Tracy Renkin, journalist

First published in the TasWeekend magazine (The Hobart Mercury)

THERE are still a lot of Tasmanian teenagers having unprotected sex, according to Sorell GP Ginny Baird. “It’s like their brain is an old-fashioned telephone box and they’ve unplugged all the wires and then put them all back into different holes,” she says. “The lights are flashing danger but these teenagers don’t have the clarity of thought.”

Every Tuesday and Thursday afternoon Dr Baird runs a sexual health clinic at the Pulse centre in Glenorchy for 12 to 24-year-olds. It’s not a popular place for boys, but teenage girls from all over Hobart and surrounding suburbs mostly bus in with a friend to either get tested for sexually transmitted infections or talk about contraception. Some of the teenagers she sees are couch-surfing because they’ve moved out of home.

Many, however, are still living at home and keeping their active sex life secret. Dr Baird has just 15 minutes to build a rapport with these young women, get a full medical, mental health, drug and alcohol history as well as a sexual one. “It never just takes 15 minutes,” Dr Baird says. “My clinics always run over time, but I have to make those minutes count.”

Dr Baird doesn’t know the official numbers of how many teenagers in Tasmania are sexually active or have STIs, or how many have fallen pregnant because they aren’t using contraception. “But I’m very busy in this clinic,” she says. “And constantly amazed at what these teenagers don’t know.”

Teenagers might be having sex, but they are still embarrassed to be seen buying contraception — so Dr Baird says teenage girls prefer this type of clinic because it guarantees anonymity, and the consultation and the contraception is free. The main reasons Tasmanian teenagers say they haven’t seen a doctor about contraception is because it’s too hard to get there, it’s too hard to get an appointment, it’s too expensive and they are worried about their parents finding out.

“The last thing young people want is to be seen by a neighbour in the GP waiting room and have to explain why they are there or to risk being seen buying condoms from the only chemist in town,” Dr Baird says.

When TasWeekend talks with Dr Baird she’s just spoken with two Grade 10 girls who’ve come into the clinic together. One is 15 and the other is 16. Both girls are in sexual relationships and have had three partners each. One has never used a condom before and the other is currently not practising safe sex.

When Dr Baird asks the girls why they weren’t insisting their partners use condoms so they didn’t fall pregnant or get an STI, they giggled, smiled at each other and shrugged their shoulders. She explains the risk of them falling pregnant — or catching an infection they may carry for life — and, she says, the girls seem to have no idea that could happen. “It’s that old story of adolescence where they think ‘it won’t happen to me’,” Dr Baird says. Most girls who walk through the doors at Pulse — an outreach service of Family Planning Tasmania — are 14 to 16.

Recently Dr Baird had to tell a 14-year-old she was pregnant. “That’s a bit difficult,” she says. “Because she was just a child herself.”

Judy Smyth has been a specialist nurse at Burnie Family Planning for 25 years. She says teenagers today are having sex younger than she’s ever heard of before. “Lots of teenagers are sexually active,” Smyth says. “In my experience we have had sexually active 12-year-olds in the clinic and some sadly even one or two years younger.

“Over the years there has always been a few younger girls who were sexually active before other girls, but now it seems to be much more accepted among teenagers themselves that it’s OK to start having sex at a young age. It’s also much more common now that these young girls are having sex with multiple partners. Of course, we get the girls who are in one relationship too, but it seems more common today that young women will have multiple, casual sexual partners.”

Smyth says it’s not uncommon for 15 and 16-year-olds to come into her clinic who have had up to 14 sexual partners in one year and who haven’t yet been tested for an STI.

Smyth recently implemented a “no mobile phone” policy in the clinic because young girls were sitting in the consultation room text messaging while she was trying to get their attention to explain the risks of unsafe sex.

Family Planning staff go out to the local high schools to talk to students about the dangers of unprotected sex. But some of these schools also organise excursions and bring teenage girls into the Burnie clinic in small groups to help them feel more comfortable in the setting. Nurses then help to dispel the many sexual mistruths they hear from their friends or have read about on the internet.

“They hear lots of silly stories, so it is important we give them the correct information,” Smyth says. “The more aware we can make them about the dangers of unprotected sex, the better outcomes we will have.”

Family Planning Tasmania chief executive Cedric Manen says much more needs to be done to get the safe sex message out to high school aged children in Tasmania. His team is trying to work out the best way to reach young people through social media. But when it comes to reaching them in person he advocates that an appropriate policy for our high schools will support teenagers better. But, Manen says, it is still unclear whether Tasmanian school nurses are allowed to hand out condoms in high schools. “Some teenagers — particularly those in smaller communities — find it difficult to obtain condoms,” Manen says.

Family Planning Tasmania’s Condoms Free4U program allows anyone, anywhere in the state, to simply send a text message to 0488 492 443 and condoms and lubricant will be mailed out to them. More than 50 per cent of these packs are posted to rural areas, but Manen says the number of people using the service has dropped. He says every day his clinic nurses scattered across the state see young teenagers with STIs and unwanted pregnancies.

While national data suggests Tasmania’s overall rate of the most common sexually transmitted infection, chlamydia, is lower than the national average, a chlamydia expert says that’s partly due to infections in the Northern Territory, Western Australia and Queensland being particularly high. Tasmania’s infection rates are quite similar to the other eastern states.

“Young people are not thinking about the consequences of unsafe sex,” she says. “It may be a case of in one ear, and out the other, but these kids don’t seem to realise for example that once you get genital herpes, you have it for life.”

Dr Nicola Stephens, who did her PHD on chlamydia at the University of Tasmania’s Menzies Institute for Research, says only about 9 per cent of teenagers in rural parts of Tasmania have been tested for chlamydia and just 15 per cent in Tasmania’s major cities. Dr Stephens says when it came to STIs, her research had raised concerns that not enough young people in Tasmania were being tested — nor were they aware of the risks involved with these infections.

“Three quarters of the young people who have chlamydia have no symptoms, so they don’t even know they are infected,” Dr Stephens says. “Not enough young people are being tested. If they are sexually active, they need to be tested every year because untreated infection can cause infertility, ectopic pregnancy and pelvic inflammatory disease.”

Dr Stephens says she believes the problem has reached epidemic status. She led the new University of Tasmania’s Menzies Institute for Research study that raises alarm bells about the rate of infection among 15-29 year olds in Tasmania. That research revealed that, of those tested, 16 per cent of males and 10 per cent of females were carrying the bacterial infection.

As teenage girls wait to see a doctor at Glenorchy’s Family Planning clinic, a poster with 10 young faces looks down at them. The words read “1 in 10 teenagers have chlamydia — which one are you?”

Gonorrhoea and syphilis rates are also increasing, according to Dr Faline Howes who runs the State Government’s Communicable Disease Prevention Unit. Her message is simple: young people need to be fully aware of the consequences of being sexually active. “We need to increase accessibility of condoms for young people and we might have to be quite innovative about how we do that,” Dr Howes says.

She says the majority of sexually active young people infected with an STI go undiagnosed because many infections don’t have symptoms. “It’s crucial young, sexually active females and males are tested every year. The tests are simple and treatments are easy and safe and effective.”

In relation to teenage pregnancies, national health figures show that while the number of teenage mothers in Tasmania has dropped over the past decade, the state’s rate still remains stubbornly above the national average and the second highest in the country. Manen says the teenage pregnancy rate is particularly high in the North-West, where it is 2.5 times higher than the national average (of about 11 births per 1000 women overall). The numbers are even higher in Devonport. Manen also cites high teenage pregnancy rates in the Huon and Derwent valleys, and suburbs in the Brighton municipality including Gagebrook and Bridgewater.

“Family Planning Tasmania works with a range of other supportive agencies who report back to us that unfortunately some of the teenagers in these areas think falling pregnant improves their status in their community when it often just comprises their life path,” Manen says.

Finding a home, attending ultrasound appointments and preparing for an unplanned baby due in April are just some of the many things on 17-year-old Kayla’s to do list. The Year 13 Claremont College student and her Year 12 boyfriend Hudson met while they were students at Montrose Bay High and had been in a relationship for two years before they found out that they were going to be parents. “I didn’t want to believe it,” Kayla says after the second pregnancy test confirmed she was going to be a mother. “I was terrified.”

The pair told a trusted teacher they were pregnant and he put them in touch with the Brave Foundation. Now they have an assigned mentor who will help them manoeuvre the many tasks that keep adding up on their parenting list: a house, further education, a job and a car. Their pathway plan will be personalised and set out in small steps. “I feel less stressed now, since being connected with Brave and more reassured,” Kayla says.

Hudson says he’s planning on continuing his studies but is looking for part-time work in retail. Tasmanian of the Year, Brave Foundation founder and once teenage mother Bernadette Black says almost 80 per cent of Australian expectant and parenting teens are on long-term welfare — each costing the government on average $648,000 over their lifetime. The problem, she says, is often cyclic.

“Young parents have a much higher risk of having children who become young parents themselves,” she says. Her not-for-profit charity works closely with young parents right around Australia. In 2017, the Federal Government gave Brave a $4.4 million boost so Black could implement a national program that helps these young parents reach educational, health and workforce goals through a personal mentoring system. The Tasmanian intake is already full with 12 in the program and another 13 almost ready to start with many more on the waiting list. Low literacy levels in our lower socio-economic areas also contribute to sexually active teenagers becoming infected with STIs, as well as falling pregnant. Family Planning Tasmania staff are currently working on new “cool” and “not daggy” messaging, and deciding what social media platforms they should be targeting to reach young people.

“There should be a handful of very short, sharp and clear messages to actually support young people to be safely intimate,” Manen says. “It’s frustrating. There’s always more work to do because we need to improve our reach to young people. Our health messages need to be well thought out and delivered well to have the right effect.”

This year Family Planning Tasmania focused on the North-West Coast to encourage more young, sexually active women there to consider using Long Acting Reversible Contraception. It believes strongly that this type of protection should be the first line contraception of choice for sexually active teenagers because they are much more effective options. They were particularly pushing Intrauterine devices (IUDs) and Implanon rods that can stop pregnancy for up to five years.

Young college students helped Family Planning Tasmania come up with the marketing campaign: “Get LARCed. Get it. Forget it”. Despite the big push in the North-West, teenage girls living in and around Hobart are using more long-term forms of contraception than teenagers in more rural parts of the state, partly because not enough GPs know how to insert the implants. Since the beginning of the year Family Planning Tasmania nurses have trained 10 North-West Coast GPs and clinic-based nurses in how to insert them.

Back in Hobart, Dr Baird is advocating for funding for a mobile sexual health service similar to the breast screen van. “The services we do have, are not reaching all the young people,” she says. “It’s a big ask to expect these young girls to navigate poorly timed public transport services and travel all the way to Glenorchy for contraception.”

She knows what it’s like to be a worrying mother — her own daughter is 15. She says based on the blank looks on the teenage faces that sit in front of her in her rooms every week, and the basic questions they ask her about STIs and pregnancy, there still needs to be a lot more work done to get the safe sex message through to them.

“Young people are not thinking about the consequences of unsafe sex,” she says. “It may be a case of in one ear, and out the other, but these kids don’t seem to realise for example that once you get genital herpes, you have it for life.”

Dr Baird says Tasmanian high schools must be allowed to do more to promote safe sex messages to their students. “Are high schools here even aware how many of their students are sexually active? Do they even have the phone numbers for services like Family Planning and Pulse up around the school?”

Baird says simple things like an information sticker about contraception services on the back of the toilet doors in high schools would be a good start. “But the problem is that [some of] the people who sit on the boards and who make these decisions get too emotional,” she says. “They think if we are talking about sex with young people then we are encouraging them to do it. It becomes political in the end. That’s why we aren’t getting information stickers on the toilet doors.”

If it were up to Dr Baird to come up with messaging for our sexually active teenagers she’d be ready to roll. “It’s as simple as ‘if it’s not on, it’s not on’ — you must always wear a condom.”