The need to provide such a high level of personalised care often conflicts with the demanding work schedules of obstetricians who take on private work to increase their incomes. Policies on healthcare financing can influence maternity care management and outcomes in unforseen ways, says the author. The prevailing business ethos in health care encourages such pragmatism among those doctors who do not have a moral objection to non-medical caesarean section. Against a background of high rates of teenage conceptions and an increasing level of sexually transmitted infections, a debate in this week's BMJ considers whether advising abstinence is an effective response to declining teenage sexual health. Abstinence makes sense and is effective, argues Trevor Stammers, a tutor in general practice and an author and broadcaster on sexual health.
Research shows that early intercourse carries greater risks and often leads to subsequent regret.
Sexually active teenagers are also more likely to be emotionally hurt and have an increased risk of depression and suicide. Easier availability of contraception and more explicit sex education at an earlier age are tired and inadequate responses to declining teenage sexual health, says the author. Doctors should encourage adolescents to avoid early sexual intercourse so that they can enjoy better long term sexual health, he concludes. Roger Ingham, a researcher on sexual conduct and sex education, believes that the answer lies in promoting greater openness about young people's sexuality. A policy of advising young people not to have sex will not encourage them to deal with issues such as peer group pressure.