Contact Name
Barbara Dietsch
562-985-9488

Contact Email
bdietsc@WestEd.org

Barbara Huberman, R.N., B.S.N.
Advocates For Youth

The United States has one of the highest teen birth rates and teen sexually transmitted disease (STD) rates of any industrialized nation. Researchers, program providers, policy makers, and prevention advocates have struggled for many years to determine how to reduce these rates in America.

Advocates For Youth and the University of North Carolina at Charlotte have sponsored a national institute each summer since 1995 to enhance the knowledge and skills of youth risk-behavior professionals. This institute, a 6 hour graduate course, was begun by the University's Dr. Linda Berne, Professor of Health Promotion, and Barbara Huberman, Director of Sexuality Education at Advocates For Youth. In 1998, the Institute became an international study tour. Three countries, the Netherlands, Germany and France, were selected to visit and identify the influences, policies and practices that have contributed to reducing and maintaining lower teen birth and STD rates. The forty-two participants selected received a syllabus with relevant data about each country and the U.S.

In each country the group made site visits to clinics, agencies, and prevention organizations. Lecturers, researchers, media experts, government offices, educators, and health professionals offered critical analyses of policy, culture, religion and strategic interventions to reduce sexual risk taking behaviors. Participants also conducted informal street interviews with young people and parents.

Each of the participants was assigned to write a paper about two of five issue areas reflecting their experiences and the research presented in Europe and in their syllabus. The five issue areas were:

• health services and access, especially contraceptive services
  
• religion and public values
  
• education, with an emphasis on sexuality education
  
• media and public education
  
• family and community relations

Participants kept journals to record observations and experiences each day. These journals, the issue papers, and their review of the literature became the bases for a monograph on "Lessons Learned," including how to create relevant programs and policies that support the rights of young people to education and services that protect them from unwanted pregnancy, STDs and HIV.

Major Data Comparison

Teen birth and STD rates in the United States are four to seven times higher than the European countries visited. The United States' teen birth rate is almost 55 per 1000, Germany's is 13 per 1000, France's is 9 per 1000 and the Netherlands' is 7 per 1000.

In the countries studied, the average age of first intercourse is 17 compared to 16 in the United States.

European teens have fewer sexual partners during their teen years and wait longer between partners than do American teens.

Welfare benefits are much higher than in the United States, social support systems such as national health plans are more comprehensive and cost less, and education for young people is a priority.

Lessons Learned

Sexuality education is not "a course" but is integrated throughout school subjects. The focus is on giving complete and accurate information. Sexuality education promotes the values of respect and responsibility and committed relationships.

Marriage occurs in the late 20's and is not a criterion for intimate sexual relationships for older adolescents. Society does not understand the concept of abstinence until marriage in today's world.

Government supports massive, consistent and long-term public education campaigns which use television, radio, billboards, discos, pharmacies and doctors to disseminate safer sex messages. Use of the media is seen as a solution, not as a problem. There appears to be little concern about sexually explicit media.

Open, honest and consistent communication about sexuality occurs between adults and teens through media, schools, families and health providers and has not resulted in earlier sexual activity.

In the three countries, public policies to reduce pregnancies, abortions and STDs are research-driven, with little influence from religious or political groups.

Being a partner in an intimate sexual relationship, especially for older adolescents, is perceived as normal and natural, and a positive and healthy component of maturation. Completing an education and attaining economic self sufficiency are the norms before having children and marriage.

National health insurance gives sexually active youth free and convenient access to contraception, including emergency contraception. The goal is to reduce abortions and STDs. Young people believe it is "stupid and irresponsible" to not use protection; their maxim is "safe sex or no sex."

In the U.S. recent federally-funded abstinence-until-marriage education suggests that the primary goal in this nation is to forbid teenagers to have sex rather than to prevent STDs and unintended pregnancy. Continuing on this path may lead to a darker picture: less contraceptive use, more unintended pregnancies, higher rates of STDs, including HIV, and more young people whose lives are burdened by early parenthood, incomplete education, and illness. What the United States most urgently needs is to protect all of its youth, both those who are involved in intimate sexual relationships and those who choose to delay sexual intercourse. Encouraging teens, particularly younger teens, to choose to postpone sex out of respect for themselves and others is healthy. The average age of puberty is now under 13, and average age of first marriage is 26 for men and 25 for women, and by age 20, about 90 percent of young people have initiated sexual intercourse. Contraceptive information and services are clearly in order for older teens.

Scientific research and the Western European experience show that providing information to young people about sex does not cause them to have sex. Openness and honesty do not lead to promiscuity-they lead to young people respecting themselves and behaving responsibly. Adults can encourage and support young people to choose abstinence in their early teen years and can also actively encourage and support sexually active youth to protect themselves.

The "Lessons Learned" from the European Study Tour could serve as the basis for a truly exciting and relevant new paradigm for the way the United States approaches adolescent sexual development and behavior: an approach that defines sexually healthy adolescents as capable of love, respect, intimacy and responsible behavior; an approach that is positive and is not based on fear of disease and dire consequences; and an approach that recognizes that young people deserve accurate information, access to reproductive health services, and opportunities to learn skills to protect themselves.