how Helen Brook shaped sexual health services for young people in the UK – Brook

In this blog, Alison Hadley* talks about the influence Brook’s founder, Helen Brook, had on shaping government policy around young people’s sexual health services over the past six decades.

When Helen Brook took the bold, and brave, decision in 1964 that Brook would welcome young unmarried women seeking contraception, she laid the foundation stone for a model of young people-friendly services that would inform and influence policy and practice for the next five decades.  

While her primary concern was to enable young women to fulfil their reproductive rights to control their fertility, Helen also wanted to provide a safe, confidential space for young people to explore and develop an understanding of their sexual feelings and be better equipped to make their own well informed choices.

Brook would be an accessible, trustworthy service, with non-judgemental staff, open to all.  

That decision in 1964 shaped many thousands of young women’s lives and contributed to a rich tapestry of social history, captured so well in Caroline Rusterholtz’ book Responsible Pleasure. I doubt though that Helen ever imagined the long reaching impact it would have on government policy and professional practice, as illustrated by these briefly described examples.  

In 1973, learning from a decade of experience, Brook developed a checklist for young people’s services which directly informed the 1974 government guidance on family planning services. Issued by the Department of Health to mark the introduction of free contraception on the NHS, the memorandum of guidance requested health authorities to develop separate services for young people to enable them to access contraception confidentially from non-judgemental staff. The following rapid expansion of services contributed to a 25% fall in the teenage pregnancy rate by the end of the 1970s.  

In the 1980s, the principle of confidential services for younger teenagers was challenged by the legal case taken by Victoria Gillick which, for almost a year, removed the right of under-16s to access contraception without their parents knowing. Adhering to Helen’s original concept that providing a safe, confidential space to talk to health professionals protected, not harmed, young people, Brook’s experience contributed to the legal challenge led by government. This resulted in the landmark ruling in 1985 that under-16s who were competent to understand their situation and the treatment they were offered, could consent without parental involvement, and the issuing by Lord Fraser of the guidelines for health professionals which apply today. But much damage was done. Young people’s trust was undermined, professionals were uncertain about the legal position and the downward trend in teenage pregnancy rates reversed. Brook led a programme of work through the late 1980s to inform all professionals and reassure young people of their rights.  

In the 1990s, the then Conservative Government published the Health of the Nation policy document which set a target to halve the under-16s conception rate by 2000, and highlighted the key importance of youth friendly services. Prompting another rapid expansion of services, Brook decided to ask young people again what the ingredients would be of a trusted and accessible service. Their responses reflected the same principles of confidentiality and non-judgemental staff that Helen had developed 30 years previously – captured in a quote from one young person which became the title of the report – Someone with a smile would be your best bet.  

In 1999, the then Labour Government published the ten year Teenage Pregnancy Strategy, with a goal of halving the under-18 conception rate. The strategy identified young people’s apprehension about accessing contraception and fears about confidentiality as key reasons for the UK’s high rate.

The strategy required all local areas to establish youth-friendly services.

The criteria set out in Someone with a Smile provided the template for Department of Health guidance published in 2000, and dedicated young people’s contraception services mushroomed across the country, often carrying a brand – 4YP or YPF – to explicitly reassure young people the service was for them. Brook’s advocacy in securing young people’s rights to confidentiality also informed the Department of Health guidance to professionals on providing contraception to under-16s.  

As the benefits of dedicated young people’s services were recognised, later in the decade the Department of Health guidance was developed into quality criteria for all health services looking after young people. You’re Welcome, which mirrored the findings from Brook’s report, was endorsed by the World Health Organisation and began to be used in a range of settings over the next ten years.  

As we enter the 6^th decade after Brook opened, a refreshed You’re Welcome has been published, providing a commissioning template for local services. Informed by consultation with young people, 50 years later, it includes the same key ingredients young people from previous decades asked for – and which Helen knew were so important.  

A confidential, welcoming, non-judgemental service was and continues to be the kernel of Brook’s identity. 

Helen was determined to give young people their rights to control their fertility and avoid what, at the time, would have been life changing and sometime life threatening consequences of an unplanned pregnancy. She had to be practical and pragmatic in navigating the obstacles in her path but she combined this with solidarity with young people and a respect for their desire and competence to have agency around their relationships and sexual and reproductive health choices. Helen’s vision, started in 1964, lives on. If she was alive today, I’m sure she would be advocating for these values to be fiercely guarded against potential challenge. 

*Alison Hadley was Brook’s Press and Information Officer 1986-89 and Brook’s National Policy Manager 1989-2000 after which she led the Labour Government’s 10 year Teenage Pregnancy Strategy. The update of her book Teenage Pregnancy and Young Parenthood  – including insights from interviews with Brook staff, was published this November.