Sex education with a contraceptive chaser

The French will distribute the morning-after pill in schools, much to parents' and the Pope's chagrin.

Published December 6, 1999 5:00PM (EST)

In several weeks, France will become the first country in the world to distribute NorLevo -- known as the morning-after pill -- in schools. The move, spearheaded by the country's education minister and motivated in part by a sharp increase in teen pregnancies and abortion, has created philosophical havoc in a place that outsiders have long perceived to be an outpost of sexual freedom but is, in fact, largely Catholic and very traditional.

Even the Pope has weighed in with his opposition to the decision by Education Minister Sigolhne Royal, who also is the target of vehement protest by Federal Parent-Teacher Association (PEEP), which represents nearly 5,000 similar associations and half a million families.

Said PEEP in its most recent statement, "This decision is an admission of failure of all the preventive health and sex education measures to date ... We're concerned that the decision will result in a banalization of the pill by an even greater number of children."

"We are not talking about children here," retorts Natalie Marinier, associate director of a federally subsidized family planning center in Paris. "We're talking about sexually active young adolescents who already are engaged in, or about to explore, the world of sexual relations. We've been asking for more rigorous and widespread education for years. The fact that parents are dissenting reflects a serious lack of awareness about what adolescents confront on a daily basis."

Intimately familiar with what adolescents confront daily are the adolescents themselves, who appear to be unanimously in favor of NorLevo in schools. "I'm 100 percent behind it," says Pauline, a 17-year old economics student at the Universith Nanterre. "The morning-after pill is already available in pharmacies. But a lot of girls don't know this, especially those who live outside of Paris. If the morning-after pill can prevent abortion, I'm all for it. And so is everyone I know."

In fact, both parents and teenagers are generally unaware of what NorLevo is and how it's been distributed. NorLevo is a non-abortive progesterone-based pill (not to be confused with the abortive RU-486 pill) that is only effective within 72 hours after sexual relations. It prevents the egg's implantation in the uterus.

In June of this year, France became the first country in the world to distribute NorLevo on the open market without prescription or parental consent. For the past seven months the pill has been available at pharmacies around the country for 60 francs ($10); it is also distributed free-of-charge along with other contraception at family planning centers.

"When NorLevo was launched on the open market without prescription, no one said a word," says Annie Filloux, member of the National Union of School Nurses and Health Counselors. "Suddenly the minister of education comes out in favor of its distribution by school nurses, and people are up in arms.

"Most young girls come to us in a state of deep distress. They've had unwanted sex, or something's gone wrong and they're panicked," adds Filloux. "For any number of reasons, they don't want to go to their parents. We have only 72 hours to help them, but often girls come to us after a weekend has gone by.

"We have very little time for any other options. We're there to help them in these cases of extreme emergency."

Extreme emergency covers a wide range of circumstances -- from adolescents who've had sex out of peer pressure or who've used a condom that has ruptured, to those who've been raped or sexually assaulted.

Until recently, rape was a silent crime in France, largely unreported in schools and shrouded in a complex blend of shame, outrage and denial. Often the first person to learn of a rape is not a parent or a police officer, but a school nurse.

The role of school nurses was put on the national agenda in 1990 during the first wave of massive school protests in France. Says Brigitte Le Chevert, secretary-general of the National Union of School Nurses and Health Counselors, "Everyone was shocked, including the prime minister, when the second student demand, often expressed in quasi-violent terms, was for more school nurses. People had no idea what our role was really all about."

That role involves an intimate and evolving interplay of technical health consultation, education and psychology. Says Le Chevert, "Students know that when they come to us with problems, they are protected. Except in cases of rape or sexual abuse, we are professionally bound to keep in confidence anything a student tells us.

"Students may come to see us for a seemingly banal problem. But frequently a headache or backache is, in fact, the reflection of much deeper emotional distress. It is frequently in the course of an ostensibly ordinary encounter that difficult memories or painful issues merge. And many adolescents, because of family barriers or culture, feel more comfortable speaking to us than to their parents."

Le Chevert adds that students are urged by school nurses to seek advice and communicate openly with parents. But many students are fearful of their parents' reactions, are burdened by a sense of shame, or simply want to keep problems to themselves.

When parents and teenagers do come together, they are often both unaware of their options. What's been characterized by health professionals as a "dramatic lack of information" about prevention and contraception has prompted education minister Royal, in conjunction with family planning and related associations, to prepare an aggressive nationwide sex education campaign for mid-January.

Previous campaigns, which focused on the use of condoms and which were largely oriented around the prevention of AIDS, have been seen as failures. This new campaign -- to be launched in schools, on metros and in other public places as well as on TV, radio and in the press -- will provide adolescents with the information they need for contraception, consultation and emergency intervention. Five million copies of a contraception guide will also be distributed in junior high and high schools with accompanying letters to parents.

"Contraception and control of our bodies is a right," says education minister Sigolhne Royal. "We've fought hard for this right and we intend to exercise it. This includes adolescents' rights to contraception. We'll be direct with young teenagers in our campaign. We'll teach them to say 'No' if they're not ready for sexual relations. We'll teach them how to respect their bodies.

"They must learn that sexuality is one of the most beautiful aspects of being human, and that their first steps toward expression of their sexuality as adolescents will inevitably shape their experience as women. If that first experience ends in abortion, it's a failure."

Of the 10,000 unwanted pregnancies last year, 6,700 ended in abortion. Students, as much as Royal and her adult supporters, cite these statistics as the main reason they are in favor of NorLevo in schools.

A small group of girls gathered in front of a school in Nanterre nod enthusiastically as their friend Pauline says she is completely in support of the program. "I've used the morning-after pill myself," adds one girl. "It saved my life." When asked about their personal experiences with abortion, they are reticent. Only one girl offers her own experience at a clinic. "Let's just say it was not a happy experience."

Filloux, also a school nurse, considers NorLevo a last resort, but a critical one. "I can't tell you how many teenage girls come to me in a state of tremendous grief and guilt. They lament that they are going to kill their unborn child. I don't want to hear this anymore."

Doctors on the front line performing abortions also express consistent astonishment at how little many adolescents know about their own bodies, about procreation or contraception. Says Royal, "This lack of education is totally unacceptable in our times. If these kids aren't getting the information they need from parents, and if the school can provide that role, it will."

It is precisely this assertive position that angers parents, many of whom are against the state's involvement in family affairs and resent implications that parental resignation has driven a wedge between them and their children. Counters Royal, "Parents can't ask for more support and social programs in schools and then prevent us from providing their children with the fruits of social progress."

PEEP members see things differently. "We aren't against contraception," says one member. "But we don't want our children getting it in schools. We want a partnership with family planning centers."

This exchange underscores a paradox in France: Of the mere 1,100 family planning centers in the country, 30 percent are in Paris. Annie Costa is a school nurse in the small town of Belmont-de-la-Loire where there is only one pharmacy and the pharmacist, as a result, "knows everyone." The closest family planning center is 60 kilometers away and closed on weekends.

"When a young adolescent comes to us in distress, the first thing we do is encourage her to speak with her parents," says Costa. "But when she absolutely refuses this option, we must respect her. Often a girl will come to us with only a few hours left before NorLevo is no longer a viable option.

"We can't call the paramedics and send her to a hospital. That would also be a flagrant violation of her need for privacy. We suggest NorLevo, but we also provide personal follow-up to assure that she's supported with the people and information she needs."

Education Minister Royal emphasizes this follow-up as part of a protocol currently being defined on a national level.

"We're creating a comprehensive sex education campaign," says Royal. "It will speak to adolescents before and after sexual relations. It's one way of reclaiming ground in the field of sex education, which currently amounts to only 30 hours over a four-year scholastic period. The morning-after pill is not a method of contraception, but a last resort at the end of what we hope will be a more global and effective public health and sex-awareness program."

Royal's decision to allow school nurses to administer the morning-after pill has been applauded by the majority of health practitioners around the country, but it still faces an uphill battle despite France's reputation as a sexually open country.

"This is a false perception," says Le Chevert. "We are a people in contradiction. We are not prude, but we are not direct either. We'll show women's breasts on TV and flaunt a certain amount of sexuality, but when it comes to our children, or to our own private lives, we are extremely closed.

"We are still very much living in a Judeo-Christian culture. We couldn't launch our campaign, for example, until well after Christmas. There was concern that if we did so before the holiday, with its religious underpinnings, we would be communicating the wrong message at the wrong time."

By Debra S. Ollivier

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