European Approaches to Adolescent Sexual Behavior and Responsibility: Executive Summary & Call to Action [PDF]

The entire monograph is also available in [PDF] format.

Rights. Responsibility. Respect. This trilogy of values underpins a social philosophy of adolescent sexual and reproductive health in the Netherlands, Germany, and France—the countries visited by a 1998 study tour, composed of 42 U.S. experts and graduate students in adolescent sexual health.

In these countries, government and society view accurate information and confidential services, not merely as needs, but as rights of adolescents. These rights, in turn, depend upon societal openness and acceptance of adolescent sexuality. In short, the Dutch, the Germans, and the French expend less time and effort trying to prevent young people from having sex and more time and effort in educating and empowering young people to behave responsibly when they decide to have sex. Each of these nations appears to have an unwritten social contract which states, "We'll respect your rights to independence and privacy; in return, you'll take the steps you need to take to avoid pregnancy, HIV/AIDS, and other sexually transmitted diseases."

Is this a formula for lax morality and promiscuity? The young people in the countries we visited commence sexual intercourse a year or two later than do U.S. teenagers. Further, the Netherlands, Germany, and France boast better public health outcomes—the teenage birth rate in the Netherlands, for example, is nearly eight times less than in the United States. Germany's gonorrhea rate is nearly 25 times less than the U.S. rate.

So, if Dutch, German, and French teens have better health outcomes and delay the onset of sexual activity longer than do U.S. youth, what's the secret? Do we have a 'silver bullet' solution for the United States that will reduce its three million new STD infections among teens each year, or the 6,000 cases of HIV infection reported so far among those ages 13 to 24, or the 800,000 teen pregnancies each year?

Could the 'silver bullet' solution for the United States be a mass media campaign like those in Europe that boast a single, consistent message—safe sex or no sex? Is it a public health system that makes contraception available at little or no expense? Could it be the fact that public health policy is based on public health research, rather than relying on the political or "moral" agendas of a strident minority?

Unfortunately, there is no single, 'silver bullet' solution. The mass media campaigns, the public health systems, and public health policies have their part in the Dutch, German, and French successes. Yet, success doesn't really rest on programs and services alone. It is the societal thinking—the norms—that make the Dutch, German, and French successes possible. It is the openness and the acceptance that young people will have intimate sexual relationships without being married and that these relationships are natural and contribute to maturing into a sexually healthy adult. It is the refusal to brand the expression of sexuality as deviant behavior or to cast it solely in a negative light. It is the determination to present sexual expression as a balance—a normal part of growing up and a responsibility to protect oneself and others. It is the respect these societies have for adolescents, valuing them as much for who they are as for the adults they will become.

But how relevant is all of this to the United States? The United States is larger, more populous, and more diverse than these European nations, and its cultural values are different. However, size and diversity do not explain the dramatic differences in public health indicators between the United States and the Netherlands, Germany, and France. They do not explain why the United States has a higher teen birth rate than the Netherlands, France, Germany, and Morocco, Albania, Brazil, and more than 50 other developing countries. They do not explain the dramatic differences in HIV and STD rates between the United States and the three European nations.

We need to look deeper—not just at contradictory and confused public policies but also at the contradictory norms that underlie those policies. As a society, we are uncomfortable discussing sexuality issues and, especially, teenage sexuality. Advertising and programming in the entertainment media too often send sexual messages that seem to say, "Just do it!" The recent, Congressionally-mandated message to students is "Just say no, until you're married." As a result, methods of dealing with teenage sexuality include pretending teens do not have sex or attempting to control and limit information about sex and contraception.

The negative message to teens is clear—"You shouldn't have sex, so protection is irrelevant!" No wonder many young people in the United States are not motivated to be sexually responsible; and when they are, they are too often thwarted as they seek the information and services they need.

Despite U.S. adults' general discomfort with the subject of teen sexuality, the vast majority do not agree with "head in the sand" approaches. Instead, the majority of adults say they want young people to have the information and services they need. The challenge will be to build on these positive attitudes and to articulate the values of honesty, openness, respect, and responsibility that promise to underpin a new, successful approach to adolescent sexual health in the United States.

Although the European experience can be helpful in guiding this effort, the United States cannot simply adapt European approaches completely. We are different in many ways. We place a greater value on abstinence and—given the early age at which our teens commence sexual activity—that is a good thing. But valuing abstinence must not override young people's rights to accurate information that can protect and even save their lives. At a time when 70 percent of 18-year-olds in the United States have had sexual intercourse, we cannot afford to ignore the needs of sexually active youth.

But we can use the experience of the Dutch, the Germans, and the French to help us find a more balanced approach to adolescent sexual health. Indeed, the three 'Rs' of sexual health—rights, responsibility, and respect—may help us overcome obstacles and achieve social and cultural consensus on sexuality as a normal and natural part of being a teen, of being human, of being alive.

James Wagoner,
President, Advocates for Youth