Unformatted text preview: 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 than 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.10,11,12,13 Percent of sexually active 15-year-old youth reporting use
of contraception at most recent sex 10,11,12,13 Condom Use, Males France 88.0% (2006) Netherlands 85.0% (2005) Germany 83.0% (2006) United States 75.0% (2005/2007*) 0 20 40 60 80 100 Condom Use, Females France 80.0% (2006) Netherlands 74.0% (2005) Germany 73.0% (2006) United States 62.0% (2005/2007*) 0 10 20 30 40 50 60 70 80 70 80 Contraceptive Pill Use, Females Netherlands 61.0% (2006) Germany 55.0% (2006) France 26.0% (2006) United States 11.0%
(2005/2007*) 0 10 20 30 40 50 60 *Averaged data for 15 year olds generated from 2005 and 2007
Youth Risk Behavior Surveillance.10,11,12 www.advocatesforyouth.org 3 The Facts 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. If U.S. rates equaled
those in: The number of U.S. teen
pregnancies would be
reduced by: The number of U.S.
teen births would be
reduced by: The number of U.S.
teen abortions would
be reduced by: France 483,000 362,000 54,023 Germany 555,000 336,000 130,902 Netherlands 627,000 385,000 124,668 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.14 If the U.S. birth rates in
2004 equaled those in: U.S. annual public
savings in the ﬁrst year
alone would have equaled: France $517,000,000 Germany $480,000,000 Netherlands $551,000,000 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 to
support families begun by a teen birth. The Lessons Learned
A Model to Improve Adolescent Sexual Health in the United States
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?
Nine million new cases of sexually transmitted infections among 15- to 24-year-old youth;15
More than ﬁve thousand new HIV infections among 13- to 24-year-old youth;16
An estimated 750,000 pregnancies among U.S. teens;15
Approximately 200,000 abortions among U.S. teens;1 and
445,000 births among 15- to 19-year-old women.4
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. The Facts 4 www.advocatesforyouth.org Adults in France, Germany, and the Netherlands view young people as assets, not as problems. Adults value and respect
adolescents and expect teens to act responsibly. Governments strongly support education and economic self-suﬃciency
Research is the basis for public health policies to reduce unintended pregnancies, abortions, and sexually transmitted
infections, including HIV. Political and religious interest groups have little inﬂuence on public health policy.
A national desire to reduce the number of abortions and to prevent sexually transmitted infections, including HIV, provides the major impetus in each country for ensuring easy access to contraception and condoms, consistent sex education, and widespread public education campaigns.
Governments support massive, consistent, long-term public education campaigns, through the Internet, television, ﬁlms,
radio, billboards, discos, pharmacies, and health care providers. Media is a respected partner in these campaigns. Campaigns are direct and humorous and focus on both safety and pleasure.
Youth have convenient access to free or low-cost contraception through national health insurance.
Sex education is not necessarily a separate curriculum and is usually integrated across school subjects and at all grade
levels. Educators provide accurate and complete information in response to students’ questions.
Families have open, honest, consistent discussions with teens about sexuality and support the role of educators and
health care providers in making sexual health information and services available to teens.
Adults see intimate sexual relationships as normal and natural for older adolescents, a positive component of emotionally
healthy maturation. At the same time, young people believe it is ‘stupid and irresponsible’ to have sex without protection. Youth rely on the maxim, ‘safer sex or no sex’.
Society weighs the morality of sexual behavior through an individual ethic that includes the values of responsibility,
respect, tolerance, and equity.
France, Germany, and the Netherlands struggle to address issues around cultural diversity, especially in regard to immigrant populations whose values related to gender and sexuality diﬀer from those of the majority culture. 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.
Adolescents have the right to balanced, accurate, and realistic sex education, conﬁdential and aﬀordable health services,
and a secure stake in the future.
Youth deserve respect. Today they are often perceived as part of ‘the problem’. Valuing young people means they are
part of the solution to societal issues and participate in developing programs and policies that aﬀect their well-being.
Society has the responsibility to provide young people with the tools they need to safeguard their sexual health and
young people have the responsibility to protect themselves from too early childbearing and sexually transmitted infections, including HIV.
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 www.advocatesforyouth.org 5 The Facts References
1. Ventura SJ, Abma JC, Mosher WD et al. Estimated
pregnancy rates by outcome for the United States,
1990-2004. National Vital Statistics Reports 2008;
nvsr56_15.pdf; accessed 7/7/2008. 2. Henshaw S. Personal Communication. Guttmacher
Institute, October 31, 2007. 3. Wijsen C, van Lee L. National Abortion Registration,
2007. Utrecht: Rutgers Nisso Groep, 2008. Accessed
from http://www.rng.nl/productenendiensten/onderzoekspublicaties/downloadbare-publicaties-in-pdf/rapport_LAR_2007.PDF on 4/22/09 4. Hamilton BE et al. Births: Preliminary Data for 2007.
National Vital Statistics Reports 2009; 57(12):1-23;
http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_12.pdf 5. World Bank. GenderStats: Database of Gender Statistics;
http://devdata.worldbank.org ; accessed 6/30/2008. 6. Kaiser Family Foundation. Globalhealthfacts.org: Global
Data on HIV, TB, Malaria and More. http://www.
globalhealthfacts.org; accessed 6/30/2008. 7. CDC. STD Surveillance, 2006 Atlanta, GA: Author,
accessed 4/27//2009. 8. van Veen MG et all. Sexually Transmitted Infections in
the Netherlands in 2006. Epidemiology and Surveillance, Centre for Infectious Disease Control. National
Institute for Public Health and the Environment, 2007:
The Netherlands. Rates calculated using Netherlands
population data: CIA World Factbook, accessed from
https://www.cia.gov/library/publications/the-worldfactbook/print/nl.html on 6/30/2008. 9. Statline. “Population: age, sex, and nationality, 1
January.” Netherlands, 2006: Central Bureau voor de
Statistiek. 10. Eaton DK et al. Youth risk behavior surveillance,
United States, 2005. Morbidity & Mortality Weekly
11. Eaton DK, Kann L, Kinchen S et al. Youth risk behavior surveillance, United States 2007. Morbidity &
Mortality Weekly Report, Surveillance Summaries 2008;
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,
pdf; accessed 7/7/2008.
16. CDC. HIV/AIDS among Youth. [CDC HIV/AIDS Fact
Sheet] Atlanta, GA: Author, 2006; http://www.cdc.
7/87/2008. This document is an updated edition of Adolescent Sexual Health in Europe and the U.S. – Why the Diﬀerence?, written by
Ammie Feijoo, MLS, and published by Advocates for Youth in 2000 and 2001. Updated by Sue Alford, MLS and Debra Hauser, MPH
3rd edition, September 2009 © Advocates for Youth ...
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