|Adolescent Sexual Health in Europe and the US|
The Case For A Rights. Respect. Responsibility.® Approach
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Adolescent Pregnancy, Birth, and Abortion Rates in Europe Are Lower Than Those in the United States*
The United States’ teen birth rate is nearly eight times higher than that of the Netherlands’, over five times higher than France’s, and over four times higher than Germany’s. (Fig. 3) [1,3,4]
In the United States, the teen abortion rate is twice that of Germany and more than 1.5 times that of the Netherlands. (Fig. 4) [1,2,3,17]
The percentage of the United States’ 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.(Fig. 5)
sexuAlly tRAnsmitted diseAses
Limited data is available for STI rates in Europe. However, data from the Netherlands found that rates of reported incidence are considerably higher in the United States.[6,7] Further, comparisons of prevalence (the proportion of a given population which is infected) find that the Chlamydia prevalence among young adults in the United States is twice that among young adults in the Netherlands.[8,9] *
Contraceptive Use at Most Recent Sexual Intercourse
U.S. teens report using contraception (usually either birth control pills or condoms or both) far more often that their peers of previous decades. However, condom and contraceptive use leveled off between 2003 and 2007. U.S. teens still use contraception or condoms much less consistently than their peers in Europe. When measuring use of highly effective hormonal contraception, condoms, or both, researchers found that German, French, and Dutch youth were significantly more likely to be well protected at most recent sex than were their U.S. peers. The greatest disparities were in contraceptive pill use among females. French young women were more than twice as likely to have been using contraceptive pills at last intercourse as young women in the United States, German youth five times as likely, and Dutch youth almost six times as likely. (Figs. 6,7,8) [10,11,12,13]
Implementing the Model: Potential Impact on Adolescent Sexual Health in the U.S.
If society in the United States were to become more comfortable with sexuality and if governmental policies were to create greater and easier access to sexual health information and services, then U.S. teens’ sexual health outcomes would improve markedly. 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. (Table 1)
It has been estimated that the public costs associated with teen birth in the United States were at least $9.1 billion in 2004, an annual average cost of $1,430 per child born to a teen mother. Therefore, if the U.S. could reduce its teen birth rate to equal that of France, Germany or the Netherlands, it would save significantly on public funds expended each year to support families begun by a teen birth. (Table 2)
The Lessons Learned
So, if Dutch, German, and French teens have better sexual health outcomes than U.S. teens, what’s the secret? Is there a ‘silver bullet’ solution for the United States that will reduce the following statistics?
Unfortunately, there is no single, ‘silver bullet’ solution. Yet, the United States can use the experience of people in the Netherlands, Germany, and France to guide its efforts to improve adolescents’ sexual health. The United States can achieve social and cultural consensus that sexuality is a normal and healthy part of being human and of being a teen. It can do this by using the lessons learned from the European study tours.
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 works to shift the current U.S. societal paradigm of adolescent sexuality away from a negative emphasis on fear and ignorance and towards an acceptance as sexuality as healthy and normal and a view of adolescents as valuable and important.
Advocates develops and disseminates campaign materials for specific audiences, such as the entertainment industry and news media professionals, policy makers, youth-serving professionals, parents, and youth activists. Advocates will continue its thought-provoking European study tours. Advocates will also collaborate with key national and statewide organizations to promote Rights. Respect. Responsibility.® through Campaign materials, workshops, presentations, and technical assistance. For additional information on the Campaign or to become a partner in this important initiative, contact Advocates for Youth at 202.419.3420 or visit www.advocatesforyouth.org.
* Throughout this fact sheet, data are the most recent available for France, Germany, and the Netherlands. Please note: French and German pregnancy, birth, and abortion data are calculated by age as defined by years of birth, not complete years of age. French and German data are for women under age 20. Pregnancy rates for the United States and for the Netherlands are for women ages 15-19.
1. Henshaw, S. Personal Communication. Guttmacher Institute, October 31, 2007.
10. Eaton DK et al. Youth risk behavior surveillance, United States, 2005. Morbidity & Mortality Weekly Report 2006;55(SS-5):1–108.
11. Eaton DK, Kann L, Kinchen S et al. Youth risk behavior surveillance, United States 2007. Morbidity & Mortality Weekly Report, Surveillance Summaries 2008; 57(SS-4):1-105.
12. Santelli, JS and Orr, MG. Personal communication. Columbia University, November 6, 2008.
13. Currie C, Gabhainn SN, Godeau E et al. Inequalities in Young People’s Health: HBSC International Report: From the 2005/2006 Survey. Geneva, Switzerland: World Health Organization, 2007.
14. Hoffman SC. By the Numbers, The Public Costs of Teen Childbearing. Washington DC: The National Campaign to Prevent Teen and Unintended Pregnancy, 2006.
15. Guttmacher Institute. Facts on American Teens’ Sexual and Reproductive Health [In Brief] New York: Author, 2006; http://www.guttmacher.org/pubs/fb_ATSRH.pdf; accessed 7/7/2008.
16. CDC. “HIV Incidence.” http://www.cdc.gov/hiv/topics/surveillance/incidence.htm, accessed 3/7/11.
17. Pazol, K et al. Abortion Surveillance – United States, 2007. MMWR 2011: 60 (1-39).
Updated by Sue Alford, MLS and Deb Hauser, MPH