical register on Tuesday for obtaining pills to give to Patrick Kneen, who had terminal prostate cancer and was afraid of a painful death.
Irwin prescribed some temazepam for himself, planning to give it to Kneen. But when Irwin arrived at his friend’s bedside Kneen was too ill to take the pills and later died in a coma. So Irwin did not help him to die; he merely intended to. For this he was disgraced; the GMC found him guilty of acting unprofessionally, inappropriately and irresponsibly and told him that he had abused the trust placed in him as a doctor.
That judgment makes no sense at all to me. As I say, I hope that when my time comes I will have a doctor as brave and compassionate as Irwin was. Of course there is a problem with prescribing drugs in a way that is technically dishonest, which Irwin plainly did. He admitted as much. On the other hand both he and his friend were active supporters of euthanasia and were campaigners for a change in the law — Irwin is a former chairman of the Voluntary Euthanasia Society — and both men knew and had publicly expressed their feelings about it. For Irwin to abuse his friend’s trust in this case would have been to have ignored his fears of a painful death when he himself, as a doctor, could offer a way out.
What happened — as always happens in such cases and as happened with the unfortunate Diane Pretty who campaigned unsuccessfully to avoid a terrible death — is that someone else did more or less what Irwin recommended anyway, but without calling it by its name. Someone else mercifully gave Kneen barbiturates for pain and he died. As Irwin said: “That’s what’s called terminal sedation but which I call slow euthanasia. It’s the current hypocrisy in the medical profession.”
I always thought, at least until recently, that hypocrisy had a useful place in human affairs and often in medicine. I used to think that it would be a mistake to legalise “assisted dying” since it could so easily be abused. Yet I’ve also always thought that it is often right and that the law should turn a blind eye whenever possible.
It does happen a great deal, although for obvious reasons it is not easy to know how much. According to one expert, British doctors help more than 18,000 people a year to die. This was the figure suggested by Dr Hazel Biggs, director of medical law at the University of Kent and an authority on euthanasia, when in September last year she gave evidence to a select committee examining Lord Joffe’s private member’s bill on assisted dying for the terminally ill.
Given such large numbers and a couple of nasty recent cases of nurses killing elderly patients more or less to tidy up their wards, I’ve come to think that there is no place for ambiguity in any of this.
Irwin refused to be ambiguous; he refused to be hypocritical, which is of course why he got into trouble. He could have spared himself a lot of bother by keeping quiet. But he chose to speak out and admit what he had in mind and — whatever the other less obvious aspects of this case — we should all be grateful. Physician-assisted suicide, or assisted dying or whatever else you call it, is going to become more and more important as people live longer and longer and as a larger proportion of the population is old or very old. It will be too important to be left to discretion or to benign hypocrisy.
There is another reason, too. The uncomfortable truth is that the temptation to end older people’s lives with or without their consent is going to grow. People already speak casually of hospital bed-blockers, meaning old people who do not really need a bed in an acute ward but have nowhere else to go. I will never forget a chilling Chinese expression I once heard for the old — “the useless mouths”.
An enormous part of National Health Service annual expenditure goes on old people. Department of Health statistics for 2002-3 show that 30.3% of all NHS spending — approaching a third — was spent on people of 75 or older; 46.7% — approaching half the entire NHS budget — was spent on people over 64. These proportions have gone up noticeably since 2000-1 when the corresponding figures were 27% and 41%.
Sooner or later these startling figures may catch the attention of the dwindling proportion of young people who are working to pay for all this. Some older people — I realise I am treading on taboos — may feel that it is not unreasonable at some point to consider, in the Japanese expression, taking a last walk up the snowy mountain.
In view of this I think any decision to do with the hour of our death ought to be returned unequivocally to the patient or to the patient’s chosen representative. For that reason I hope that Joffe’s controversial bill will succeed, although I think it is much too limited.
A more extensive bill would set free all those who want to die to do so with dignity. Also — and it’s a pity that those who passionately oppose euthanasia do not see this — it would, by laying down clear rules and restraints, protect all those who do not want to be pressed into the arms of the grim reaper before their appointed hour.
The Sunday Times | Sunday, October 02, 2005 | Comments (0)
