In a 1967 article published in the Birmingham Post, a young couple shared their experience of attending the Brook Advisory Centre (BAC), the first centre to provide contraceptive advice for young people in post-war Britain. The ‘girl’, twenty-one and engaged, explained that she had been sleeping with her fiancé since she was sixteen. She stated that she had had ‘a major scare’ and phoned a Family Planning Association clinic for help. She was told that they could only see her if she was getting married in the coming three months. Since this was not the case, they directed her to BAC. The ‘girl’ explained that she was ‘apprehensive’ before phoning BAC, but was amazed by the reaction on the other end of the line; she was asked about the urgency of her needs and told that ‘We’re not concerned with whether you have a steady relationship or not’. The client thought that ‘that was marvellous: they were concerned with your needs, your real needs, and not to sit in judgement on your morals’.²

First opened in 1964 in London for unmarried people over the age of sixteen, the Brook Advisory Centres’ aims were ‘the prevention and the mitigation of the suffering caused by unwanted pregnancy and illegal abortion by educating young persons in matter[s]‌ of sex and contraception and developing among them a sense of responsibility in regard to sexual behaviours’.³ While a charity, BAC also had a close connection with the NHS; from 1974 onwards, the Department of Health and Social Security retained BAC in an official role as a provider of services. They also offered contraceptive advice and prescribed contraceptives provided by the NHS free of charge, irrespective of age or marital status. My analysis stretches from the creation of BAC in 1964 to the Gillick case in 1985, when the prescription of contraception for under-sixteens without their parents’ consent became illegal for a short time. Drawing on archive material, mass media, teenage magazines and oral histories conducted with former clients of BAC, this chapter assesses whether young clients influenced and informed sexual health policy. By focusing on young people’s lived experience with voluntary sexual health services, this chapter contributes to two different scholarships: the history of the mixed economy of welfare services in post-war Britain and the history of sexuality.

Recent research has emphasized the continuous role played by voluntary organizations in Britain during the long twentieth century, referring to it as the mixed economy of welfare.⁴ Both John Davis and Julie Grier have shown the tensions between local authorities and voluntary agencies that sought to limit urban deprivation and improve childcare provision, respectively.⁵ Alex Mold and Virginia Berridge’s study of drug users from the 1960s has qualified the relationship between the state and voluntary agencies as one of mutual dependence.⁶ Adding to this scholarship on the tensions between the state and the voluntary sector, this chapter focuses on the BAC charity, the first institution to tackle young people’s need for contraception and counselling on pregnancy and sexual problems. There had been a long tradition of state resistance to funding sexual health services in Britain. Voluntary organizations such as the National Birth Control Association, which became the Family Planning Association (FPA), provided assistance in areas considered to be controversial, such as birth control, and faced great difficulties in securing state financial support.⁷ When the NHS was introduced in 1948, family planning and contraception were not integrated into its responsibilities. In a context where one’s marital status remained key to accessing modern methods of contraception, BAC broke with the tradition of condemning unmarried sexual activity and became the main provider of contraception for young people. However, its charitable status posed limits to its scope; a lack of funding prevented it from expanding its services and meeting its clients’ needs. Funding from Area Health Authorities greatly differed between local branches, reflecting tensions between the charity and the local authorities.

This chapter argues that young people not only became a target for health campaigners but actively used and influenced these services. Practical help with sexual health was a desperate need for them, but it was not merely imposed upon them; young people were therefore not passive users of these services. They moved between different providers that held contradictory policies and ideologies. Before turning to BAC, some consulted their GPs, FPA clinics, friends and magazines, thereby actively trying to find information and gain access to contraception. Friendship was a major source of information for young people, and word of mouth proved crucial in advertising the services. This revealed an intricate network of sexual health knowledge and services that young people navigated, at times confidently and at other times in despair.

In addition, this chapter demonstrates that the building of a trusted relationship between BAC and its clients was crucial not only for the successful running of the clinics, but for the young people who attended the service. Indeed, some young people used BAC services at turning points in their life, when making a decision that had long-lasting implications for their well-being or what Amartya Sen refers as ‘human flourishing’.⁸ Finding a friendly, non-judgemental and confidential service, a place where they could express their anxieties, fears and emotions, was central for them. Young people valued self-determination and praised a service that took them seriously. Some even went on to work for BAC. However, limits were imposed on their behaviours, and under-sixteens were especially vulnerable to attacks by conservative lobbies.

This chapter also argues that considering the views of young people adds to recent criticisms of the concept of permissive society.⁹ The period from the late 1950s to the late 1960s is often referred to as the ‘permissive society’ in order to describe, among other elements, a loosening of ‘moral’ attitudes towards sexuality. A ‘legislation of consent’, to borrow from Marxist sociologist Stuart Hall, was one of the many features of this ‘permissive society’; it was marked by the decriminalization of abortion and sex between men in England and Wales (1967), as well as the 1967 Labour MP Edwin Brook’s Family Planning Act, which allowed local authorities to provide birth control to all women, regardless of their marital status.¹⁰ In this context, teenage ‘sexual promiscuity’ was examined intensely amid growing concerns around the spread of venereal disease and the increasing number of teenage pregnancies.¹¹ For under-twenties, the annual birth rate in England and Wales increased from 34 per 1,000 in 1960 to 48.9 in 1968, peaked at 50.6 in 1971, and then decreased to 26.9 by 1983.¹² Recent research has challenged the idea of the 1960s as a turning point. In particular, Frank Mort has qualified ‘permissiveness’ as a slippery term, while Claire Langhamer, Mathew Thomson and Thomas Dixon have all argued that the 1950s marked a cultural, emotional and social milestone where new definitions and understandings of the self were created, challenging the chronology of the permissive society.¹³

Historians focusing on youth and sexuality have tended to prioritize the ‘problem’ young. Pat Thane and Tanya Evans have explored the experiences of unmarried mothers over the twentieth century, foregrounding the relative disadvantage they experienced and the essential work done by voluntary agencies in supporting them. They have identified a discrepancy between public condemnations of unmarried motherhood and the more complex and messy experiences of unmarried mothers, who were often supported by their families.¹⁴ Pamela Cox has traced the development of the juvenile justice system in England and Wales and shown the key role played by voluntary agencies in the sexual policing of ‘problem’ girls.¹⁵ Adrian Bingham, Lucy Delap, Louise Jackson and Louise Settle have focused on child sexual abuse, while Carole Dyhouse has shown how the place of girls and young women in society has always provoked moral panic.¹⁶ These historians have focused on the ‘problem’ young and children as objects of historical analysis. Therefore, there exists a lack of research on ‘normal’ teenagers, with the exception of Hannah Charnock’s work on female teenagers’ sexuality and friendship. Charnock argues that peer relationships were crucial in shaping young women’s views on sex and that sexual meanings were in flux between the 1950s and 1980s. Sexual experience was at once condemned through the trope of the ‘nice girl’ and valued among girls as a form of social currency.¹⁷

An analysis of BAC clientele reveals that while ‘problem’ girls (i.e. unmarried pregnant girls, ‘promiscuous’ girls) did attend the clinic, the majority of clients were young people in steady relationships who wanted to improve their lives by adopting contraception and protecting themselves against unwanted pregnancies, before getting married in the near future. They were not ‘promiscuous’, and love was very often the driver of their sexual experience. In this way, they willingly aligned themselves with BAC’s aims by displaying ‘responsible’ sexual behaviour. This element supports Claire Langhamer’s argument that love became paramount in post-war Britain¹⁸ and challenges the notion of permissiveness. However, some young people also faced emotional struggles due to the new ‘libertarian/permissive’ climate. The chapter’s focus on the BAC clientele offers an alternative picture of young people in the 1960s, 1970s and 1980s that functions as an obverse to the well-trodden narrative about ashamed unmarried mothers and the ‘problem’ young.¹⁹

The first section of the chapter engages with the difficulty of finding clients’ voices and experiences in the archives of public services. The second section offers a brief history of the creation of BAC and an analysis and overview of the clients in terms of age, class, gender and needs through the statistics compiled by the centres. The third section concentrates on clients’ experiences with the service, while the fourth section assesses clients’ influence on the development of BAC services. Finally, the last section deals with the issue of confidentiality for under-sixteens and shows the limits imposed on young clients’ agency.

Clients’ experiences of sexual services: the challenge of finding sources

Any historian of post-war Britain who tries to document patients’ or clients’ experiences with public health services finds herself limited by the policy on data protection. Clients’ records are either completely protected or under restricted access. Added to this difficulty is the fact that the lived sexual experiences of young people are themselves hard to come by, apart from in sexual attitudes surveys. This holds especially true when documenting young people’s experiences with sexual health services. This chapter relies on a combination of sources that shed light on different aspects of the work of the clinics and young people’s experiences. Documenting the activity of the centres is straightforward due to the archives held at the Wellcome Library. Minutes, reports, leaflets and educational material offer rich insights into the administrative and daily work of the clinics, while statistics collected by each centre provide glimpses of the demographics of the clients. In the first annual reports, statistics were broken down by age, occupation and gender as well as reasons for visiting the centre; however, since the mid-1970s, annual reports have unfortunately limited their statistical analysis to the number of clients attending the clinics.

These sources enable institutional work to be documented, but what remains obscured is BAC’s influence on young people’s sexual behaviours and, in turn, how their needs influenced the development of BAC’s services. Oral history appears to be a promising method for gauging young people’s experiences with BAC. However, reaching former clients of BAC has proved difficult, since they constitute a ‘niche’ population. This chapter uses six oral history interviews carried out with former clients of BAC recruited through social media. This method of collecting testimonies resulted in a small number of participants; the majority had visited BAC in their teens and ended up working for the charity.²⁰ All the interviews have been anonymized.²¹ To complement these sources, case histories have been used as a way of grasping clients’ experiences. Case histories regularly appeared in the annual reports of BAC, articles written by BAC staff and articles published in the mass media that covered the work of BAC. Such histories are problematic sources; though they were presented as ‘reflecting typical clients’, they were seemingly selected for their potential to attract attention and provoke emotion. Furthermore, they are few in number; this is mainly due to the fact that BAC members acknowledged the unethical aspect of presenting cases to the press:

The confidentiality of the service was a key factor for BAC and was deeply valued by its clients. Another way of gaining insight into young people’s experiences and subjectivity is the study of ‘problem pages’ in teenage magazines; several of the agony aunts for these magazines either were BAC members or maintained close relationships with BAC. Problem pages and advice columns constituted precious sources of information on sex and sexual health for their readers.²³ This was particularly the case for advice columns in teenage magazine at a time when school sex education was scarce and limited entirely to the facts of life or simply non-existent.²⁴ Similarly, many parents were seemingly too embarrassed to approach the topic with their teenagers, as revealed by many studies.²⁵ While some broached the topic, discussion was very often limited on the facts of life. Teenage magazines therefore offered an alternative way of finding sexual information. However, here again, the letters published were selected based on their ability to connect with a target audience. Nevertheless, by combining these different types of sources, we can develop a better understanding of the BAC’s clients, their needs and the way BAC answered them.

The Brook Advisory Centre and its clientele

From the inter-war years up until 1974, when the National Health Service incorporated family planning under the NHS Reorganisation Act, multiple charities, agencies and spheres of activity conglomerated to form a network of what would today be called sexual health services. Key players among them were, of course, the Family Planning Association, the Marie Stopes clinic and the Marriage Guidance Council.²⁶ These voluntary services focused on providing contraceptive advice to married women or mothers only, as well as counselling couples on their marital difficulties. What made BAC distinctive was its focus on young unmarried people. In 1964, Helen Brook, director of the Marie Stopes Memorial Foundation Clinic and member of the Family Planning Association, opened the first Brook Advisory Centre in London, followed by a second in 1965. Other BAC centres were established across Britain, with Cambridge, Birmingham, Avon and Edinburgh among them. The use of the service offered by BAC grew drastically and the demand quickly exceeded the capacity of the centres. There was a long waiting list for each centre.²⁷

The status of Brook as a charity meant that there were recurrent concerns about attracting and securing funding. In several cases, local and Area Health Authorities were reluctant to support BAC financially. In London, several Area Health Authorities provided financial support to BAC by paying per capita fees for their residents who visited the clinic; these authorities included Southwark, Camden and Hackney, to name a few.²⁸ In Birmingham, the Health Committee of the local council, which had a Conservative majority, flatly refused to support the work of the centre from its creation in 1966 up until 1972, when a new city council with a Labour majority made birth control free and available.²⁹ From then on, BAC Birmingham received financial help. The refusal was connected to a concern about morality, with the committee fearing that funding the service would condone ‘promiscuity’.³⁰

Despite these limited resources, BAC attracted a growing number of young people who were having their first sexual intercourse at a younger age than the previous generation. Indeed, the average age of first sexual intercourse fell from a range of nineteen to twenty-three years during 1951–5 to seventeen to twenty-one years during 1966–70.³¹ The percentage of young people who had had sexual intercourse between fifteen and nineteen years old also increased. Two sociological surveys carried out at ten-year intervals revealed that in 1964, sixteen per cent of the fifteen- to nineteen-year-olds said they had experienced sexual intercourse at least once; this number had increased to fifty-one per cent by 1975.³²

Therefore, as sexual experience became more common for young people and occurred at a younger age, more young people turned to the BAC for help and advice. The number of clients seen in BAC centres increased from 1,056 clients in 1965 to 59,265 by 1980.³³ The founder and chairperson of the centre, Helen Brook, used the term ‘clients’ from the first annual report onwards. However, this terminology was not consistent across the local branches; the majority of their annual reports used the term ‘patients’ until 1972, when they all changed to ‘clients’. This change in terminology was important and suggests a turning point in the way BAC conceptualized its work and its relationship with its ‘clients’. ‘Patients’ implies an unbalanced power relationship where the doctor knows best, whereas ‘clients’ implies agency and choice with a consumerist approach, where ‘the patient is making the decision [and] becoming the Consumer’.³⁴

The first report of the Brook Centre following its official opening in 1964 provided a glimpse into the clients’ demographics and reasons for attending. Out of the 1,056 clients in 1965, the majority were young women, one-third were students, one-third were secretaries and the remaining one-third were professional people. BAC annual reports until the end of the 1970s used the terms ‘girls’, ‘young women’, ‘boys’ and ‘young men’ to refer to their clients aged between sixteen and twenty-five. The age of majority was twenty-one until 1970, when it was lowered to eighteen. However, the age of consent was sixteen. BAC initially only saw clients between sixteen and twenty-five in order to stay within the remit of the law.

Under the Family Law Reform Act of 1969, a person over sixteen was medically an adult and able to consent to her own treatment, and thus had a right to professional confidentiality. BAC applied this principle. The upper age limit was not a consistent rule across BAC centres; clients were welcome to use the service for as long as they wanted, provided there were enough sessions to cater for them. However, the common practice was to refer clients to FPA clinics once they were married. From 1969, Helen Brook decided to allow under-sixteens to be seen in the clinics and prescribed contraception.³⁵ She recalled having taken the decision without informing her committee at an FPA meeting; the press was present and pushed the FPA to clarify its position on the subject. Brook stood up and said, ‘Well, Brook will see the under-sixteens from now on’.³⁶ In the annual reports, under-sixteens were always referred to as ‘girls’ and ‘boys’, never as ‘children’. These carefully chosen words suggested that clients, even those who were under sixteen, had already left childhood, which was characterized by parental protection. However, as we will see in the last section, under-sixteens were referred to as children by conservative lobbies. The terminology of ‘girls’ and ‘boys’ was also used by the popular press when reporting on BAC’s services. Clients, on the other hand, seemed to perceive themselves as ‘adults’. This discrepancy between the staff’s and clients’ understandings of age indicated the staff’s belief that young people needed guidance during this crucial phase of their development; they were transitioning between childhood and adulthood, with entry into adulthood plausibly defined by marriage instead of majority.

‘Girls’ who visited the clinic were mainly between eighteen and twenty-five years old. Twelve per cent of them were either pregnant when they came to the centre or had given birth, and three per cent had undergone abortions. The majority of the clients were in ‘steady relationships’ and attended in order to obtain contraception. As a BAC doctor put it, ‘They make a sincere effort to be responsible, listen objectively to what is said, very nearly always have come because they don’t like their present method or don’t trust it’.³⁷ Instilling a sense of responsibility in the client was a key task in BAC’s work and central to its public narrative. BAC were regularly accused of encouraging promiscuity; their main defence was the affirmation that they helped young people in steady relationships to adopt responsible sexual behaviours, namely protected intercourse. Therefore, rather than creating a permissive society, BAC was dealing with the consequences of this permissiveness and trying to encourage a model of ‘good’ sexuality where commitment was paramount.³⁸

A minority of clients appear to have had more traumatic backgrounds and were referred by other agencies and social workers. In 1966, Helen Brook gave a conference to an audience of social workers in Westminster. She presented cases that did not fit the model of responsible young people in steady relationships, and exemplified how ill-equipped some ‘girls’ were to protect themselves against unwanted pregnancy. Yet due to the help they received from BAC, these young women were from then on able to behave ‘responsibly’, namely to protect themselves against unwanted pregnancies.³⁹

In 1972, based on the statistics published by the centre, the ‘typical’ BAC client was a ‘girl aged nineteen or twenty, a student, receptionist or secretary, who had come because a friend recommended the BAC. She had a steady boyfriend, her first sexual partner, who had been using condoms and she was prescribed the pill for greater safety’.⁴⁰ As Table 10.1 shows, between 1972 and 1980, this age group continued to comprise the largest proportion of BAC clients. During this period, an increasing proportion of under-sixteens also visited the centre. This new category posed additional challenges, as we shall see in the last section.

The reasons for attending the centre were recorded in the statistics, but unfortunately not broken down by age. Table 10.2 shows that friends and clients were the main channel for young people in finding out about the services, followed by the press. There were some local differences. For instance, in the Wessex branch, GPs were more inclined to refer clients to BAC than in Edinburgh, testifying to different medical views on the subject. Young people talked about sex, their sexual experiences, problems and anxieties with their friends and peers (as ‘existing clients’ implies), and word of mouth functioned as a powerful channel of information. These findings support Hannah Charnock’s claim that friendship became a central facet in the way young people negotiated their sexuality.⁴¹

Table 10.3 shows that the majority of the clients (about eighty-five per cent) attended for birth control methods and advice. Among them, the pill was the favourite method,⁴² followed by the cap in the early days of BAC, and then the Intra-Uterine Device (IUD). Some came for a pregnancy test or were referred for a termination, while an increasing number of clients wanted to discuss their sexual and emotional problems, showing that anxieties towards sex were common in young people. As reported by BAC staff, anxieties were mainly due to the fact that while sex was omnipresent in the mass media, young people were given conflicting messages, since pre-marital chastity remained the only behaviour accepted by ‘the Church and the Establishment’.⁴³

Young men also visited the centre. ‘Boys’ accompanied their girlfriends, and very often were the ones who booked the appointments over the phone. In 1973, twelve per cent of female clients were accompanied by their boyfriends or partners. Boys also often visited the centre in groups, as a dare, since they knew that the centre gave out condoms for free. This is indicative of a masculine culture where boys teased each other and boasted about contraception. Over the years, young men, albeit still a tiny minority, visited the centres on their own to speak about their fear about sexual performance and inadequacy. In 1981 London, male clients comprised two per cent of all new clients and three per cent in 1982; these numbers did not count boys who accompanied their girlfriends.⁴⁴ During the 1970s and 1980s, sexual health services such as BAC and the Family Planning Association tried to alter the gendered division of contraceptive responsibility by campaigning to involve boys in contraceptive decisions.⁴⁵ In 1982, a special session reserved for boys was set up in Walworth Brook, London, to cater for boys’ needs and London annual reports specifically mentioned ‘boys’ as a sub-category.⁴⁶

Clients’ lived experiences with the clinic

Teenagers who attended the clinic of their own accord displayed agency in their sexual life; they came to the centre because they had specific needs and demands. The majority wanted to protect themselves against unwanted pregnancies by going on the pill. For instance, Florence, born in 1968, whose mother worked at Birmingham BAC, visited the centre when she was seventeen to attain the pill. She remembered going to the centre regularly with her mother when she was a child and loved the friendly atmosphere. She explained, ‘I went knowing what I wanted. I knew exactly what I wanted.’⁴⁷

BAC’s peculiarity rested in their emphasis on their clients’ needs and their provision of a space where young people could discuss their feelings without any judgemental attitudes and in confidence. This focus on youth was a key reason why young people attended the clinic. Sarah, born in 1947, visited the BAC clinic in Edinburgh in 1968 when she was a student at university and wanted to go on the pill.⁴⁸ She recalled that she had first tried a family planning clinic in 1967, but had needed to lie about her marital status in order to obtain the contraceptive pill. When she learnt about the opening of BAC, she ‘was over the moon, you know because it was intended [for] young people. It was bloody marvellous’. She went with a friend after having read about the centre in the press. When asked whether she discussed the subject with her parents, she replied that she had wanted to protect them from ‘what she was up to’. There was also the possibility of seeing a GP, Sarah explained, but she did not trust the one in her neighbourhood, as some of her friends had reported bad experiences with him. Her friend’s experience proved essential in Sarah’s assessment of her options. Sarah’s example, in particular her lack of communication with her family, refusal to see a GP and trust in her friend, was typical of many BAC’s clients’ experiences.

The lack of communication with parents was a recurrent motive for visiting BAC. Time and again, BAC’s reports, as well as the media coverage of the centre’s work, stressed the generation gap, due to which young people felt unable to discuss the topic of sex with their parents. BAC members tried to encourage dialogue between teenagers and parents, but confidentiality took priority. However, not all parents were reluctant or opposed to discussing sexuality with their offspring. Indeed, some parents brought their teenagers to the clinic. In an article covering the first year of activity of Birmingham BAC, the journalist interviewed a married couple; the wife had accompanied the couple’s daughter to BAC. The journalist took great care to stress that this example was rather exceptional. Highly educated, with a ‘background of liberal thought and experience’, and exceptionally close to their seventeen-year-old daughter, these parents ‘could discuss sex naturally and openly with their children’.⁴⁹ The daughter had told her parents about her sexual experience from the start, and the family decided it would be better for her to use contraception. The girl was nevertheless rather anxious about going to the centre on her own, and the mother told the journalist that her daughter ‘was glad (she) had gone along with her’. Both mother and daughter were ‘tremendously impressed with the happy atmosphere there among the girls as well as staff’ – so much so, explained the mother, that she took leaflets advertising the centre home with her and gave them to her friends. Both parents stressed how important these centres were for ‘avoid[ing the] futile anxiety which so filled the life of their generation’. This example suggests that some parents wanted to provide a different upbringing to their children from that of their own youth, when sex had been shrouded in secrecy. In so doing, they supported their daughters’ greater freedom.

Another example of a parent’s gratitude towards Brook could be found in a letter discussed in the annual report of 1981. Of course, BAC only published positive letters supporting its work and stressing the quality of its services. Nevertheless, this letter revealed that some parents were supportive of their teenagers’ experiences. A mother wrote to BAC, thanking them ‘for the marvellous way doctors and counsellors at Brook helped my daughter recently’.⁵⁰ Aged seventeen, the girl ‘was distraught’ to find she was pregnant, and the mother booked her an appointment at BAC ‘to receive help and advice’. The letter explained that communication existed between the mother and the daughter but help was nevertheless needed at this ‘difficult time’. The mother, who was also writing on behalf of her daughter, stressed how grateful they were for the quality of the service:

Clients turned to BAC because they trusted the charity more than their GP, who was generally their family doctor and from an older generation. It was for the doctor to decide whether to prescribe contraceptive advice and treatment, but young people over sixteen did not need the consent of a parent or guardian for medical treatment. Some had bad experiences with their own GP, who had proven to be judgemental or patronizing, while others simply did not investigate this option because of friends’ bad experiences. The lack of faith in GPs, combined with the fact that BAC offered a trusted and confidential service, explained the popularity of the latter. For instance, in 1983, a married woman wrote a letter to the Daily Mail to ‘put the record straight’ in view of the bad publicity given to BAC by the newspaper. She shared her experience and stressed the positive influence that BAC had been on her when she was nineteen with ‘a lot of family and personal problems’ and was ‘desperate’.⁵² Before turning to BAC, she went to her GP, but did not receive the help she expected. She visited BAC for more than two years and received ‘expert counselling’ free of charge. Now happily married with a loving husband, two children and a beautiful home, she stated that she ‘owed’ the centre her current situation and praised ‘the help and encouragement’ she had received. ‘It’s an excellent service for a lot of young people and a place of trust for them’, she concluded. The centre had a long-lasting positive impact on this woman, and she presented the help she received as transformative. This testimony also hints at another central element for young people: the fact that the centre provided a space where a trusted relationship could develop.

This trusted relationship was also valued by twenty-one-year-old Jenny who visited BAC in 1980.⁵³ Before turning to BAC, seventeen-year-old Jenny went to her family planning clinic in Sheffield, as there was no BAC in Sheffield at the time, and was fitted with an IUD. She then moved to Birmingham. Due to bad bleeding from the IUD, she was put on the pill by the university service. After leaving university, needing a prescription, she attended BAC. Jenny explained that another option would have been her GP, but she had soon rejected this option as he was very conservative; once, she had been to see him for a cold and had been asked about her marital status and whether she was on the pill, and encouraged to see the nurse about the natural method of birth control. During the interview, Jenny could not remember where she had learnt about BAC, but said ‘everyone knew about it’. During her visit, she had a discussion about which method suited her best and asked to be fitted with another IUD. Thinking that the bleeding might have been coincidental, the BAC doctor agreed to give it another try. Since Birmingham BAC did not have an age limit, Jenny continued to use them until she was sterilized aged thirty-seven. Jenny’s example shows determination on her part, a strong desire to attain her favoured contraceptive method and the trust she placed in BAC’s services. Jenny’s needs and opinions were respected, which explained why she used the BAC service until the end of her reproductive life.

The ability of BAC to build and maintain the trust of their clients can be seen in the example of John. He burst into the clinic one evening with his group of friends, ‘laughing and giggling and their comments and jokes got louder and more risqué’.⁵⁴ Peer influences played a key role in John’s choice to visit the centre. However, one counsellor herded them into her room for a chat and succeeded in getting them to open up about their sexual relationships. John, who had a girlfriend and was having sex with her, was concerned about her and asked several questions. He listened carefully to the advice given and took the sheaths handed out by the counsellor. He then came back several times for both extra condoms and further advice, showing the trust he placed in the service. Eventually, he returned, together with his mother and his girlfriend. She was put on the pill, and John’s mother eventually helped his girlfriend to broach the matter with her own mother. This example attests to the way John built a trusted relationship with BAC counsellors, which led him to involve his mother and girlfriend.

Not all clients visited the clinics in person; thousands of letters were sent each year to BAC local branches asking for advice. Excerpts from several such letters were provided in the annual reports. What is striking to the reader is the way that young clients framed their narrative around the values of responsibility and committed relationships so cherished by BAC. This way of presenting themselves was arguably a strategy to align with the BAC public narrative of what constituted good sexuality, namely protected intercourse in a steady relationship. However, the choice of letters containing these elements also reflected BAC’s concern about its public image. A letter from a seventeen-year-old emphasized that she had been ‘involved in a real and steady relationship for over a year’. Still a virgin, she was nevertheless considering a sexual relationship, since ‘we both realize the extent of our feelings for one another and know that our relationship is deep and meaningful [enough] for sexual intercourse to form a natural part of it’.⁵⁵ She had rejected the idea of turning to her family doctor for help, fearing he would tell her parents. This fear might have been triggered by the 1970 case of Dr Browne, discussed in the final section, who broke his patient’s confidentiality. These letters attest to the trust the young writers placed in BAC as a resource that preserved confidentiality and offered advice. Here, again, this letter shows that GPs were not perceived as a reliable source of help.

Similarly, another girl wrote a letter to ask where to obtain the pill, since she was planning to spend a weekend with her boyfriend. Although she felt the need to emphasize her morality, stating that she did not ‘believe in sex before marriage’, she nevertheless wanted to take precautions in case she ‘should forget herself’.⁵⁶

Besides writing to the centre, many teenagers were actively trying to find help and advice about their sex lives in other ways. One option was to write to magazine agony aunts to seek help with sexuality. Many agony aunts encouraged these young writers to go to BAC. An example among many was that of a sixteen-year-old who wrote to She for help about her lack of sexual experience. Created in 1956, She was a monthly women’s magazine targeting the young. The girl felt pressured into having sex by her friends, who were teasing her because she was still a virgin; the girl wanted to ‘keep herself for the man she [would] marry’. She ended her letter by stating she was tempted to ‘give way’. The agony aunt, Denise Robins, emphasized in her reply that the decision to have sex should be made freely by the girl herself and recommended a visit to BAC: ‘It’s your life and your conscience. Whatever you decide don’t risk pregnancy. You could go to the nearest Brook Advisory Centre. Women counsellors will talk things over with you and give you advice’.⁵⁷

In addition to these ‘mediated testimonies’, there are indicators that clients were generally happy with the services they received. Many young people visited their local BAC on more than one occasion. Indeed, while 1979 saw 23,413 new clients, the number of returning clients was 34,627. The positive experience some young clients had with Brook led them to work for the charity later on. Jenny’s experience with BAC, mentioned before, was so positive that she ended up working for them. This was also the case for Sarah, who attended Edinburgh BAC in 1968; she went on to work for BAC London in 1973. After university, she had left Edinburgh for a ‘boring’ job in Brighton. There, she was part of the Women’s Liberation Movement and therefore very supportive of women’s access to reliable contraception. She saw an advertisement for a job as personal assistant to the General Secretary of BAC. Having had ‘a good experience at BAC’ and sharing their views on enabling access to contraception for young women, she applied and was offered the job. She worked there for a year, doing administrative work as well as outreach work with schools.⁵⁸

Clients’ influence over the service

BAC prided itself on listening to its clients’ demands and devising its policy accordingly. In this process, client experiences retained a central position. Several strategies were implemented by BAC to assess the quality of its services and evaluate the satisfaction and needs of its clients. As early as 1969, Joan Woodward from Birmingham BAC carried out a survey on a sample of BAC’s clients (117 of the 846 female clients who attended the centre in 1967) in order to assess their needs and the extent to which they thought BAC services were meeting their expectations.⁵⁹ Clients were generally happy about the care they received and enjoyed coming to the centre due to the friendly atmosphere and because it ‘was so nice to be treated as a responsible adult’, as one client put it. Criticisms were nevertheless voiced, concerning the overcrowding of the clinics and the subsequent feeling of embarrassment. In addition, clients expressed the desire to be seen by the same doctor at each appointment, in order to develop a more trusting relationship. Trust in BAC services was crucial for clients, who needed a safe space where they could freely discuss their fears and anxieties. Finally, the survey revealed the need to develop counselling; young people generally needed more time to express their reasons for coming to the centre and needed counselling that was specifically aimed at understanding the anxieties they felt. Birmingham BAC, receptive to its clients’ feedback, took measures to address these concerns; new clients were assigned a specific doctor, and a multidisciplinary team of counsellors, doctors and nurses was set up with additional sessions being reserved for longer counselling.

Similarly, in Bristol, a pregnancy advisory session was created for the first time in a BAC centre, due to the high number of clients attending the clinic in distress, fearing that they were pregnant. These clients did not yet know whether they wanted to pursue the pregnancy or undergo a termination. The majority of clients’ parents were ignorant about what was happening in their life. Counselling was therefore set up as a way of helping these clients consider their options and work out what they wanted. Emotional support, advice and help were provided.⁶⁰

In 1973, ‘talkabout’ sessions also started in London. They were presented as an experiment to help BAC members ‘consider how to improve the quality of their services’.⁶¹ New clients were invited as a group ‘to discuss birth control methods, their feelings and anxieties relating to a possible pregnancy and their motivation towards contraception’ in an informal setting with music playing in the background, creating a relaxed atmosphere. While discussions were taking place among the group, each client had the opportunity to see the doctor individually and in private. These sessions were conceived as a place where young people could talk about their problems freely and where staff could gain a sense of clients’ needs. What transpired from this experiment was that an informal atmosphere helped to create a trusted environment where young people could open up. Accordingly, music became a part of the daily routine of the clinic. More importantly, clients of the BAC explained that they valued having the time to discuss their emotions with the staff. Consequently, an additional counsellor was hired to allow more time for each appointment.⁶²

In spite of the emphasis on clients’ needs, some clients felt that BAC failed to meet their needs. For instance, a testimony of a former client found on a Mumsnet forum thread is indicative of the way agency was restricted. The anonymous mum answered a call for testimonies from BAC to celebrate its fiftieth birthday. Writing in 2013, the Mumsnet user described her bad experience in the 1980s when she refused to undergo an internal examination:

Although this testimony was made retrospectively, on an open web platform, and few details were given about the BAC user, it nevertheless informs us of resistance from BAC’s users when they met with demands they considered inappropriate. In this case, the user was not a passive client but instead resisted the power of the doctor and found an alternative way of getting what she wanted. While this resistance was individual, some clients were less fortunate, and it was not staff members as such who represented obstacles to their agency but instead their own general practitioners.

Contraception and the under-sixteens

The majority of BAC’s clients were over sixteen, yet there were an increasing number of very young clients coming to the centres to ask for help. As Table 10.1 shows, the percentage rose from just over one per cent in 1972 to six per cent in 1980. The issue of providing contraceptive advice to under-sixteens without parents’ consent has already received scholarly attention. In particular, the Gillick case has been the object of in-depth studies, showing how conservative lobbies worked to reassert the supremacy of parental rights over doctors’ duty to maintain confidentiality.⁶⁴ While these studies shed light on the main high-profile actors, they did not assess the impact that the Gillick case had on young people’s behaviours. In addition, the Gillick case was not the first instance when confidentiality was broken. This last section of this chapter delves into the enduring debate over contraceptive provision for under-sixteens and the issue of confidentiality.

Sociological surveys have shown that the period under study witnessed an increase in the proportion of under-sixteens with sexual experience, from about five per cent in 1964 to twenty-one per cent in 1974 to fifty-two per cent in 1989.⁶⁵ Because the age of consent was sixteen, sexual relationships with and between young people under sixteen were deemed unlawful. The under-sixteens were considered a vulnerable category, requiring longer counselling sessions to ensure that these young girls had entered sexual relationships of their own free will. Young boys were a minority among the clientele and, as such, their sexual behaviour attracted less concern. Some young girls who attended the clinic were already pregnant and desperate for help and advice. Following the 1967 Abortion Act, termination was a possibility, but required the approval of two doctors and, for a minor, a parent. BAC members acted as facilitators for communication between young girls and their parents. When a young client was put on the pill, it was considered good practice at BAC to inform the client’s GP, upon approval by the client, and encourage the client to tell her parents. This policy was implemented on the basis that the GP would respect the confidentiality of their patient. However, as hinted in several previous examples, young people turned to BAC because they distrusted their GP and feared the latter would breach confidentiality, jeopardizing the client’s well-being.

A case of breach of confidentiality by a Birmingham GP attracted public attention in 1970 because BAC members reported the culprit to the General Medical Council (GMC) for professional misconduct. BAC Birmingham did not want to take ‘punitive’ action against the GP, but hoped that the outcome would be a test case that would finally clarify the policy on confidentiality.⁶⁶ Going to the GMC was exceptional. In 1970, a sixteen-year-old girl attended Birmingham BAC with her boyfriend to obtain the pill. They had already had intercourse using a sheath, but feared this method was not reliable and wanted to go on the pill. The girl was hesitant to let BAC inform her GP, Dr Browne, since her father had a close relationship with him. The counsellor reassured her by emphasizing that the letter would be written in confidence.⁶⁷ However, Dr Browne broke his patient’s confidentiality and informed her parents without telling her first, because, as he later explained, ‘every attempt had to be made to point out to her the error of her ways’.⁶⁸ Following the case, Birmingham Brook took a strong stance by expressing publicly ‘its determination to continue to assist the unmarried of any age who show a responsible attitude in choosing to consult its professional experts in order to avoid the risks of unwanted pregnancy and abortion’.⁶⁹ The centre guaranteed the ‘strictest confidence to all its clients’. National and local newspapers covered the case extensively, amounting to more than 400 articles on the subject, with people supporting Browne and parents’ right to know about their children’s sex lives pitted against partisans for confidentiality. While Dr Browne was found ‘not guilty’ of professional misconduct by the GMC, the British Medical Association nevertheless reaffirmed the supremacy of confidentiality by stating that a doctor could not ethically second-guess a patient’s judgement of his or her best interest and must respect their refusal to allow information to be given to a third party.⁷⁰ Following the Browne case, BAC reported an increase in young people seeking contraceptive advice, especially those aged sixteen and under. In 1974, the Department of Health and Social Security (DHSS) advised that a doctor who provided contraceptives for a girl under sixteen even when he ‘was unable to obtain a parent’s permission was not acting unlawfully’,⁷¹ provided that he acted ‘in good faith’ to protect the girl against the ‘potentially harmful effects of intercourse’.⁷²

However, age became a major area of contention, with the provision of contraception for under-sixteens subjected to serious and sustained challenges and attacks by conservative lobbies. The contentious issue was the idea that under-sixteens were ‘children’ and as such, parents’ rights and control took precedence over their children’s agency and doctors’ confidentiality. Above all, under-sixteens were conceptualized as ‘children’ who needed to be protected from permissive lobbies such as BAC.⁷³ These attacks culminated in the 1984 Gillick case, where Victoria Gillick went to court to fight her Area Health Authority’s refusal to promise not to give contraception to her daughters under the age of sixteen without her consent. Her case was unsuccessful, but she continued to appeal to the court. In December 1984, the latter ruled in her favour, stating that the DHSS guideline was unlawful and that parents’ consent prevailed over that of children. This decision was reversed by law in October 1985. However, Gillick’s victory, albeit short-lived, had drastic consequences for young people under sixteen who were attending BAC clinics, in that they could no longer be prescribed contraception.

BAC members were deeply worried about the Gillick victory and wrote lengthy reports on its dramatic consequences for their clients. Jane was an example of a client badly affected by this new ruling. The first time she attended the centre to obtain contraception, she was fifteen and had already had an abortion. Prior to December 1984, Jane received counselling and contraceptive help at BAC. After December, however, the centre could not give her contraceptives without her mother’s consent, which put Jane in an impossible situation. A committed Catholic, her mother refused to give her permission to use contraception despite knowing about the abortion. The mother stated that she would rather not have been asked. When Jane returned to the centre in 1985, she was pregnant again and desperate for a second abortion.⁷⁴ Adolescent girls were not the only ones affected; young boys’ agency was also limited, as shown by the example of John. A regular at BAC, John started attending the clinic during his first sexual relationship when he was fourteen. Following a counselling session, he was given sheaths and thereafter attended regularly for more supplies. On one occasion, he brought his girlfriend along to discuss different contraceptive options. After December 1984, John only visited BAC once to explain that he could not face asking his mother for permission to be given contraceptives. After that, BAC staff never saw him again.⁷⁵ These two examples show that, while young people were taking steps to act responsibly and protect themselves against unwanted pregnancy, their agency was hindered by laws that put their well-being at risk.

Conclusion

Through a close analysis of BAC annual reports, case histories, magazines and oral history interviews, this chapter has shown that young people’s experiences with and expectations of sexual health services proved to be essential to the shaping of sexual welfare in modern Britain. The BAC charity offered a much-needed service at a time when youth sexuality was becoming a topic of public discussion and concern. With the opening of BAC, for the first time, sex was officially perceived as an important element of young people’s welfare. However, this recognition had its limits, especially when it came to the under-sixteens.

BAC was set up as a way of teaching young people responsible sexual behaviours, namely protected intercourse in a steady relationship. There existed an inherent paradox in the service; while young people between sixteen and twenty-five were perceived as mature enough to make informed decisions about their sexual life, they were nevertheless deemed in need of guidance about displaying sexual maturity. However, this paradox was rarely denounced by clients. They valued BAC services and were happy to have found a confidential service where their needs and opinions were taken seriously and where they could develop a trusted relationship with BAC staff. Young people turned to BAC because they mistrusted their own GPs; they were often told about the service by their friends. Friendship functioned as a source of support for young people, and word of mouth meant the service was widely known. In turn, BAC took their clients’ experiences seriously and tailored their services to meet their clients’ needs and expectations.

Gender and age were key elements in the BAC service. The majority of the clients were young women, indicating that responsible sexual behaviour was considered a young woman’s responsibility. However, over the years, young men also visited BAC, and the centre campaigned to encourage young men to share birth control responsibility. Age, on the other hand, proved controversial. The confidentiality of the service for those between the age of consent (sixteen) and the age of majority (twenty-one until 1970 and then eighteen) was guaranteed by BAC. However, BAC’s policy to inform the client’s GP, upon the client’s approval, had resulted in a high-profile case of breach of confidentiality. Yet, the under-sixteens remained the object of sustained media and political attention. They were perceived as a vulnerable category and received longer counselling sessions to ensure that they understood the implications of sexual intercourse. In the view of BAC opponents, under-sixteens were children who needed to be protected from sexual activity, and the confidentiality of the service became the focus of a battleground, culminating in the short-lived Gillick case. This chapter has revealed that a close focus on age nuances the common narrative about the liberalization of sexuality. The sexual experiences of people under sixteen persisted as subjects of intense controversy. Age, at times, functioned as a barrier to young people’s access to sexual health services.