Page last updated at 13:15 GMT, Friday, 29 May 2009 14:15 UK

Islands turn tide on abortion

By Mona McAlinden
BBC Scotland news website

Kirkwall, Orkney (Pic from Undiscovered Scotland)
Orkney, like Shetland, has a population of about 20,000 people

Fifteen years ago, Orkney had one of the worst teenage pregnancy rates in Scotland - only Glasgow and Tayside were higher.

Now the archipelago stands out for very different reasons.

Its teenage pregnancy rate has now halved - the Scottish average at the latest count was 57.9 per 1,000 women, Orkney's was 30.2.

The low rate mirrors the abortion rate; terminations are so low that the three island groups - Orkney, Shetland and the Western Isles - are lumped together by statisticians to protect confidentiality.

Abortions in Scotland, however, are at an all-time high, according to figures out this week, so why are the island communities now bucking the national trend?

"It is an incredible turnaround," says Kara Leslie, who has been Orkney's health improvement officer for the past nine years.

"Work has been under way since the early 1990s because of the high pregnancy rate - the first step in that was to make condoms freely available throughout the community, from various outlets.

Sometimes on the islands we feel as though we're a bit behind the times but I think with our sex and relationships education we're actually ahead
Kara Leslie
NHS Orkney

"That's really quite important, especially in places like the smaller islands where it might be embarrassing for someone to go to the shop, where their aunt or someone in the family circle is behind the counter.

"Emergency contraception is also available from hospitals and we do a lot of work promoting this to the general population and especially young people."

Ms Leslie said the current approach to sex education has marked a radical departure from the past.

"When I was at school we were sat down for half an hour and told about the mechanics of sex," she said.

"Now we base it around relationships, not just the nuts and bolts of it, so young people have the skills to know how to negotiate in relationships and have responsibility for their own health and that of their partner.

"Health board people like myself do a lot of work in schools - there's a real partnership between health and education - it's easy in a small community to work together and have a unified approach.

Shetland's very different to Orkney because of the influence of the oil money and jobs
Dr Sarah Taylor
NHS Shetland

"Sometimes on the islands we feel as though we're a bit behind the times but I think with our sex and relationships education we're actually ahead."

However, Ms Leslie said "a jigsaw" of other factors also explained why there were three times fewer unwanted pregnancies on Orkney than in mainland cities like Dundee.

"We've don't have many young people leaving school without going into employment, education or training," she said.

"In my mind, that's a big factor, if our young folk have a stake in their future and high expectations, then low rates of unintended pregnancies are linked to that."

And the figures bear this out, with 70% of the islands' 16-year-olds staying on at school to do Highers in 2006-07.

Further up the North Sea, in Shetland, there's a similar story, with the lowest abortion and teenage pregnancy rates in Scotland.

However, its director of public health, Dr Sarah Taylor, says the circumstances there are very different to its neighbour.

Lerwick, Shetland (Pic courtesy of Undiscoverd Scotland)
Dr Taylor said the challenge was getting services to outlying islands

"In contrast with Orkney, there hasn't historically been a problem here," she said, adding that she believed socio-economic factors were the key factor in the low rates.

"Shetland's very different to Orkney because of the influence of the oil money and jobs.

"We generally have a good quality of life here, high employment, high educational attainment.

"We know that in other areas, high abortion statistics go with difficult social circumstances and those aren't at play in the same way in Shetland.

"When people feel they have good control over their life and a good quality of life then they are more likely to be able to look after their health, in prevention terms as well."

But she said the authority "tries hard not to be complacent" and that the biggest challenge is making services and support available to the population in the outlying islands.

"One of the issues is to think of ways to go round about the islands rather than putting something in the main town, Lerwick, where it'll be accessible to some but not all.

"So some of it is about making sure that there are a number of people in youth services or schools that young people can confide in."

Dr Taylor also said the statistics would not be affected by women travelling to the mainland for a termination, because it is the place of residence that is recorded, not where the abortion is carried out.

The Western Isles said no-one was available to discuss the issue.

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