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

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

In the European nations studied, a major public health goal is to ensure that everyone, including adolescents, has the necessary skills to behave responsibly when sexually active. Consequently, major efforts go into developing and delivering effective mass media campaigns. Mass media play an important role in educating entire populations as well as shaping perceptions and behaviors. In each of the three countries visited, mass media promote more open and frank discussions about sexuality than existed before. Dutch, German, and French experts believe such discussions contribute to the acceptance of sexuality as a normal and healthy component of life for everyone.

The Netherlands, Germany, and France target all sexually active residents with messages to have safer sex. In general, their campaigns encourage specific sexually healthy behaviors and do not stress fear or shame. They show people in pleasurable relationships. The messages are generally engaging and appealing. They present images and concepts that relate to sexuality in a sensual, amusing, or attractive way.

In all three European nations, great value is placed on individual ethical behavior in choosing sexual health and responsibility, and none of the three nations appears to value collective force to motivate behavior. The responsibility placed on each individual, regardless of age, to act ethically in making sexual choices then creates in each society a community responsibility to ensure that everyone has the knowledge and health services needed to support those choices.

In all three nations, adults encourage teens to be responsible about sex. National health care in each country covers the costs of most forms of contraception, emergency contraception, abortion, counseling services, physical exams, screening, and treatments. Condoms are inexpensive and widely available. All levels of health care personnel, including those staffing front desks, work hard to reduce or remove barriers that deter young people from getting needed health services and to establish and maintain a high degree of trust between young people and health practitioners. Educators, media professionals, and communities collaborate to motivate young people to recognize the benefits of responsible sexual behavior and to acquire and use contraception.

In the Netherlands, Germany, and France, sexual development in adolescents is seen as a normal and healthy biological, social, emotional, and cultural process. Education focuses on informed choice and sexual responsibility for all members of the society, including adolescents. Public campaigns coordinate with school sexuality education, condom and contraceptive access, and nonjudgmental attitudes from adults to protect sexual health. Scientific research drives sexuality-related public policies in all three nations.

In the schools, no sexual health topic is prohibited, and teachers are free to teach in response to students' questions. No topics are too controversial if young people want to discuss them. Public and private schools in the Netherlands and Germany acknowledge that sexuality education is important and concentrate it most heavily in middle and secondary years. While sexuality education is taught as a specific health unit in Germany and France, it is also widely and naturally integrated wherever it is relevant—in literature, languages, social studies, religion, sciences, or current events in all three nations. The teaching is a collaborative effort among school personnel, community youth workers, reproductive health clinicians, parents, and communities.

In the three European countries, parents and communities accept youth as sexual beings and accept sexual intercourse as a logical outcome in intimate relationships. Most adults in these three nations do not see teenage sex as a problem so long as protection is used. Parents in the Netherlands, Germany, and France want young people to develop a healthy sexuality and support both abstinent and sexually active teens in making responsible decisions. Dutch, German, and French parents use multiple channels to ensure that teens are well informed and socially skilled and may provide teens with condoms and contraception to protect themselves. Parents then trust teens to make good choices for themselves and to be responsible.

The United States provides few consistent, continuous, effective mass media campaigns promoting healthy sexuality. Many barriers deter U.S. teens from accessing contraception including high costs, pelvic exams, limited clinic hours, disapproving adults, and fear that parents will find out. Politics, not research, usually dictates the content of sexuality education programs and creates a climate in which important personal and public health services may be withheld from teens.

Many parents do not provide their children with as much honest, open communication regarding sexuality as the young people need. Teens receive little parental and community support or information about respect, intimate relationships, responsible decision making, and using protection in sexual relationships. Some teens in the United States feel alienated from their families and communities and have little motivation to protect themselves or their sexual partners.

Another fundamental difference is how teen sexual behavior is defined. This difference profoundly affects how families, communities, and nations address adolescent sexuality. In the Netherlands, Germany, and France, teen sexual behavior is a developmental and public health issue. The consensus about this demands family and community support and all adults' having a role in communicating with teens about prevention and protection. Teen sexual behavior in the United States is viewed in many contexts: a moral failing, a political issue, a private family matter, or a public health concern, but seldom as a developmental matter. These multiple perspectives create a confusion of efforts at all levels and provide a backdrop for competing and conflicting messages to U.S. teenagers.

The lessons learned by the European Study Tour in the summer of 1998 can have valuable implications for U.S. efforts to improve the sexual health of adolescents.

• The Dutch, Germans, and French view young people as assets, not as problems. They value and respect adolescents and expect teens to act responsibly. Governments strongly support education and economic self-sufficiency for youth.
• The morality of sexual behavior is weighed through an individual ethic that includes the values of responsibility, love, respect, tolerance, and equity. The morality of sexual behavior is not the result of collective force, such as religious dogma.
• Families, educators, and health care providers have open, honest, consistent discussions with teens about sexuality.
• Adults see intimate sexual relationships as normal and natural for older adolescents, a positive component of emotionally healthy maturation. Young people believe it is 'stupid and irresponsible' to have sex without protection and use the maxim, 'safe sex or no sex.'
• Marriage is not a criterion for intimate sexual relationships for older adolescents.
• The major impetus for improved access to contraception, consistent sexuality education, and widespread public education campaigns is a national desire to reduce the numbers of abortions and to prevent HIV infection.
• Sexually active youth have free, convenient access to contraception through national health insurance.
• Sexuality education is not necessarily a curriculum; it may be integrated through many school subjects and at all grade levels. Educators provide accurate and complete information in response to students' questions.
• Governments support massive, consistent, long-term public education campaigns utilizing television, films, radio, billboards, discos, pharmacies, and health care providers. Media is a partner, not a problem, in these campaigns. Sexually explicit campaigns arouse little concern.
• Research is the basis for public policies to reduce pregnancies, abortions, and STDs. Political and religious interest groups have little influence in public health policy.