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If it is not challenged then it will continue to adversely affect and limit all parts of society.

In addition to the provision of education, young people also need good quality sildenafil citrate and vardenafil buy online, accessible services from health and social care professionals about sexual health, STIs, contraception and relationships. They have a right to confidential advice: anxiety about confidentiality can be a major deterrent to not seeking advice. One of the first reasons that young people contact health services independently is when they need emergency contraception or a pregnancy test. Young people may return repeatedly for emergency contraception or pregnancy tests and these visits can be used as opportunities for sexual health and/or relationships advice.

This advice may not be acted on by the young person immediately but may form the basis of a positive advisory relationship for the future. Essential elements for sexual health services for young people include the core provision of reproductive health advice within accessible and young person-friendly settings where non-judgemental staff of both genders are available to offer advice and treatment to self-referred young people. Staff should be aware of issues of consent and competence, confidentiality and clinical care and there should be clearly defined routes of liaison with other child welfare services.

Kristin Luker’s work on young people’s contraceptive decisions identified that young people use a type of cost–benefit analysis in relation to their behaviour, with the short-term risks of having to admit to being sexually active and risking disapproval or loss of reputation sometimes far outweighing the more serious but distant risks of an STI or an unplanned pregnancy. Services thus have to work to ensure that their reputation for discretion and respect can overcome young people’s anxiety and embarrassment.

Professionals need to treat young people with respect and provide them with sufficient time and support to make informed choices about their existing and future sexual behaviour. The avoidance of a moralizing or paternalistic response is key.

Apart from the provision of education and services, parents, carers, educators and health and social care professionals need to provide the ingredients through which children and young people can develop a happy, healthy sexuality including:

• love, affection, respect and acceptance to help provide the young person with a strong sense of identity and self-esteem
• security and safety, which includes protection from exploitation and abuse as well as the chance to experiment and take risks in order to build resilience and future independence
• good relationship role-models within the family or wider social circles
• support for any developing relationships
• sources of advice, both within and outside the family environment, with the understanding that, for most young people, some topics will always remain private from their parents.

This chapter is a little different from others in this volume. It has a broader scope. Such a focus, however, makes a great deal of sense. There is little discussion and much less research exploring ethnicity and fertility. This is perhaps not surprising and represents a more general problem: research rarely responds to the multiethnic nature of developed countries, while policy and practice struggle to engage with minority ethnic populations. At best this means the perspectives and needs as defined by minority ethnic people and their families do not adequately inform the priorities of public services. At worst it means that policy and practice are informed by racist myths and stereotypes.

This is why, when trying to understand a particular issue such as growing up with fertility difficulties, we need to begin by exploring the context in which we come to make sense of ideas such as diversity, difference and disadvantage. This provides an initial framework in which to understand the experience of young people and their families as they negotiate transitions to adulthood. It also ensures that any future debates about fertility and ethnicity are not only appropriately contextualized with ongoing theoretical debates but also able to make use of, and develop, transferable empirical insights gained from the more general literature.

Taking this as our starting point, this chapter offers an agenda for future engagement for those wishing to explore fertility, sexuality and ethnicity in which broader concepts such as citizenship, social justice and identity assume prominence. In adopting such a position our aim is not to offer ‘essentialized’ cultural accounts that treat minority ethnic populations as the ‘other’. Our chapter, therefore, will not offer neat prescriptive cultural sildenafil Canada descriptions that purport to explain ‘ethnicity’ and fertility. Not everything can be reduced to culture. Our concern is to offer a broader discussion that appropriately contextualizes diversity and difference in a way that enables fertility policy, practice and research to engage with, and understand, minority ethnic populations without recourse to simplistic explanations and naive solutions that perpetuate disadvantage and discrimination.

We begin with an account of institutional racism – a concept that has assumed recent legitimacy in explaining disadvantage and discrimination. We then specifically explore what is meant by diversity and difference and end by reflecting on the importance of using evidence to improve outcomes. Throughout the chapter we draw out differences and similarities between the experience of minority ethnic people and the dominant ethnic population and introduce relevant empirical examples.