Safeguarding Adolescents through Comprehensive Sexual Education

1. Importance of Sexual Education Dr ANNE VEROUGSTRAETE César De Paepe Hospital Brussels (ULB) SJERP-DILEMMA VUB: Family Planning and Abortion Centre of the “Vrije Universiteit Brussel” CCNAC: Central Coordination of Flemish Abortion Centres

2. Long term psychosocial consequences for adolescent mothers • OR * • Low education level 1,7-1,9 • Lives isolated 1,5-2,3 • High parity 2,6-6,0 • Unemployment 1,9-2,6 • > Poverty • > Insalubrious housing • Mental health • > depressions & suicides • > more familial conflict situations, more breaking up * Fam plann perspect 33 2001 Olausson Sweden: n=888044

3. Children of adolescent mothers • Live often in single-parent family • > Poverty • > Insalubrious housing • > Bad nutrition • > Ill-treated • > Separated from family by the authorities • > Suicides at adult age (x 2) • > Risk to be adolescent parents themselves

4. Lancet 25/10/04

5. Britain: early heterosexual experience (Natsal 2000) • Age first sex: 13-14 15 16 17 18-24 • Men: in % • Wish waited longer: 42 26 19 12 8 • No condom 31 19 19 18 19 • No contraception 18 10 8 3 7 • Partner more willing 9 7 7 6 5 • Women: in % • Wish waited longer: 8449 34 34 19 • No condom: 34 17 20 21 21 • No contraception: 22 10 9 9 10 • Partner more willing: 3326 20 16 18

6. What is a “Nice” adolescent? • One who has no sex? • OR • One who only has sex • When she wants to • When she enjoys it • With a partner of her choice • In a mutual positive relationship • Protected against unwanted pregnancy • Protected against HIV and other STD

7. Sexual maturation Three levels: Sence Emotions Biology threeleves

8. Children • Don’t push children to accept intimacy they don’t want: like kissing the aunt they don’t like • Intimacy is something that should be wanted by both: you can’t kiss someone who does not like it • Respect the child and stimulate his self-esteem • Tell them: • Don’t let people touch you if you don’t want to: tell them: “no”, “go away” and tell an adult you trust immediately • Each part of your body has a special name • Some parts of your body are intimate and private

9. Boys • Give a positive aproach about condom use: • “you have the right to use condoms and to decide where your sperm goes, to decide about your parenthood” (Finland: R. Cacciatore)

10. Girls • Stimulate their self-confidence, their self-esteem, learn them to balance power: • The use of contraception gives you more freedom in your relationship • Be strong, decide for yourself, be an adult woman • To take the pill does not mean you have to have sex if you don’t want to!

11. Parents are very important! • Adolescents coming from a family that is a “warm nest”, where there is an open atmosphere about sexuality use condoms more • Belgium: 80% of girls say that their parents pay for their contraception: we have good parents! • If a girl can put her pillstrip next to that of her mother’s or next to her toothbrush, she is less likely to forget her pill • Parents also need information and possibility of discussion: at school evenings (“how to stimulate self-esteem in children”), internet forums, special telephones

12. Contraception = sex with “premeditation” • Conflicting moral norms • Ambivalence about sex • Ambivalence about contraception: you need to take pills every day (that reminds you every day that you are breaking the rules), you need to go to the doctor, your mother may find the pillstrips, the prescriptions….its too risky • => it is difficult to use contraception properly

13. When your autonomy in life decisions is limited, it is difficult to use contraception properly • Male dominant position ( young girls with older partners), complicates correct use of contraception • Balancing power in the relation is difficult in this age group! • Difficult to impose condom use if you don’t use the pill or forgot pills • Difficult to say no

14. Discovering your sexual orientation • Where can young homosexuals go for help? • More suicide attempts in young homosexuals!

15. PEERS • Can have a positive influence concerning attitudes of young people • They are trendsetters

16. Video’s in classroom • Show video films with several situations, and stop to discuss the options with the students: what’s going on here? how would you react? what could they do about it? • Unwanted intimacy: how to learn to put limits; what about emotions? • Condom or pill problems • Unplanned pregnancy

17. Demystification of “first time” • First time sex = training time! It will not always be “Nirvana” : sex education should decrease the feeling of embarassement and failure. • Lack of sex education can induce poor sex experience and sexual problems that continue to develop later in life

18. Safer-sex education • Does not increase sexual activity • Increases condom use atfirst intercourse • Increases contraceptive use • Reduces unprotected sex • Abstinence-only education • Delays onset of sex for a short time only • Has no effect on sexually active teens • Does not reduce unprotected sex • Stimulate guilt feelings about sex

19. Sex education in school • In groups: • everybody together then with only girls or boys • Knowledge (correct use of pills, emergency contraception) • Attitudes , values, myths • Emotional & relational education • in schools: in islamic groups => social control • Individual information • Unmarried girls need to know providers will respect confidentiality: it can be life saving!

20. For Adolescents we should have • Contraception courses with practical & up to date information for all students of secundary school (whatever their religion), and easy access to information when needed: it is a public health issue! • Sex education in school to strengthen self-esteem, socio-emotional skills of children and to give them strategies to resist outer pressure and unwanted intimacy. Involve parents in evening lessons. • Easy & cheap access to reliable contraceptive methods • Easy & cheap access to emergency contraception without prescription • Safe and cheap abortion without mandatory consent of parents (in France, minors bring an adult of their choice, who will help them in this period)

21. Finland & The Netherlands • The example of Finland & The Netherland shows us society has to maintain the effort in providing sex education, and confidential free health services to each cohort of young people • If society stops the effort, there is a rise of teen pregnancies, abortions and STI in the next cohort!