Sexual health policies in other industrialized countries: are there lessons for the United States? - Statistical Data Included

Journal of Sex Research, Feb, 2002 by Ilsa L. Lottes

APPROACHES TO SEXUAL HEALTH IN EUROPE

The Advocates of Youth--whose goal is to help young people make safe and responsible decisions about sex--and the University of North Carolina at Charlotte sponsored a study tour to learn about European approaches to adolescent sexual behavior (Berne & Huberman, 1999). Experts from the U.S. in adolescent health, teen journalists, and graduate students participated in the study tour and worked together to write a report of their findings. The three countries visited--The Netherlands, Germany, and France--all have significantly lower rates of STDs and teen pregnancy than does the U.S. In these countries teens are older, on average, than teens in the U.S. when they have their first sexual intercourse.

Adolescent sexual health in these countries is based on values of rights, responsibility, and respect. Government and the general society consider it not only a duty to provide accurate information and confidential contraceptive services to the young, but also that provision of such services and information to adolescents is part of their rights. There is no attempt to motivate behavior of teenagers through a collective effort to demand abstinence. Thus, the goal is not to prevent adolescents from having sex but to educate and thereby empower them to make responsible decisions. By respecting the independence and privacy of adolescents the expectation is that, in return, the majority will act responsibly to try to avoid pregnancy and STDs. The more tolerant attitude toward sexual expression of teenagers also makes it easier for them to get the services they need. Teenagers do not have to feel guilty or ashamed of using contraceptives. In fact, they will more likely feel they have been irresponsible if they fail to use it.

A similar approach has also been adopted in the Nordic countries, and it also has not led to promiscuity. In the Nordic countries as well as the previously mentioned study tour countries, public health policy is based on public health research and input from well-trained sex educators, not on political or religious definitions of moral behavior. In addition, these countries provide national health insurance that covers most of the costs of contraceptives and related services. The low cost and easy accessibility of services help adolescents take advantage of preventive health measures.

The Netherlands deserves attention, for it is the western country that has had the lowest rates of unplanned pregnancy, abortion, and teen pregnancy for quite some time (Jones et al., 1988; Ketting, 1994; Ketting & Visser, 1994; Singh & Darroch, 2000). In 1995 the teenage abortion and pregnancy rates in the U.S. were about seven times that of The Netherlands (29.2 vs. 4.0 and 83.6 vs. 12.2, respectively; Singh & Darroch, 2000). Dutch policy makers use research, pragmatism, and an ethics approach that tries to teach responsibility in sexual decision making as the basis for their sexual health programs. The goal is to allow an open discussion about sexual issues and encourage adolescents to talk about sex and topics that interest them. The attitude of the government is that both the public and families have a responsibility to help young people avoid unwanted pregnancies and STDs. The goal is to instill a sense of responsibility in the young and to give them the knowledge to act accordingly. It is also important that the general public is tolerant and accepting of teenage sexual experiences. The view is that it is impossible and quite ridiculous to try to prevent teenagers from having sex. Thus, the sensible action is to prepare them to act responsibly. Contrary to the view held by many in the U.S., this liberal attitude seems to be consistent with the findings that Dutch teenagers have fewer partners than their American counterparts and have their first sexual intercourse at an older age--15.8 for USA and 17.7 for The Netherlands (Berne & Huberman, 1999). Condom use does not vary greatly in the two countries but what distinguishes The Netherlands is that sexually active young adults use more effective contraception such as the pill at a much higher rate: 67% of sexually active female adolescents used the pill at their most recent intercourse in contrast to 20.5% in the U.S.(Berne & Huberman, 1999).