Adolescent sexuality: an educational and counseling challenge.

A review of family-planning literature reveals that researchers adopt narrow definitions of sexual behavior and focus almost exclusively on risks of pregnancy and diseases. Little concern is shown in these articles about promoting the idea of more communicative, pleasurable, and egalitarian sexual relations among teenagers, because the focus is on avoiding behaviors that are defined as "high risk." In the United States, there is little evidence that these contraceptive-based sex education programs have resulted in reduced sexual activity, diminished teenage-pregnancy rates, or increased effective contraceptive use. In Canada the clinical evidence is that existing prevention strategies are not working. In Sweden the increasing rates of STDs and teenage pregnancies in the late 1980s worried authorities. The figures were brought down in the 1990s by extensive efforts both in schools and at publicly funded adolescent health clinics and family-planning units. It has been shown that girls with good self-esteem and a sense of responsibility avoided pregnancies and STDs in follow-up studies. Girls with a high degree of risk-prone behavior or attitudes and girls with a problematic life situation and without adequate family support were those who became unintentionally pregnant and/or acquired an STD. Countries where sex education has been accepted, combined with widely spread family-planning services and abortion on demand, have the lowest pregnancy and abortion rates in the world. But even they could do better by putting sex education in its proper place in society and by using both old and new methods.