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Devolution and Termination of Pregnancy: Principles and Practice

9 Mar, 16 | by shaworth

The British Parliament is currently debating the Scotland Bill within the House of Lords, legislation that is designed to expand the powers devolved to the Scottish Parliament in Holyrood. Within this Bill, is the proposal to revoke the segment which prohibits Scotland from making legislation about abortion, essentially making this a devolved matter, as it is in Northern Ireland. Currently, abortion provision in mainland UK is dictated by the Abortion Act of 1967, which permits abortion in certain circumstances. Abortion in Northern Ireland is more highly restricted, and currently the majority of women seeking to terminate their pregnancy travel to mainland UK in order to undergo termination.

The Smith Commission, set up by the UK government in the final days of the referendum on Scottish independence, which promised to identify further powers which could be devolved to Scotland, reported on the possibility of devolving abortion legislation, but advised that this was a matter which required consultation. Instead, several MPs, who have expressed views against abortion in the past, have tabled the amendment to devolve abortion legislation. Currently, the First Minister of Scotland, Nicola Sturgeon, has affirmed that her government has no plans to amend the legislation as it stands, but critics of the idea have pointed out that the devolution could result in restrictions for women seeking to terminate pregnancies both north and south of the border.

Traditionally, Scottish law has been liberal where abortion is concerned. Termination of pregnancy could be provided by medical professions after consideration of the case, and abortion reformer Dugald Baird confirmed in the 1930s that legal action against medical professionals terminating pregnancies was unlikely without proven criminal intent. Of course, his view was not necessarily shared by all, and the concern of various human rights advocacy groups is that devolution could represent the start of an erosion of reproductive rights. During the parliamentary debates in the Commons, Yvette Cooper illustrated that whilst abortion in the US is legal after Roe vs Wade, those lobbying against abortion have campaigned for more restrictive laws at state level, leading to substantial reductions in the number of clinics providing abortion services.

Whilst public opinion in Scotland seems to support legal abortion, the reality of the situation is somewhat different, and this is not something that has been covered in any political debates. The majority of Scottish women seeking termination for reasons not relating to fetal abnormality or due to life threatening complications of pregnancy, are not able to obtain termination of pregnancy after 18 weeks of gestation. Instead, there is an arrangement by which they can travel south of the border to organisations such as BPAS and then claim re-imbursement for this. This is partly due to a lack of trained staff to perform second trimster surgical abortion, and the need to perform fetacide for medical termination after 21+6 weeks. So despite their legal entitlement to termination of pregnancy services, Scottish women already face restrictions in doing so.

Overall, Scotland has shown itself to be capable to self-government, the Scottish Parliament has proved itself capable in debating complex ethical issues such as care at the end of life, and in social issues such as equal marriage. There follows a logic which would suggest that perhaps Scotland is able to debate and decide on these issues for itself, however, it remains to be seen if the results of these decisions will still help keep Scottish women safe, or whether this is the first stage is a battle against those who seek to reduce their freedoms.

User Controlled Implantable Contraception: Baby, You Can Turn Me On

26 Jan, 16 | by shaworth

Over the course of this month, there has been quite a bit of press attention given to the Bimek SLV, a device purporting to be the first attempt to achieve user-reversible, surgical, male contraception.

Men have, for a considerable amount of time, been left behind in the field of contraception. Women have both hormonal and non-hormonal methods of which both short and long acting are available. Men, on the other hand, have the dichotomy of condoms or vasectomy, with no halfway option between instantly reversible and surgical permanence. Unsurprisingly, those who wish permanent contraception sometimes wish to have the procedure reversed, which is not guaranteed to be successful.

On the face of it, the Bimek SLV seems to be a good idea. Implanted into the vas deferens, the device contains an occluding valve, which can be changed from an open to a closed position by the user pressing a switch attached to it. However, there were some worrying gaps in the press reports about the device: what were its success rates so far, for example? It transpires that the device is beginning Phase I trials soon, and that the only person in which the device has been implanted is the inventor himself.

Further review of the product information reveals that so far, no animal testing has been performed for the device at all, and this is revealed as a selling point, so that the device can be used by vegan men. Yet despite the lack of objective evidence, the product literature, and website, contain references to the apparent safety of the device, and that the procedure is “low risk”. It’s easier to find information on investing in the project that it is to find information on trial participation.

Bimek himself is not a medical professional, and has brought the device to preliminary trials under his own steam. He is seeking further funding in order to proceed, hence the attempt to drum up media support. In the age of crowd-funding and peer-to-peer lending, traditional methods of research and development are being bypassed. Perhaps this is of value, and perhaps the drive to implantable technology without animal testing will revolutionise healthcare research as we known it, but given that earlier this week a Phase I trial in France resulted in the death of a participant and the hospitalisation of several others, perhaps Bimek would do well to tone down their claims of safety, in the face of scant supporting evidence.

Ultimately, for the time being, what the Bimek SLV has done well to showcase, is that sensationalist reporting without a full grasp of the facts, remains depressingly popular as a way of communicating new science developments to the masses. Here’s hoping that time, and further research, means that it can prove its claims.

Constructing Information Requests: Making The New Normal

1 Jan, 16 | by shaworth

When we collect information from our patients, we ask, often unthinkingly, for quite a lot of it. Some of it has obvious value to our consultations: how long has it been there, and where does it itch? Some of it has additional use in research, and in auditing our practice. Today, we’re going to take a look at how we ask for some of these basic demographics and what it says about our perception of society, and of our patients’ lives, when we do.

In the UK, we classify infants at birth by many characteristics, and sex is one of those. This is obvious to anyone who has tried to pick a gift, or a card, to congratulate new parents: we, as a society as a whole, treat sex as a dichotomy of male or female. This is referred to as the gender binary. If this were a fundamental truth, it makes collecting information regarding sex to be as simple as checking a box for either, and in turn, stored in a binary form digitally; however, the truth is more complex. Many countries allow for the legal recognition of a third gender, and this is a state welcomed by people who do not identify with either, or with aspects of both. This may due to an intersex condition diagnosed at birth, or a subjective lack of affiliation with either sex despite sexual organs and characteristics of one sex. One can argue that the reasons are academic, as it is the end state of requiring an option outside of the gender binary that matters.

For many people, the definition of the word “gender” is roughly interchangeable with “sex”, and both terms are taken to mean the reproductive organs existing within a person and associated secondary sexual characteristics; however, some people and organisations define gender as being the abstract social roles based on sex, and diverging the definition of “sex” to be the definition stated above, pertaining to sexual organs and characteristics. In this post, we’ll be using the latter.

One organisation which collects vast amounts of personal data: Facebook, has come into focus as it demonstrates how to handle information outside of the gender binary in an attempt to sensitively reflect the real life experiences of users; however, as a recent paper reviewing Facebook’s handling of this information shows, the way that Facebook deals with the information regarding sex is not new, but over time has been changed by user pressure. When Facebook began to collect user data on sex, it allowed options for male, female or other and subsequently used this information to provide gender based pronouns describing user activity. Over time, the use of “they” as a gender neutral pronoun created some translation difficulties and was derided as grammatically incorrect, so an attempt was made to force users to choose a pronoun on the basis of sex, and this overrode the original sex identity e.g. if you chose a female pronoun, your choice of “other” was changed to female.

Users self-organised to protest this, driving change by producing guides on amending the source code of the pages to allow reversion to the original “other” state, raising the question why this needed changed in the first place if the choice was not removed from the database itself. Over time, Facebook amended its policy and in 2014, allowed limited use of gender neutral pronouns and a greater range of non-binary identities; although the choice of a gender specific pronoun reverts the stored identity to a binary one.

The multiple options presented when signing up for Facebook with relation to sex is potentially confusing and, whilst presenting many options, remains restrictive if your choice is not offered, raising the question if there is a better way of working when requesting information. Web designer Sarah Dopp, who wrote an open letter to web designers and developers regarding this in 2010, and reminding us that the dangers of the gender binary, and the promotion of it as normal at the expense of all else, marginalises those who already feel marginalised, something that we, as healthcare professionals, should be striving to avoid.

So, the next time we sit down to ask a patient, or client, for their gender, we should take the time to reflect that whilst this may be a single question in a page of several, and perhaps just a tick in a box to us, that for them it may be a huge part of their identity that we are refusing to acknowledge through ignorance, and souring our relationship with them before we start.

For those of us who are doctors, we have benefited from the privilege of a free gender-neutral pronoun as a by-product of completion of a degree. If it’s important to us to use this title as an expression of professional identity, we could at least extend the courtesy to our patients to express, fundamentally, who they are.

Lost Boys: Universal HPV Vaccination

10 Dec, 15 | by shaworth

Last month, the government announced an extension of the national HPV vaccination campaign to include men who have sex with men who are aged less than forty. This was welcomed, as this group, particularly men who exclusively have sex with men, are excluded from the direct effects of the vaccination of women. Vaccination is offered when men come into contact with health services.


Around 20% of 16-20 year old men who have sex with men (MSM) are HPV positive, Whilst the age at which gay men identify as gay appears to be decreasing with increasing acceptance of non-hetrosexual identities, the targeted vaccination campaign towards MSM makes the presumption that all MSM wish to identify as such to their health provider, at an age at which they will still be seronegative. We have the opportunity to offer to vaccinate MSM where we find them, but this will not be a great deal of comfort to those who have already been exposed to HPV and already suffer from the disease burden, usually in the form of genital warts. Australian data after the introduction of the quadrivalent vaccine to women showed that significant declines could be achieved by vaccinating women and heterosexual men, but the rates in MSM remained static.


The estimated cost of rolling out vaccination to all children is estimated to be around £20 million pounds. Some good analysis of the cost of anal cancers, a disease that disproportionately affects MSM has has already been done, the cost effectiveness of the additional protection from vaccinating boys on HPV related disease has already been done. The JCVI will convene in two years to decide whether universal vaccination of children is cost-effective.


Cost effectiveness is the ultimate outcome measure for a healthcare system that is government funded, as we as taxpayers want to see the most value for our money, but in focusing the entire argument on the basis of cost, do we effectively say that the lives of MSM are not worth enough?


Organisation Focus: National Ugly Mugs Scheme

1 Nov, 15 | by shaworth

Some readers may already be familiar with the National Ugly Mugs Scheme, an initiative  which started life in Australia in 1986, developed by a collective of sex workers to circulated descriptions of people that they had encountered, or situations that they had been in, which had been dangerous. Sex workers have an increased risk of violence, and due to the ongoing criminalisation of sex work, this violence is less likely to reported to police.

Many local services supporting sex workers, and sex worker collectives in the UK had their own schemes, but in 2012, that National Ugly Mugs Scheme was launched as a pilot project in the UK, initially funded for twelve months, to draw these initiatives together. Some successful prosecutions by local initiatives working together The project continues to be funded partly by local police forces, essentially acting as an arm’s length reporting tool, allowing them to engage with sex workers without entering into conflict about the illegality of their work. The project remains on the only attempt at a nationally coordinated effort to protect sex workers through anonymised reporting.

Recent evaluation of the scheme suggests that sex workers are more likely to report violence as a result of the service, as they can initially start notification through the NUMS scheme. There are currently 10,000 subscribers to the service, and 16% have avoided a potential client as a result of their use of the service. This would imply, by extrapolation, a significant amount of crimes prevented. Currently 60 incidents per month are reported anonymously to the service, and a quarter of these will then go on to report directly to the police.

To make a report, a sex worker can join the organisation for free, and also register to receive alerts about Ugly Mugs in their area. Those providing healthcare to sex workers should be aware of anonymised reporting schemes in their area.


Interview With MSP Jean Urquhart

24 Oct, 15 | by shaworth

Readers, in particular those in Scotland, may have read about the recent opening of a consultation to decriminalise sex work in Scotland. This Bill, Prostitution Law Reform (Scotland) Bill, is the first stage of an attempt to pass this legislation through the Scottish Parliament. Currently, in Scotland, the issue of sex working is covered by several different pieces of legislation, and the Bill is seeking to revoke these laws to allow adult sex workers to work both in their own premises, licensed brothels and on the street. This Bill has been modeled on pioneering legislation which has been in place since 2003 in New Zealand, and differs significantly from the oft-discussed Swedish model, which criminalises the purchase of sex, but not the selling of it. Views on both sides have been hotly debated recently when the charity Amnesty recommended decriminalisation as a key aim.

The consultation has been developed by the independent MSP for the Highlands and Islands Jean Urquhart, and we are very privileged to have been given the change to interview her for this blog.

You’ve put forward a consultation regarding the legal status of sex work in Scotland and proposed something quite radical, which is that we should repeal the criminalisation of sex work in Scotland and bring in legislation which reflects the New Zealand model of practice where sex work is legal.

That’s correct. My interest grew when MSP Rhoda Grant brought in a Bill -which actually fell- to criminalise the purchase of sex and, at the time, not knowing anything about prostitution or sex work at all, I went to a meeting where Rhoda was talking about her Bill, and met some prostitutes. I found myself thinking, and common sense told me, that actually the prostitutes themselves were making a better case, and I was interested to hear their stories. When we looked at the Swedish model and, listened to the experiences of prostitutes, I realised that criminalisation will never work.

I think that’s because most times criminalisation is brought about by people who want to stop any kind of commercial sexual activity. If you accept, as I believe most people seem to, prostitution as a business that will never be stopped, that we just have to be grown up about this and tackle it head on. In the meantime, what we’re doing is encouraging violence and encouraging people to ignore their health and there’s lots of evidence that shows that. Far better that we accept that there will always be both men and women who sell sex that we have an obligation to protect their health and make it as safe as we can do.

Rhoda Grant’s Bill fell due to a lack of cross party support. Why do you think that now is the right time for Scotland to be considering something like this?

I think that since the Referendum, there’s certainly a lot more interest in everything that we do and how Scotland deals with its own situation. Recently, Edinburgh had always turned a blind eye to things, and then Police Scotland declared nationwide law enforcement and that changed things for quite a few women. I just feel that if we’re going to be a progressive country, rather than go back and take some kind of hard line for the wrong reasons, can we have a debate about the alternatives to that? Without citing the New Zealand model, we can’t have a proper debate about the Swedish model, and we should consider all options. I want people to have a view, and have the debate. It’s not about my view, about whether I consider prostitution right or wrong, moral or immoral, that’s neither here nor there. It’s about giving working men and women the same rights as other people.

This reflects the principles behind the New Zealand Prostitution Reform Act (PRA), in that the position is ethically neutral, and more aiming to protect the rights of sex workers?

That’s right.

You mentioned the importance of having a debate about this issue. This consultation at the moment, won’t lead directly to a Bill?

In time, it would be good to think that it would, but as far as taking it forward is concerned, it won’t go through in this parliamentary session. It’ll have to wait until after the election, (MSPs have the right to introduce a Member’s Bill if a final proposal has cross-party support, but only up until the beginning of June in the penultimate year of that Parliamentary session, a deadline which has since passed) but we will have moved the debate on. Having the results of the public consultation, and the arguments made for and against, it’s easier to present this to the Parliament, or have another MSP take it forward.

What are the opinions of the members of the other parties at present? Is there support for this measure?

There are a number of MPs in every party who have been supportive of the discussion. It’s impossible to say what will happen after the election, as they may, or may not, be there. I do think it’s interesting that because it’s something that’s not really talked about, and once people are used to talking about it, or meet and talk to sex workers, they begin to see things in a different light. That’s not saying that the prostitutes I’ve met are all happy at their work, that’s not the case. I meet lots of people who are not happy at their work, but people have to work.

You’ve mentioned about the importance of talking to and involving sex workers. The consultation is open to everyone, but what efforts have been taken to encourage sex workers to have a voice within it?

The work that I’ve been doing has been with Scot-PEP, which is a sex workers organisation. Certainly on social media the calls have gone out from them to say that this consultation is there and asking for a response. I fondly imagined, after the launch, and we have had a certain amount of publicity, that people would have been rushing to put forward their views, but the deadline is the 1st of December, and I’m led to believe that people usually work to a deadline, and most responses come in the last week. I am keen to talk about the Bill as much as possible, and encouraging people to learn what the Bill is about, as people will have preconceptions that this will result on prostitutes on every corner.

It’s very readable, and the appeal of this for me is that it’s practical and common sense. If you care a bit about these women, then do read it. I was very aware of the argument, and I was part of that before myself, that it’s violent against women. I’m not supporting prostitution, but it can either go on in a safe environment, or underground. We can’t make it go away.

A lot of the words of prostitutes are in this bill, and they say that it is scary. With being criminalised themselves, they have to make decisions about taking clients quickly, and if a client is violent, they know that they aren’t likely to be prosecuted for this. They are always on the edge and always vulnerable. They could be much safer. As far as being safer, we have the situation in Edinburgh now where using a condom can be used against them. Also, people aren’t flush with cash at the moment. If they are prosecuted, they have a criminal record and have to pay a fine. They have to go back to prostitution to pay the fine. We have to break that chain.

You’ve mentioned that people might think that the proposed Bill could lead to “prostitutes on every corner”. Do you think that there is the risk that whilst the people in Scotland may be supportive, that it’s not something they want to see happening close to them?

Sex work is not something that equates to red lights and women sitting in windows, although it might do in some cities. It’s something that is actually quite discreet. Already we know that illegally there are prostitues who work together, and that’s what we want to make legal. But neither they, nor their customers are keen for it to be broadcast. They’re happy with the idea that they can’t advertise. I suspect that there are flats with several women working, but very quietly.

That said, in Edinburgh, with regard to the saunas: there was no one in the streets demanding that they close prior to the Police enforced the licensing. So we already live with it, and there’s no great cry about it. I live in a rural area, but none of the politicians here, our mailbags are not full of letters of complaint about “There’s a prostitute working on my stair, what are you going to do about it?” So Scotland seems to have tolerated it very well in an unofficial way.

You mentioned about the collective working of sex workers. The situation in Scotland is that currently, a single sex worker, working from home, is working within the law, but can’t work with any others in the premises. The New Zealand legislation allows for both sex workers working within premises collectively, and owner operated licensed brothels. Are you to keen to replicate this situation in Scotland?

I think that’s what most people prefer. They’d like to go out to work, and have a safe place to work, which is the big ask. In other words, a brothel, a licensed brothel, would have to be licensed by the local council. All incomes would therefore be declared, so the tax man would be happy!

At the moment, the situation is that anyone benefiting from the earnings of prostitution is a criminal: be they partners or children. The thing is that most prostitutes are people like you and me. There’s a stigma attached to prostitution and certain stereotypes, but they are as diverse as any other group of working women, as are their clients. We need to stop stereotyping prostitutes and the people who buy sex, because they look just like our fathers, brothers and uncles. Even if we can get people to recognise this fact, that would be something.

With regard to the licensing by local authorities, what is to stop local authorities who do not agree with the change in the legislation merely passing by-laws, rejecting all licensing applications for brothels, or putting in prohibitive fees for the process of licensing? In New Zealand certain regions passed legislation banning all trade on the streets, thereby banning street-based prostitution.

We can’t really cover that in the Bill, as the Bill is an ask, and these have to be negotiated with the local authorities. I think these are other fights for other days, as it does not have the stipulations for these. We would just asked that applications meet the criteria set down by local authorities. If we were able to see as much of this law passed as possible, we can work out the details to be taken forward, or amendments. I’m not sure how New Zealand dealt with that.

In addition, New Zealand’s research picked up that about a quarter of sex workers used drugs, and research from Glasgow has suggested that the figure is higher. Is there the possibility that this could be exploited, by say, the Police, who will no longer have the power to enter brothels?

The Bill isn’t attempting to solve the problems of human trafficking, drug and alcohol addiction, or poverty. The Bill does require cooperation from the Police. Drug use is covered by other legislation, and the Police enforce that how they wish. The idea that criminalisation of the purchase of sex is a cure all for trafficking, or drug use or rape is nonsense.

You have specifically mentioned the case in Edinburgh where the change in local policy with regard to the brothels has been brought about by the Police. Did they find in New Zealand that their relationship with the Police improved after the PRA was introduced?

What’s interesting about the New Zealand model, on which the Bill is based, is that it was only passed by the chairman’s casting vote. Politicians were clearly divided. It was passed, but by one vote, on the caveat that it would be implemented immediately, but reviewed in five years. Five years later, it was reviewed and agreed to be re-reviewed in eighteen years. So that suggests that whilst it’s not perfect, and no-legislation is, but if the Police had serious issues with it, or if it wasn’t working, then this wouldn’t be the case. But I think this Bill moves us on and shows us as a progressive nation. I can’t tell you the situation exactly with regard to the relationship with the Police in New Zealand, I can’t tell you categorically, but it’s indicative of something that they are prepared to review it again in eighteen years.

Moving on, you’ve mentioned the improvements in health, and our readers obviously have an interested in the prevention of transmission of sexually transmitted disease. The New Zealand PRA made the use of condoms mandatory, with fines against clients who refuse to wear them are you intending to propose something similar?

At the moment prostitutes are panicking about this, because in Edinburgh the presence of condoms has been used as evidence against them. So the current legislation isn’t helping in encouraging prostitutes to use condoms. All of the evidence: the Lancet, in Healthier Scotland, the UN Aids program… they are all supportive of decriminalisation in terms of allowing ease of access to preventative methods, so this would seem to me to be in their favour.

The New Zealand PRA makes inspection of the licensed brothels mandatory, to check that they are meeting Health and Safety standards. Are there plans for similar measures in Scotland, will there need to be a new body for inspection created?

No, there wouldn’t need to be a new body. It would be carried out by the local authority, or by Health and Safety, in the usual way. I think that checking that a business meets the standards is the responsibility of the Local Authority.

Our readers are, as health professionals, are also interested in child protection. You’ve stipulated that our laws in Scotland regarding the issue of under-age sex work are already robust; however, are those who are under-age, and selling sex, at risk of prosecution themselves, or are they considered to victims of circumstance?

Absolutely. This was something that was really concerning me. There is a commonly held belief that children that are abused are more inclined to prostitution, or children of prostitutes are more included to prostitution, but there is no difference, but we should be entirely intolerant of those under eighteen being sex workers. The prostitutes themselves agree with this, and we do refer to this in the Bill. This Bill is for those eighteen and over, and there is zero tolerance for exploitation.

You’d mentioned about the issue of trafficking.

Amendments to current legislation with regard to trafficking, specifically in relation to prostitution, failed during current consideration. We didn’t want to conflate the issue of prostitution and trafficking, as there are many kinds of slavery. Our point, is that trafficking is not just about prostitution. We have no doubt that people are trafficked into prostitution in the UK, and those people who have trafficked should be prosecuted.

Just a final point, this Bill does cover the issue of both male and female sex workers?

Yes, there are a growing number of male sex workers, and women who buy sex from male sex workers; although we do frequently talk just about women selling sex.

For those readers who are interested in contributing to the consultation, you can find the documentation here, and details of how to respond at the end. The closing date for submissions is the 1st of December 2015.

Web-App Review: Petals

12 Oct, 15 | by shaworth

Ground breaking-anonymity features, and well-presented information, but needs to follow through.

Petals is an online web application, developed by Coventry University, which aims to provide information and assistance to those who wish to know more about, or who are at risk of, FGM.

Using the site is fairly straightforward. Accessed through the Petals homepage, it contains a home screen which demonstrates the subsections relating to advice, a quiz on the user’s knowledge of the subject, how to take action, and the details of organisations which support those who have undergone and those at risk of FGM. It also has examples of the views of different people and organisations about FGM, collecting together material already produced elsewhere.

One striking aspect of the application are the baked-in anonymity features. The website has a feature which allows the window, or tab, to be closed and the details of the page removed from the browsing history, without further intervention needed by the user. It also contains some easy-to-follow instructions for those who to remove the browsing history manually. Part of the reason behind the app’s name is that it is not directly connected with the practice of FGM, meaning that the user can hide within obscurity if they cannot anonymise their browsing. The webpage also does not use any images of FGM, presumably for the same reason.

The information in the website is presented in a clear and easy-to-understand manner. It does not rely on gimmicks, or attempt to appropriate youth cultures or speech, which means that it retains a mantle of respectability, and appears authoritative. At the same time, the ideas are presented in a way which is accessible.

The app’s slant towards persons who may not themselves be in danger of FGM, friends or male relatives, is a useful inclusion. These groups may not agree with the practice, but may feel powerless to bring about change, yet their inclusion is key to the eradication of the practice: if FGM is seen as undesirable in a female partner, market forces should prevail.

Criticism of the app is that it does not include information for those who have been victims of FGM themselves, and by emphasising the harm of the practice, without any information as to whether or not it can be reversed, or solutions to the health problems it lists, it may risk instilling a sense of powerlessness and shame in victims. Also, whilst it may have noble intentions by providing information as to what happens to adults who perform or are complicit with FGM, it provides little reassurance to those who wish to report that they can do so anonymously, or how to go about this, bar contacting the NSPCC helpline. Whilst young people may be synonymous with rebellion in the eyes of some, informing the authorities about goings-on within your family, is something that may have long term impacts on family relationships. Some information about how to mitigate or avoid this possibility may encourage reporting.

Overall, Petals has taken a really groundbreaking stance with its efforts to present information to young people in a straightforward manner, and offering vital protections with user anonymity, but needs further refinement to support those taking action.

Peer Reviewers Wanted

21 Sep, 15 | by shaworth

The Journal is seeking new peer reviewers.

This would involve occasional work reviewing submitted papers for acceptance and advising on any final fine-tuning which needs to take place. This is done online, and reviewers can claim CPD using this work.

If you would like further information, please contact

Data Use In Sexual Health

14 Sep, 15 | by shaworth

Last week, a London HIV clinic hit the headlines: in emailing service users en-masse with a newsletter, the service inadvertently emailed all clients, with names and email addresses visible to all recipients.

Like the majority of information security breaches, this was not the result of a clever hack. Many media outlets have reported this breach as being the result of “human error” as the email addresses were entered entering into the CC (Carbon Copy) rather the BCC (Blind Carbon Copy) field. By viewing the incident from this angle alone, copying and pasting into the wrong field is human error, but fails to understand that doing so is bad practice, and one which occurs due to lack of knowledge and understanding about information security.

Email can be a powerful tool for communication, and computerised databases allow us to handle information easily and effectively, but both can be crippled as a result of human users failing to understand the significance of information security, and designing systems and processes which rely on human involvement where there should be none.

Blind Carbon Copy, the function relied on by the clinic can be implemented in several ways, but the most common one is that where the BCC recipient sees only their own email address in this field. In certain situations, it is possible for users to see other BCC recipients. The security of the function depends on the implementation. A good security feature would be to use mail software that flags the use of the carbon copy field as potentially inappropriate for disseminating emails to many people, but this might not prevent leakage altogether.

It also wouldn’t address the fact that modern data management should avoid copying and pasting email addresses into emails meant for multiple recipients altogether. Plenty of off-the-peg systems exist that will automate the sending of emails to multiple clients as individuals. The concept of in-built mail merge is not a new one, but the function needs to exist within well-designed, working software. How many of us know who to ask to purchase secure software, or how long the approval process takes? If a user is faced with the option of copying-and-pasting, or waiting several weeks for an approved process to be arranged, corners will start to be cut.

All staff working within the NHS need to have, at least, a rudimentary understanding of the principles of information security, and the NHS needs to be able to provide training for them to do so, in addition to make the processes for keeping information security easily available. With increasing fragmentation of the NHS in England, and the cheapest provider chosen for service provision, this could become an increasingly common problem as users and support services diverge further.

Review of Glow: A Reproductive Health App

25 Aug, 15 | by shaworth

Glow is a reproductive health app for Android and iOS, developed and released this year. It forms part of a triad of apps including Glow Nurture, which allows logging of pregnancy data, and Ruby (currently only available for iOS) which logs and advises on contraceptive use.

The purpose of Glow is to centralise fertility awareness measures for either optimisation of fertility, or for use as part of family planning through fertility awareness methods. Users can log their cycle length, body temperature and cervical mucus consistency to determine ovulation periods. After logging data, the app generates “insights” based on the data supplied i.e. short snippets of advice for improving fertility, or managing symptoms. In addition, Glow collects data on weight, stress levels, alcohol intake and exercise. Users are advised to enter a daily health log, and set reminders about user dependent contraceptive methods and pre-natal supplementation.

For all the data entry that is required, Glow is remarkably streamlined. It took very little time to enter a daily log, largely because the user interface to do so is excellent. Once the data is logged, the app returns to its home screen where the day of the cycle is demonstrated, alternating with the risk of conception (unless you’re using LARC, where it does not show this and is a nice touch). From here, it’s possible to navigate to all other areas of the app.

Glow’s user interface is exceptionally well designed, and using it feels intuitive. There are no flashy trimmings: the interface is streamlined, which is is probably why it comes in at around 24MB on your device. It can also synch with some fitness accounts with other providers.

Glow is free to download and use, and during my short time using it, I did not notice the presence of intrusive ads; although Glow’s ToCs do stipulate that advertised content is provided. Glow’s privacy statement says that personally identifiably data is not shared with third parties; although aggregate data is, which might explain where some of the profit comes from.

The main drawback to using Glow is that it is US-centric, and as such, its advice is based on US healthcare advice and guidelines. This said, the app can be used by people in other countries without feeling disconnected from the user’s personal experience.

Overall verdict: a powerful tool which can give women the tools to optimise fertility without taking up valuable baby-making time.

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