The Facts
Adolescent
Sexual Health in Europe and the U.S.—Why
the Difference?
Also
available in [PDF] format.
Each summer since in 1998,
Advocates for Youth and the University of North Carolina at Charlotte
sponsor annual study tours to France,
Germany, and the Netherlands to explore why adolescent sexual health
outcomes are so much more positive in the three European countries than
in the U.S.
Rights. Respect. Responsibility.® The
study tour participants—policy makers, researchers, youth-serving
professionals, foundation officers, and youth—have found that this
trilogy of values underpins a social philosophy regarding adolescent
sexual health in these
countries. Each of these nations has an unwritten social contract
with young people: "We'll respect your right to act responsibly,
giving you the tools you need to avoid unintended pregnancy and sexually
transmitted
infections, including HIV."
In these nations, societal openness and comfort in dealing with sexuality,
including teen sexuality, and pragmatic governmental policies create
greater, easier access to sexual health information and services for all people,
including teens. Easy access to sexual health information and services leads
to better sexual health outcomes for French, German, and Dutch teens when compared
to U.S. teens.
Adolescent
Pregnancy, Birth, and Abortion Rates in Europe Far Outshine
Those in the U.S.*
Pregnancy
In the United States, the teen pregnancy
rate is more than nine times higher than
that in the Netherlands, nearly four times higher than the rate in France,
and nearly five times higher than that in Germany.1,2,3 |
|
Birth
In
the United States, the teen birth rate is
nearly 11 times higher than that of the Netherlands,
nearly five times higher than the rate in France, and
nearly four times higher than that in Germany.2,3,4 |
|
Abortion
In
the United States, the teen abortion rate is
nearly eight times higher than the rate in Germany,
nearly seven times higher than that in the Netherlands,
and nearly three times higher than the rate in France.1,2,3 |
|
U.S. HIV/STI Rates Also Compare
Poorly.
HIV in Young Women and Men
In
the United States, the estimated HIV prevalence
rate in young men ages 15 to 24 is
over five times higher than the rate in Germany,
nearly
three times higher than the rate in the Netherlands,
and about 1 ½ times higher than that in France.5 |
|
In
the United States, the estimated HIV prevalence
rate in young women ages 15 to 24 is six times
higher than the rate in Germany, nearly three times
higher than the rate in the Netherlands, and is the
same as that in France.5 |
|
Syphilis
In
the United States, the teen
syphilis rate is over
six times higher than that of the Netherlands, over five
times higher than the rate in former West Germany, and
nearly three times higher than that in former East Germany.
Data are not available for France.6 |
|
Gonorrhea
In the United States, the teen gonorrhea
rate is over 74 times higher than that in the
Netherlands and France, over 66 times higher than the
rate in former West Germany, and over 38 times higher
than that in former East Germany.6 |
|
Chlamydia
In
the United States, the teen chlamydia rate is
over 20 times higher than that in France. Data are not
available for Germany or the Netherlands.6 |
|
American Youth Have Sex at
the Same Age or Even Earlier than Youth in Europe.
Young People in the U.S. Have More Sexual Partners.
In
the United States, young people typically initiate
sexual intercourse at the same age or even earlier compared
to young people
in the Netherlands and France.3,7 Data
are not available for Germany.
Finally, the proportion of sexually active teenage men
and women ages 18 to 19 that had two or more sexual partners
within the past year is substantially
higher in the United States than in France. Data on number of sexual partners
are not available for Germany or the Netherlands. Having two or more sexual
partners increases youth's potential risk of becoming infected with HIV
and other STIs.7
|
% With Two or More
Sexual Partners in Past Year7
|
Typical Age at
First Sexual Intercourse3,7 |
|
Women Ages 18 to
19
|
Men Ages 18 to
19
|
United
States |
48.6% |
48.8% |
17.4
years |
Netherlands |
— |
— |
17.7
years |
France |
12.8% |
28.8% |
18.0
years |
Germany |
— |
— |
— |
Implementing the Model: Potential
Impact on Adolescent Sexual Health in the U.S.
If
society in the United States became more comfortable
with sexuality and if governmental policies created
greater, easier access
to sexual health information and services, adolescents'
sexual health outcomes could improve markedly. Imagine that the
United States' adolescent pregnancy, birth, and abortion
rates improved to match those in the European nations studied.
The reduced rates would mean large reductions in the numbers
of pregnancies, births, and abortions to teens in the United
States each year—and in the public funds needed to support
families begun with a birth to a teen.
If the U.S. Rates
Equaled Rates in:
|
Fewer Pregnancies
|
Fewer Births
|
Fewer Abortions
|
Lower Public Costs8
|
Netherlands |
657,000 |
441,000 |
215,000 |
$921 million |
France |
550,000 |
391,000 |
160,000 |
$815 million |
Germany |
588,000 |
367,000 |
221,000 |
$767 million |
The Lessons Learned: A Model
to Improve Adolescent Sexual Health in the U.S.9
So,
if Dutch, German, and French teens have better sexual health outcomes,
have fewer sexual partners, and initiate sexual activity
at the same age or even later than U.S. youth, what's the
secret? Is there a 'silver bullet' solution for the United
States that will reduce the nearly four million new sexually
transmitted infections occurring among U.S. teens each year,
or the 20,000 new HIV infections among 13- to 24-year-old
youth, or the 900,000 teen pregnancies?1,10,11
Unfortunately, there is not a single, 'silver bullet' solution. Yet, the United
States can use the experience of the Dutch, Germans, and French to guide its
efforts to improve adolescents' sexual health. Indeed, the United States can
overcome obstacles and achieve social and cultural consensus respecting sexuality
as a normal and healthy part of being human and of being a teen by using lessons
learned from the European study tours.
- Adults in the Netherlands,
France, and Germany view young people as assets, not
as problems. Adults value and respect adolescents and
expect teens to act responsibly. Governments strongly
support education and economic self-sufficiency for
youth.
- Research is the basis for
public policies to reduce unintended pregnancy,
abortion, and sexually transmitted infections, including HIV.
Political and religious interest groups have
little influence on public health policy.
- A national desire to reduce
the number of abortions and to prevent sexually
transmitted infections, including HIV, provides the major impetus
in each country for unimpeded access to contraception,
including condoms, consistent sexuality education,
and widespread public education campaigns.
- Governments support massive,
consistent, long-term public education campaigns
utilizing the Internet, television, films, radio, billboards,
discos, pharmacies, and health care providers.
Media is a partner, not a problem, in these campaigns. Campaigns
are far more direct and humorous than in the
U.S. and focus on safety and pleasure.
- Youth have convenient access
to free or low-cost contraception through national
health insurance.
- Sexuality education is
not necessarily a separate curriculum and may
be integrated across school subjects and at all grade levels. Educators
provide accurate and complete information in
response
to students' questions.
- Families have open, honest,
consistent discussions with teens about sexuality
and support the role of educators and health care providers
in making sexual health information and services
available for teens.
- Adults see intimate sexual
relationships as normal and natural for older
adolescents, a positive component of emotionally healthy maturation.
At the same time, young people believe it is "stupid
and irresponsible " to have sex without protection
and use the maxim, "safer sex or no sex."
- The morality of sexual
behavior is weighed through an individual ethic
that includes the values of responsibility, respect, tolerance,
and equity.
- France, Germany, and the
Netherlands work to address issues around cultural
diversity in regard to immigrant populations
and their values that differ from those of the majority culture.
Rights. Respect. Responsibility.®:
A National Campaign to Improve Adolescent Sexual Health
In
October 2001, Advocates for Youth launched a long-term
campaign — Rights.
Respect. Responsibility.® — based
on the lessons learned from the European study tours. The
Campaign will work to shift the current societal paradigm
of adolescent sexuality away from a negative emphasis on
fear and ignorance and towards an acceptance of sexuality
as healthy and normal and a view of adolescents as a valuable
resource.
- Adolescents have the right to
balanced, accurate, and realistic sexuality education,
confidential and affordable sexual health services,
and a secure stake in the future.
- Youth deserve respect.
Today, they are perceived only as part of the
problem. Valuing young people means they are part of the solution
and are included in the development of programs
and policies that affect their well-being.
- Society has the responsibility to
provide young people with the tools they need
to safeguard their sexual health and young people have the responsibility to
protect themselves from too early childbearing
and sexually transmitted infections, including HIV.
Advocates is developing and disseminating
campaign materials for specific audiences, such as entertainment
industry and news media professionals, policy makers, youth-serving professionals,
parents, and youth activists.
Each summer, Advocates
will continue its thought-provoking European study tours.
Advocates will also collaborate with key national organizations
and state-based stakeholders to promote Rights. Respect.
Responsibility.® through
campaign materials, workshops, presentations, and technical
assistance. For additional information on the Campaign or
to become an organizational partner in this important initiative,
contact Advocates for Youth at 202.419.3420 or visit www.advocatesforyouth.org.
References
- Ventura SJ et
al. Trends in pregnancy
rates for the United States, 1976-97: an update. National
Vital Statistics Reports 2001;49(4):1-10.
- Singh S, Darroch JE. Adolescent
pregnancy and childbearing: levels and trends
in developed countries. Family Planning Perspectives 2000;32(1):14-23.
- Rademakers J. Sex Education
in the Netherlands. Paper presented to
the European
Study Tour. Utrecht, Netherlands: NISSO,
2001.
- Martin JA et
al. Births: preliminary
data for 2000. National Vital Statistics Reports 2001;49(5):1-20.
- UNAIDS. Report
on the Global HIV/AIDS Epidemic.
Geneva, Switzerland: UNAIDS, 2000.
- Panchaud C et
al. Sexually transmitted
diseases among adolescents in developed countries. Family
Planning Perspectives 2000;32(1):24-32 & 45.
- Darroch JE et
al. Adolescent Sexual and Reproductive
Health: A Developed Country Comparison. New
York, NY: The
Alan Guttmacher Institute, forthcoming in Family
Planning Perspectives.
- Calculations, using 1997
data, are based on Feijoo AN. Teenage
Pregnancy, the Case for Prevention.
Washington, DC: Advocates for Youth, 1999.
- Berne L and Huberman B. European
Approaches to Adolescent Sexual Behavior & Responsibility.
Washington, DC: Advocates for Youth, 1999.
- American Social Health Association. Sexually
Transmitted Diseases in America: How Many Cases and
at What Cost? Research Triangle Park,
NC: ASHA, 1998.
- Office of National AIDS
Policy. Youth and HIV/AIDS 2000: A New American
Agenda. Washington, DC: ONAP, 2000.
*Throughout this
fact sheet, data are the most recent available for each
country, ranging from years 1995 to 2000. Pregnancy data
do not include fetal losses.
U.S. birth data are for 1999 while U.S. pregnancy and abortion
data are for 1997.
Written by Ammie N. Feijoo
2nd edition, October 2001 © Advocates for Youth
This document is
an updated edition of Adolescent
Sexual Health in Europe and the U.S.—Why the Difference?,
written by Sue Alford and Ammie N. Feijoo and published by
Advocates for Youth in 2000.
|