|European Approaches to Adolescent Sexual Behavior and Responsibility: Call to Action|
Teen birth, abortion, and sexually transmitted disease (STD) rates in the United States are higher than in most other industrialized countries. For the last two decades, U.S. public health experts have worked to address these problems. One such effort, sponsored by Advocates for Youth and the University of North Carolina at Charlotte, is the Summer Institute, a six-credit graduate course about adolescent sexuality. In 1998, the Institute initiated an international fact-finding mission to the Netherlands, Germany, and France to explore how these European nations have achieved successful adolescent sexual health indicators. A team of 40 adolescent health experts and graduate students from throughout the United States, along with two teen journalists, participated in the mission.
In each country, the participants conducted qualitative, critical analyses of issues which research demonstrates to have an impact on adolescent reproductive and sexual health attitudes, behaviors, and outcomes. Those issues, and the public policies and practices related to them, include:
Comparing the four countries, U.S. teens are the youngest—at an average age of 15.8— to experience first sexual intercourse.1 Teens in the Netherlands—which exhibits the most liberal attitudes about sexuality and sexual behavior—experience first intercourse at the latest average age, 17.7.2 The teens of Germany and France experience first sex at 16.2 and 16.8, respectively.1,2
Teen condom use is fairly consistent among the four nations. In the Netherlands, 85 percent of Dutch adolescents use protection at first sexual intercourse—46 percent use condoms and 24 percent use both condoms and the pill.2 Further, 29 percent of sexually active teens used condoms at most recent intercourse, while eight percent used both condoms and oral contraceptives at the same time.3 In Germany, 56 percent of sexually active male teens used condoms at first intercourse and 57 percent at most recent intercourse.4 In the United States, teens' use of condoms or other contraception at first intercourse has risen to 65 percent.5 Among sexually active U.S. teens, 65 percent reported using a condom at most recent intercourse.6,7 Finally, in a nationally representative sample of sexually experienced U.S. youth ages 14-22, 25 percent of young men reported dual use of condoms and oral contraception.8
Differences emerge strongly when teen use of other effective means of contraception is compared. In the Netherlands, nearly 67 percent of sexually active adolescent females use oral contraceptives.9 In Germany, about 63 percent of sexually active adolescent females report using oral contraceptives at most recent intercourse.4 By contrast, 20.5 percent of sexually active adolescent females in the United States report using oral contraceptives at most recent intercourse.7
The United States has much higher rates of teen birth and abortion when compared with the other three nations. In 1996, the U.S. adolescent fertility rate was 54.4 per 1000 women ages 15 to 19, four times higher than Germany's rate of 13 per 1000.10,11,12 The Netherlands has the lowest confirmed teen fertility rate in the world—6.9 per 1000 women ages 15 to 19.3 While teen abortion rates are not available for Germany, the abortion rate for U.S. teenagers is more than double that of France and more than triple that of the Netherlands.3,11,13,14
The United States also has the highest poverty level among major industrialized nations. In measuring poverty in industrial economies, United Nations analysts look at longevity, literacy, disposable income below 50 percent of the median, and long-term employment. With those measures, the United States earned a poverty score of 16.5 percent; by comparison, the Netherlands scored 8.2 percent, Germany scored 10.5 percent, and France scored 11.8 percent.14a Poverty is significant to adolescent sexual health indicators because of its association with adolescent pregnancy and its impact on youth goals, aspirations, and risk behaviors.14b