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

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

Many adults in the United States believe that sexuality education should begin in the home. Yet, evidence suggests that families provide too little sexuality education and often provide it too late. According to one study, U.S. family communication about sex includes "a few direct, sometimes forceful, verbal messages; a lot of indirect verbal messages; and a background mosaic of innumerable nonverbal messages."⁵⁵ Only 10 percent of families have any kind of on-going discussion about sex, and a significant majority of young people and parents report dissatisfaction with the quantity and quality of family discussions about sexual issues.⁵⁵

When a national sample of parents was asked how often they talked with their children about sex, 54 percent reported never, 28 percent said rarely, and five percent said about once a year. Those parents who reported discussing sex with their children said they did so about twice as frequently as the teens said they did. Further, while 81 percent of parents felt they got honest answers from their children about sexual issues, only 22 percent of teens agreed.⁵⁶

In some families, youth receive the message while quite young that they should not ask questions about sexuality.⁵⁷ Teenage women report more discussions with parents about sex than do teenage males, but both genders agree that parents talk less about contraception and STDs than about dating, alcohol, and drugs.58 Most teens who do have discussions about sexuality with a parent report having them with their mothers.^57,58 Finally, 43 percent of teenage men and 65 percent of teenage women say they have no talks with their fathers about sexuality.⁵⁷ Many teens believe that adults give inadequate information about birth control because adults: 1) think teens cannot make their own decisions; 2) tell teens things too late; 3) do not listen and want to do all the talking; and 4) talk about things irrelevant to the situations teens actually deal with.⁵⁸ In one recent poll, over half of young people surveyed say there are times when they want to talk with their parents about sexuality issues but feel they will not be understood or that their parents are too busy to listen.⁵⁹

Parents acknowledge that they are ill prepared to discuss sexuality issues with their children—84 percent in one survey said they need help while 54 percent in another survey reported being unsure what to discuss with their children about HIV/AIDS.^1,60 At the same time, parents in nine out of 10 U.S. families understand that teaching the facts about contraception increases the use of protection among teens who are already sexually active.¹

Although many parents believe that they lack guidance for talking with young people about sexuality, several national and community-based organizations provide and support such programs. For example, every October since 1980, Let's Talk Month has encouraged parents to become their children's first sexuality educators. National organizations—such as Advocates for Youth and Planned Parenthood Federation of America (PPFA)— as well as state and local coalitions have developed and presented parenting programs on sexuality education. Unfortunately, most of these programs are not well attended, and the people who attend may not be the parents in the greatest need of such classes.

Communities continue to provide the strongest efforts to prevent teen pregnancy and STDs in the United States. Local affiliates of the Young Women's Christian Association (YWCA), Young Men's Christian Association (YMCA), and Girls Incorporated provide after school programs for youth as well as programs especially for teenage parents. Although many of these programs are actually designed to increase life options for young people rather than to deal specifically with sexuality, some of the programs have been effective in delaying first intercourse and increasing the use of contraception among sexually active youth.^61,62,63

Other effective life options and youth development programs, replicated in communities around the United States, include Teen Outreach Program (TOP) and the Adolescent Pregnancy Prevention Program of the Children's Aid Society. TOP has demonstrated lowered rates of teen birth, course failure, and school dropout while the other program has demonstrated delayed first intercourse, increased use of contraception, and reduced adolescent births.^61,62,64 Two community-based models that have shown promise include School/Community Sexual Risk Reduction,⁶⁵ currently being replicated at several sites in Kansas, and the Plain Talk Initiatives,⁶⁶ currently implemented in five cities. In addition, national organizations—such as Advocates for Youth, PPFA, the Sex Information and Education Council of the U.S. (SIECUS), and the recently created National Campaign to Prevent Teen Pregnancy—also provide technical support and assistance for state and local coalitions in teen pregnancy prevention program design and implementation.

Some sexuality education programs, such as Sex Respect, focus on the dangers of sex and its negative consequences, as well as its supposed psychological and emotional risks.^67,68 Despite inconclusive or negative findings from evaluations of such abstinence-only or abstinence-until-marriage programs,⁶¹ many conservative organizations, such as Focus on the Family, the Family Research Council, Citizens for Excellence in Education, and Concerned Women of America, provide strong support for these programs.

In the United States, parents and communities want youth to be sexually healthy, and teens want accurate information, accessible services, and discussions with their parents. Parents know that discussions with their children about sexuality are important; but, most parents are uncomfortable discussing sexuality with youth and uncertain how to do so. At the same time, several studies show that most U.S. residents support sexuality education for teens that teaches both abstinence and safer sex.^69,70 While some communities support abstinence-until-marriage education, other communities promote balanced, realistic education—abstinence plus contraceptive and safer sex education. Overall, communities and families in the United States disagree or feel uncertainty as to the best means to promote adolescent sexual health.

Key to attitudes about sexuality in the Netherlands is the view that decisions about sexual behavior belong to the individual rather than to community, church, or family. To support this individual ethic, the community as a whole has a responsibility to provide open, honest, and complete education that can empower the individual to avoid irresponsible and unprotected sexual behavior.^47,71 Open and frank depictions of sexuality in the media are reinforced by equally open and frank discussions in peer groups, schools, medical practices, youth agencies, and families. This individual ethic requires that parents and others support young people in fostering communication and healthy relationship skills. The Dutch see these skills as key to reducing sexual risk among adolescents. Parents accept that their young people will probably become sexually active during their later teen years, and they openly discuss sexuality and sexual behavior with their children.^47,72

Most adults in the Netherlands expect young people to progress from peer friendship groups to a phase of being attracted to potential partners, then to a phase of sexual experimentation during which teens form a series of short-term relationships that may or may not include sexual intercourse, to the final phase of seeking long-term emotionally committed relationships. Most Dutch parents also understand that experimentation is a natural and healthy part of adolescent development.²

In street interviews with Dutch parents, study tour participants learned that parents are usually uncomfortable watching their teens experience these phases but also want teens to have a positive outlook on sexuality and to become sexually healthy adults. Restrictive permissiveness describes the approach most Dutch parents take with their teens—trying to pace their youth in their sexual development and encouraging them to be informed about all issues and to seek information from many sources. Most Dutch parents expect their teens to use birth control.²

In the Netherlands, most parents provide support from a distance and give teens permission to ask questions without incurring either judgment or consequences.² Few adults attempt to scare youth about sex. Instead, most adults focus on sexual choice and, therefore, give adolescents rights, respect, and responsibility.⁷² Relatively few Dutch parents set age limits for teens to begin dating or become sexually active. In one study, many Dutch parents reported forbidding nothing; however, 50 percent of the parents reported providing guidelines about love, serious relationships, and safer sex. Another 30 percent of the parents indicated that they believe sexuality to be a private matter and that they trust their teens to make good decisions. Finally, 20 percent of parents encourage their children to experiment during adolescence. Most parents, however, also reported hoping their young people will not date too early or experience sexual intercourse before they are ready.⁷²

In Germany, the positive influences of public education campaigns are reinforced by the sexuality education that youth receive from their parents, most of whom regard sexuality as a natural part of human development. In recent decades, the German courts, the Ministry of Education, and laws regarding schools have all made sexuality education the primary responsibility of parents even though previous studies indicated that sexuality education received at home was often inadequate.⁵⁰ A recent survey indicates that parents consider sexuality education an important preventive measure.⁷³

In a recent random sample of German parents,74 percent indicated that they would not be opposed to a teen, under 18 but in a steady relationship, having sexual intercourse—with the use of contraception. In fact, 67 percent of the parents would allow their teens to have sexual intercourse in the family home.²⁰ Generally, German families and communities support delaying first sexual intercourse. In one study, many teens reported wanting to remain abstinent because they felt too shy or too young, had no interest yet in sex, or had not found the right person.⁷⁴ In another study, although some parents reported discussions about sexuality with their children, 90 percent of parents reported that they would like the schools to provide such instruction.³⁴

Regarding parent-child communication, a survey among approximately 3,000 parents and 3,000 of their 14- to 17-year-olds found that:

• 73 percent of daughters and 53 percent of sons reported receiving sexuality education from their parents.
• 69 percent of daughters and 49 percent of sons reported their mothers as the most important source of information.
• Parents discussed different subjects depending on the teen's gender. More discussions were held with daughters in every subject area.
• Both genders received information about reproductive anatomy, contraception, and STDs. Sexual practices, homosexuality, and masturbation were less frequently addressed.
• Parents of lower socioeconomic status and more conservative parents were less likely to discuss sexuality and more likely to leave sexuality education to the schools and other sources.⁷³

Various community efforts work to help parents become better sexuality educators of their own children. ProFamilia provides clinical services, counseling, and sexuality education. Staffed with educators, social workers, counselors, and doctors, the 150 ProFamilia centers throughout Germany provide support to parents and teachers, leading skills-building and educational sessions. Other German organizations also provide community-based sexual health programs. For instance, the Love Tour is a mobile sex education project, sponsored by the German Red Cross and FCHE. It travels throughout eastern Germany to reach youth in need of services and information in such environments as discos, clubs, and festivals.

Information about the influence of the family and community on adolescent sexual attitudes, behaviors, and health is somewhat limited in the French scientific literature. One study found that 60 percent of French adults consider sex a private matter and are reluctant to discuss it.⁷⁴ The French people value individualism and respect young people's right to make decisions regarding their sexuality. Parents provide little sexuality education; in fact, most French parents do not feel comfortable talking with their teens about sexuality issues.³⁹ In street interviews with citizens in Paris, study tour participants learned that most respondents do not discuss sexuality in their homes or in the homes of their friends.

Lack of openness about sexuality in families is attributed to the French culture's placing a high degree of responsibility on the individual and respecting the individual's privacy. While most French parents assume that adolescents will be sexually active before marriage, they do not explicitly encourage or permit it. Communities, therefore, place great emphasis on sexuality education occurring within community and social contexts.⁷⁴

Sexuality education and programs supporting safer sex practices are widely available to youth within most communities. The Documentation Centre of the Mouvement Francais pour le Planning Familial (MFPF) and the Regional Center for the Prevention of AIDS (CRIPS) work cooperatively to protect the rights of people to be informed and protected from STDs, HIV, unintended pregnancy, sexual exploitation, and sexual abuse. MFPF, operating with 66 associations throughout the country, is popular with young people for education and reproductive services. On Wednesday afternoons, when French teens are out of school, clinicians, counselors and educators are available for walk-in as well as previously scheduled appointments. Further, medical and educational resources are free to young people under age 18.

To support adolescent sexual health, the French rely heavily on mass media combined with community outreach. Early and open communication is established through mass media campaigns. Many young visitors to MFPF's Wednesday clinics—designed especially for teens because schools dismiss early—come because of mass media or word-of-mouth advertising. These clinics are teen friendly, and providers work to adapt their services to the developmental level of the clients. After-hours answering machines provide information on alternative services as well as how to access and use emergency contraception. On holidays like New Years Eve, some clinics remain open all night to help adolescents in crisis situations.

Established religion plays an important role in the lives of residents of the United States, and religion is frequently important in transmitting values, including those related to sexuality, reproduction, and families. While many religious institutions support contraception and the right of women to choose abortion, others forbid abortion and contraceptive use. In the United States, the religious right—a political movement whose motive is to create public policy with a particular religious agenda and call it "morality"—has a strong role in the creation of many abstinence-only or abstinence-until-marriage programs and in the formation of the conservative organizations that embrace them. The processes in the United States, has successfully placed supporters on school boards, county governing boards, and in state legislatures and twists public policy to further a religiously-based agenda that is at odds with the wishes and attitudes of most citizens of the United States.

By contrast, in the Netherlands, Germany, and France, residents generally do not consider established religion relevant to values related to sexual and reproductive health. Collective force, such as church dogma or legislative dictum, does not determine the morality of sexuality in any of the three European countries. Instead, individual freedom and responsibility form the foundation of an ethic by which a person weighs the morality of his or her sexual behavior. That ethic includes the values of responsibility, love, respect, tolerance, and equity.