Teenage sex: don't scoff at abstinence

We pride ourselves on our openness, but we aren't open about the dangers of early sexual experience:

Britain has never been a nation at ease with sex. Our Victorian forebears couldn't look at the legs of a piano without getting hot under the collar. Now, in the aftermath of the Sixties sexual revolution, we worry that things have gone too far, what with young holidaymakers putting it about in Faliraki, footballers bragging about "roasting" young women and 18-year-olds getting jiggy in the Big Brother house. Are we ever going to get it right? Legislation won't put any self-respecting adolescent off "shagging" and, anyway, we're too progressive for that. All we can do is ply them with condoms and hope they don't get knocked up or stricken down with any love bugs.

In contrast, in the United States, chastity is all the rage. George Bush has created a $74m fund for sex education, available only to schools and groups that exclusively promote abstinence - contraception can be mentioned only in terms of its fallibility. In 35 per cent of all US school districts, sex education has been replaced with classes that focus solely on the abstinence-only approach. Funding for abstinence campaigns now outstrips safe-sex campaigns threefold, with beneficiaries including the Silver Ring Thing, a faith-based organisation that encourages teenagers to purchase a $12 silver ring as a symbol of their commitment to remaining chaste until marriage. Abstinence movements now claim a membership of 2.5 million teenagers in the US.

The idea of Bush defending the honour of his nation's daughters (pledgers are largely teenage girls) by bashing his Bible and flogging them cheap jewellery has provoked an understandably negative reaction from sexual health charities. Dr Kate Worsley, of Marie Stopes International, complains of the "focus on judgement" and neglect of "providing information and education to young people or helping them to make informed choices". Instead, Marie Stopes advocates a non-judgemental approach, offering "empowerment and negotiating skills" through discussion and information on contraception. Its "Like It Is" website for teenagers offers "everything you need to know about sex with no frills, no judgements, and definitely no holds barred". Careful to advocate contraception at every stage, it makes no attempt to talk down the joys of sex, offering only a brief caveat that "sex won't be perfect the first time".

Other liberal voices concur. "The focus on abstinence harkens a return to the dark ages," wrote Suzanne Goldenberg in the Guardian after visiting a Silver Ring Thing convention in the States. "Just say no to abstinence," cried Zoe Williams, lamenting the "bogus concepts of morality" of the chastity movement. Keep your moral repression, give us our hard-won sexual liberation, is the progressive consensus. But is prioritising sexual "openness" really doing young people any favours? A report from the House of Commons health committee in May warned that the country is experiencing a "crisis in sexual health". Britain has the highest rate of teenage pregnancy in Europe. Sexually transmitted diseases have risen to levels where the health service is unable to cope, with annual diagnoses of syphilis up 500 per cent and one in ten people aged 16-24 infected with chlamydia. Most sexual health clinics have waiting times of ten days for an appointment and, says the report, some are turning away hundreds of people a week. And though many infections are treatable with antibiotics, conditions such as pelvic inflammatory disease, which is often a result of untreated chlamydia, cause permanent internal damage and infertility. Those who have sex younger are much more likely to contract a sexually transmitted disease: among the under 16s, one in seven sexually active girls tests positive for chlamydia.

The health committee explicitly attributes the rise in rates of infection to changing sexual behaviour in Britain. Any benefits of better education about and access to contraception are outweighed by the drop in the average age at which people first have sex, and the rise in the average number of partners. The 2001 National Survey of Sexual Attitudes and Lifestyles found that between 1990 and 2001 the average number of sexual partners increased from 8.6 to 12.7 for men and 3.7 to 6.5 for women, and that average age at first intercourse has fallen from 17 to 16. Although condom use is up, the overall figures for "high risk" sexual activity have also increased.

There are also strong arguments that even 100 per cent condom use would not be enough. Evidence is emerging that condoms do not protect from the human papilloma virus (HPV), which causes genital warts and cervical and anal cancer. Dr Trevor Stammers, a senior tutor at St George's Hospital, London, who has written extensively on sexual health, claims that sexual health campaigns have deliberately downplayed the fallibility of condoms on the basis that any doubts about their effectiveness would trigger a rise in HIV. "But HIV is the tip of the iceberg in terms of sexually transmitted diseases," he says. "Aids is fatal, but so is HPV, and condoms offer no protection."

Even more controversial is a report due to be presented at a meeting in the House of Commons this month. The research by Dr David Paton, professor of industrial economics at Nottingham University, has found a link between an increase in sexual health provision and rates of disease contraction - in other words, that the advice and access to contraception championed by those unwilling to appear moralistic about abstinence actually cause higher rates of disease. The Sexual Health of the Nation meeting will also examine how a campaign focusing on the reduction of casual sex, and not just wider access to contraception, has been responsible for success in fighting HIV in Uganda. Uganda has adopted what it calls the ABC approach to reducing HIV: "Abstain (from sex), Be Faithful (together), Condom Use (every time)." As a result, HIV rates dropped from 21 per cent to 9.8 per cent between 1991 and 1998.

Not that sexual health is only about reducing rates of disease; the health committee report defines it as "a state of physical, emotional, mental and social well-being related to sexuality". Critics of abstinence argue that curiosity and exploration are a natural part of youth; a vision often not shared by surveyed teenagers. In the US, the Alan Guttmacher Institute found that 70 per cent of girls who had sex before the age of 16 regretted it, and one in five complained of physical coercion.

In a survey by the Institute of Education and University College London, 36 per cent of girls who had lost their virginity at 13 said they were "unhappy" about it, and 18 per cent said it "never should have happened". Early sex correlates positively with low socio-economic status, social exclusion and broken families. Dr Stammers, who has been teaching sex education in schools for more than ten years, says: "Most teenagers I have taught or talked to are not looking for sex, they're looking for love. I have sensitively discussed the idea of abstinence with classes of teenagers, listening to what they have to say, and they have on several occasions burst into applause when I finished. The resistance to the abstinence message does not come from the teenagers themselves."

Young people growing up in our consumer culture are not short of information about sex. It is all around them. They receive the message loud and clear that sex - preferably with a number of different partners - is an essential part of being a normal, happy person. We are not so good at being "open" about the reasons for waiting until you find someone you really desire and trust before becoming sexually active. One in three teenagers say they lost their virginity in a one-night stand, and only 15 per cent of boys cite "love and commitment" as their reason for first having sex. If, as these statistics suggest, teenagers have sex more from a sense of urgency than desire, and many subsequently feel unhappy about having done so, we need to ask where they will find any support for a positive alternative.

"I'm not sure how you would teach abstinence - the body of evidence shows it doesn't work," says Dr Worsley of Marie Stopes. "Abstinence messages conflict with all the other messages about sex which teenagers receive from the culture around them. And a cultural shift is very difficult to achieve."

The answer may indeed be to look to the United States - but to some progressive programmes that have been quietly revolutionising teenagers' sexual behaviour. Reva Klein, a journalist who has done extensive research into progressive education in the US and UK, emphasises that the most effective sex education programmes aim to build young people's self-esteem and "discourage them from seeking affirmation and escape through sexual relationships". She tells of one example of a "social and emotional development curriculum" in New Haven, Connecticut, where teenagers have been trained as peer educators and sex education classes are run without adults present. Within seven years, teenage pregnancy rates plummeted in this deprived urban area. Change is possible, she says, but we need to "tackle the root causes and take education much more seriously".

Education is undoubtedly where we must start. The problem extends far beyond the failings of traditional sex education. Teenagers - young, inexperienced and vulnerable to pressure - are left at the mercy of a culture which tells them that sex is the answer to everything. We must celebrate our prized sexual openness by using it to help them make positive decisions about when to start having sex. And maybe that decision will be to wait a while.

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