Teenagers need sex education, not just abstinence advice

In revised guidelines, the American Academy of Pediatrics has recommended that teenagers receive counselling to postpone sexual activity and also information about and access to contraception, including over the counter emergency contraception without a prescription (Pediatrics 2005;115: 281-6). The academy's 60 000 members provide primary care to infants, children, and teenagers up to the age of 18 or 21.

Jonathan Klein, chairman of the committee that drew up the guidelines, told the BMJ that the new report was a routine update to consider newer options such as emergency contraception, not a reaction to the Bush administration's programmes promoting abstinence until marriage and monogamy thereafter. The report says that teenage pregnancy poses medical and psychosocial complications, and that children of very young mothers do not do as well as those of adult women.

Although sexual activity and teen pregnancy rates have declined, they remain a concern. More than 45% of girls and 48% of boys at high school (aged 13 or 14 to 17 or 18) have had sexual intercourse. The average age of first intercourse is 17 for girls and 16 for boys, but about a quarter of teenagers report having had intercourse by age 15.

Figure 1.

Margaret Hill, aged 19, from Mississippi, takes part in a rally on Capitol Hill to promote fidelity. Now doctors say that teaching abstinence is not enough

Credit: BRIAN K DIGGS/AP

Every year, 900 000 teenage girls become pregnant. Half of teenagers' pregnancies are within six months of first intercourse. More than 40% of adolescent girls become pregnant at least once before the age of 20, although most pregnancies are in teenagers aged 18 or 19. Education about HIV and sexually transmitted disease has led more teenagers to use barrier contraceptives, but only 63% reported having used a condom the last time they had intercourse.

Births to teenagers aged 15 to 19 in the US are far higher than in other industrialised countries: 61 per 1000 in the US, compared with 41 in Canada, 33 in the United Kingdom, eight in the Netherlands, and four in Japan.

Dr Klein, of the University of Rochester School of Medicine, New York, said that the abstinence programme, which costs up to $87.5m (£50.4m; €73.3m) a year and is shared by the federal government and the states, “was not based on medical or health information.” He told the BMJ, “The academy believes young people and families ought to have access to comprehensive reproductive health information.”

A report to the federal Department of Health and Human Services in June showed that abstinence programmes increased teenagers' awareness of abstinence but did not decrease teenagers' sexual activity, pregnancy, or infection with sexually transmitted diseases (http://aspe.hhs.gov/hsp/05/abstinence/report.pdf).