A quick-reference guide to important issues in adolescent reproductive and sexual health, with Advocates for Youth’s position and links to more in-depth information. Skip to a topic using the links below.
Abstinence | Abstinence-Only-Until-Marriage Programs | Adolescent Sexual Behavior in the United States | Adolescent Sexual Health in the U.S. and Europe | Comprehensive Sex Education | Condoms | Contraceptive Access | Emergency Contraception | Gay, Lesbian, Bisexual, Transgender, and Questioning Youth | HIV | Health Disparities and HIV | Parent-Child Communication | Peer Education | Sexually Transmitted Diseases | Teen Pregnancy Prevention | Youth in Low and Middle Income Countries | Youth of Color
Advocates for Youth supports encouraging youth, especially young teens, to delay sexual initiation. We also support sex education that includes abstinence and medically accurate information about contraception and condoms.
- Abstinence means voluntarily refraining from sexual activity, including vaginal, anal and oral sex.
- When strictly and consistently adhered to, abstinence is the only 100 percent effective method for avoiding unintended pregnancy and sexually transmitted infections (STIs), including HIV.
- Even young people who intend to remain abstinent need information about contraception and condoms to help them prevent unintended pregnancy, HIV and other STIs when they do become sexually active.
By law, abstinence-only-until-marriage programs are prohibited from providing lifesaving information about the health benefits of contraception and condoms for the prevention of STIs, including HIV/AIDS, and unintended pregnancy. These programs can only teach about failure rates of contraception.
Advocates for Youth supports the complete elimination of all funding for these ineffective abstinence-only-until-marriage programs. Funding should, instead, be directed into comprehensive sex education that provides information about abstinence and contraception.
- Funds for these programs remain in the Affordable Health Care Act and in the Office of Adolescent Health Teen Pregnancy Prevention Initiative.
- The federal and state governments have spent over $1.5 billion on abstinence-only-until-marriage programs despite evidence that they do not work.
- Abstinence-only-until-marriage programs do not change teen sexual behavior. Studies have shown that students who receive them don’t have lower pregnancy, HIV, or STI rates. And worse, students who receive abstinence-only programs are less likely to use contraception and condoms when they do have sex.
- Abstinence-only-until-marriage curricula teach that sexual expression outside of marriage will have harmful social, psychological and physical consequences, thereby stigmatizing and shaming students who have already had sex;.
- Abstinence-only-until-marriage programs discriminate against GLBTQ students who can’t legally marry by expressing relationships in strict heterosexual standards.
Adolescent Sexual Behavior in the United States
Young people’s decision whether to have sex is as diverse as they are; many factors are influential — most of which youth have very little control over — including socioeconomic status, ethnicity, family structure, educational aspirations, age and life experiences.
Advocates for Youth believes that young people have a right to accurate and comprehensive sexual health information, confidential reproductive and sexual health services and a secure stake in decision making about their futures.
- Forty percent of all high school students in the United States have already had sex.
- Most young people have sex for the first time at about age 17, but do not marry until their middle or late 20s. They need information, services, and access to contraception and condoms during this near decade of sexual activity before marriage.
- Each year in the United States, about 750,000 young women become pregnant, 20,000 young people are newly infected with HIV, and nearly four million new STI infections occur among 15- to 19-year-olds.
Adolescent Sexual Health in the U.S. and Europe
Many factors influence teens contraceptive us, including societal attitudes toward teenage sexual relationships, access to and the cost of reproductive health services, attitudes toward contraceptive methods and motivation to delay motherhood or pregnancy.
Advocates for Youth believes that there are many lessons to be learned from European approaches to adolescent sexuality. Adults in France, Germany, and the Netherlands 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. 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 to teens.
- U.S. teens account for about 71 percent of all teenage births occurring in all developed countries. The United States’ teen birth rate is nearly nine times higher the Netherlands’, four and a half times higher than France’s, and over four times higher than Germany’s.
- The percentage of the United States’ adolescent and adult population that has been diagnosed with HIV or AIDS is six times greater than in Germany, three times greater than in the Netherlands, and one and a half times greater than in France
- Although U.S. teens report using contraception (usually either birth control pills or condoms or both) far more often that their peers of previous decades, U.S. teens still use contraception or condoms much less consistently than their peers in Europe.
- Imagine that the United States’ teen pregnancy, birth, and abortion rates would improve to match those of the Netherlands, Germany, and France. Improved rates would mean large reductions in the numbers of pregnancies, births, and abortions to U.S. teens each year.
Comprehensive Sex Education
Comprehensive sex education is a holistic approach to teaching young people about sex and sexual health; it is comprised of age and culturally appropriate, medically accurate information about reducing the risk of pregnancy and sexually transmitted diseases and infections (STDs & STIs).
Advocates for Youth joins medical, public health, educational, religious, HIV/AIDS, and reproductive health organizations in support of providing with age-appropriate, medically accurate information about abstinence and contraception so thay they can make responsible decisions about their sexual health. Advocates believes that the federal government should eliminate funding for ineffective abstinence-only programs and fund comprehensive sex education.
- Comprehensive sex education addresses both abstinence and age-appropriate, medically accurate information about contraception. Depending on grade level, comprehensive sex education also introduces information on relationships, decision-making, assertiveness, and skill building to resist social/peer pressure.
- Comprehensive sex education and HIV/ STI prevention programs do not increase rates of sexual initiation, do not lower the age at which youth initiate sex, and do not increase the frequency of sex or the number of sex partners among sexually active youth.
- Teens who receive sex education that includes abstinence and contraception are more likely than those who receive abstinence-only-until-marriage messages to delay sexual activity and use contraception when they do become sexually active.
The Centers for Disease Control and Prevention (CDC) has found that condoms are highly effective in preventing the transmission of HIV and effective in preventing other sexually transmitted infections (STIs) and unwanted pregnancy.
Advocates for Youth believes that young people need all the facts about condoms and not just the negative spin from social conservatives.
- Research clearly indicates that educating youth about condoms does not lead to increased rates of sexual initiation, lower the age of sexual initiation, or increase sexual activity among young people.
- Condoms are the most common contraceptive method used by young people at first intercourse.
- Research shows that young people who are educated about the health benefits of condoms are more likely than uninformed young people to use condoms when they eventually decide to have sex.
- Experts agree that consistent and correct condom use greatly reduces the risk of HIV transmission among sexually active youth. In fact, the American Academy of Pediatrics, American College of Obstetricians & Gynecologists, American Medical Association, and Institute of Medicine all support communities' making condoms available to teens.
Recent studies show that the reduction of teen pregnancy has been largely fueled by teen’s use of effective contraception.
Advocates for Youth believes that birth control is basic health care and that confidential access to birth control benefits. Every person has the right to decide when they want to have children and how many.
- A sexually active teen who does not use contraceptives has a 90 percent chance of becoming pregnant within a year. In fact, young women aged 15–19 who do not use a contraceptive at first sex are twice as likely to become teen mothers as are teenagers who use a method of contraception.
- Although parental involvement in a young person’s decision to use contraceptives is desirable, the truth is many young people will remain sexually active but not seek services if it means they will have to tell their parents.
- Despite the many recognized benefits of contraception, social conservatives continue to place ideology over science, undermining women’s — especially young women’s — access to this critical health service.
In 2006, overruling a 23-4 vote by its medical advisory panel, the Food and Drug Administration (FDA) ruled that emergency contraception in the form of Plan B® would be available to women 18 years old and older. In 2011 the FDA lifted the age restriction entirely, but was overruled by the Department of Health and Human Services. Emergency contraception remains available without a prescription for those ages 17 and over, while those 16 and younger still need a prescription.
- Emergency contraception (EC), also known as "the morning-after pill" is a safe and effective way to prevent pregnancy after unprotected intercourse. It consists of the same hormones found in ordinary birth control pills.
- When taken in a concentrated dosage within 72-120 hours after unprotected intercourse, EC can prevent a pregnancy from occurring.
- EC is not the same as the abortion pill; it is a different medication. EC will not cause an abortion and will not harm an existing pregnancy.
Advocates for Youth supports removing the arbitrary age restriction for emergency contraception over-the-counter for all women of reproductive age. No young woman should have to face an unwanted pregnancy when a remedy exists to prevent pregnancy.
In one nationwide survey, more than 84 percent of GLBTQ students reported verbal harassment at school; more than 39 percent reported being punched, kicked, or injured with a weapon at school because of their sexual orientation; and 55 percent of transgender youth reported physical attacks because of their gender identity or gender expression.
Advocates for Youth believes that every young person is of infinite value, regardless of race/ethnicity, gender, health status, socio-economic background, sexual orientation, or gender identity and supports each person’s right to fully participate in the American dream.
- Gay, lesbian, bisexual, transgender and questioning (GLBTQ) youth face tremendous difficulties in a society where heterosexuality often seems the only acceptable orientation, homosexuality is regarded as deviant and variation from cultural notions of "normal gender" often evoke hostility or violence.
- GLBTQ youth of color face additional challenges when many ethnic minority communities reinforce negative cultural perceptions of homosexuality.
- Approximately 46 percent of GLBTQ youth of color report experiencing physical violence related to their sexual orientation; and nearly 45 percent of youth in one survey were verbally harassed in school regarding their sexual orientation and race/ethnicity.
- Abstinence-only-until-marriage programs teach that marriage is the only appropriate context for a sexual relationship, yet gay marriage is banned in the majority of states and at the federal level.
Young people ages 13-29 account for 1/3 of new HIV infections in the United States. From 2006-2009 there was an estimated 21% increase in HIV incidence for people aged 13-29 years, driven by a 34% increase in young men who have sex with men (the only group to experience a significant increase in incidence in this age range).
- Young African Americans and young men who have sex with men experience disproportionately high rates of HIV.
- Poverty, lack of education and information, sexual violence, stigma and gender inequality all contribute to an increased risk of HIV infection among youth.
- Comprehensive, culturally competent programs can help young people protect themselves from HIV infection.
Health Disparities and HIV
A common misconception is that groups with high HIV rates simply are less careful about protecting their sexual and reproductive health. But research shows that stigma and discrimination, poverty, and unequal access to education and resources play a huge role in health outcomes for these groups.
- Although African Americans make up only about 13 percent of the population of the United States, almost half of those living with HIV or AIDS are African American.
- Even though they make up only 17 percent of the population, African Americans comprise 69 percent of HIV positive youth ages 13-19.
- Young people of color and GLBTQ youth face negative sexual health outcomes at rates unequal to population.
- For example, even with equal risk behaviors, young people of color are more likely to acquire HIV or an STI than young whites.
Advocates for Youth believes that programs that target young people of color must be science based and accurate and must address issues of poverty and empowerment.
- The research is clear — young people who feel connected to family are more likely to avoid risky behaviors in adolescence.
- Positive, open communication between parents and children helps young people to establish individual values and make healthy, responsible decisions about sexuality.
- Contrary to popular belief, research shows that teens actually prefer to get information about contraception from their parents — rather than from community health centers, classes, hospitals, private doctors, television or friends.
- Many parents need help discussing sex with their teens; and parents overwhelmingly support comprehensive sex education in schools that includes information about abstinence, contraception and preventing unintended pregnancy and sexually transmitted infections, including HIV.
Research suggests that people are more likely to respond to a message if they can relate to who and where the message is coming from; potential for attitude and behavior change increases when people believe the messenger is similar to them and faces the same concerns and pressures.
- Studies show that their young people’s peers influence health behaviors — not only in regard to sexuality, but also in regard to violence and substance use.
- Youth deserve respect — valuing young people means they are part of the solution and are included in developing programs and policies that affect their well-being.
- Young people gain more from an experience, program or policy when they are actively involved.
Sexually Transmitted Infections
- In the United States, sexually active teens experience some of the highest rates of sexually transmitted infections (STIs) in the developed world.
- While young people 15 to 24 years of age make up only one-quarter of the sexually active population, they account for nearly one-half of the 19 million new sexually transmitted infections that occur each year.
- One in four young women between the ages of 15 and 19 – or 3.2 million teenage girls – is infected with at least one of the most common sexually transmitted diseases.
- Young people of color are disproportionately affected by STIs. Even with identical risk behaviors, young people of color are more likely to contract an STI than young whites.
- Studies show that the spread of STIs can be reduced through comprehensive, medically accurate information — making comprehensive sex education critical for reducing transmission among youth.
Teen Pregnancy Prevention
- U.S. teen pregnancy and teen birth rates are the second highest among 46 countries in the developed world — and international comparisons show that the United States could do much better in improving teen pregnancy and birth rates.
- Each year in the United States, more than 750,000 women aged 15-19 become pregnant, with more than 80 percent of these pregnancies unintended.
- Teens need comprehensive, medically accurate information about contraception and abstinence, as well as support and access to related services, to avoid unintended pregnancy.
- Young women of color face a disproportionately high risk of teen pregnancy. Research demonstrates that economic and social disadvantage is among the causes of teenage pregnancy in the U.S.
Youth in Low and Middle Income Countries
- At least 95 percent of all new HIV infections occur in low and middle income countries, with young women comprising ¾ of HIV cases.
- Complications from pregnancy, including unsafe labor and unsafe abortion, are the leading cause of death for young women ages 15-19 in low and middle income countries.
- In many countries, gender imbalance leads to many negative outcomes for young women, including child marriage, too-early childbearing, and lack of access to reproductive supplies, services, and information.
- United States foreign policy which censors information about condoms and contraception is culturally inappropriate and dangerous to public health.
Youth of Color
- In the United States, rates of HIV, sexually transmitted infections (STIs), and unintended pregnancy are disproportionately high among youth of color, particularly young African American and Latina women, when compared to other youth.
- Discrimination, poverty, unemployment, and unequal access to education and other resources put young people of color at higher risk than whites. Even with identical risk behaviors, young people of color are more likely to contract HIV and other STIs than young whites.
- To help prevent negative sexual health outcomes, youth of color need accurate, comprehensive, culturally competent programs which reflect the realities of their lives.