In most European nations, sexuality is embraced as a positive, natural part of life. There is open dialogue and positive social norms associated with sexual health and sexuality. In contrast, many Americans are uncomfortable talking about sex. While American girls most often initiate the conversation, they worry that their partners will react negatively, either rejecting them or questioning their sexual history. Most young adults report that they would postpone sexual activity if they could converse more openly and honestly with their parents. Meanwhile many parents say they don’t know how to talk to their kids about sex and tend to avoid the subject altogether. Teens and their healthcare providers also rarely talk about sex, with 66% of teens aged 15-17 saying they have never discussed condoms or birth control with their doctor.
However, an Advocates for Youth study found that parents in countries such as the Netherlands, Germany, and France accept that sexual behavior is a normal part of human development. In these countries, adults tend to have greater respect for adolescents while expecting them, in turn, to act responsibly. There is also strong government support for sexuality education, long-term public education campaigns, and access to sexual health care services, including contraception. It is easier for European families to engage in open and honest discussions with teens about sexuality and sexual health services. When sexual health and sexuality are positively discussed and addressed, the overall quality of life and health of society is improved.
Unfortunately, the U.S. lags behind most other western nations in achieving optimal sexual health. Rooted in our longstanding, conservative attitudes, our approach to sexual health and sexuality is often negative, focused on disease and risks, incomplete, and sensationalized. Many Americans also lack access to adequate sexual health education and health services. These factors have contributed to high levels of sexually transmitted infections and chronic illnesses, unintended pregnancies, infertility, discrimination, stigma and partner violence.
The U.S has made significant progress —the teen pregnancy rate has declined 42% since 1990 — but is still nearly three times greater than rates in France and Germany. Similarly, the 2008 U.S. teen birth rate was nearly two times greater than the United Kingdom and ten times greater than Switzerland’s. Not surprisingly, European youth are more likely to be well protected during their most recent sex than their U.S. peers, with significantly higher levels of condom and contraceptive pill use. These teenage trends continue into adulthood. The prevalence of HIV among the adult U.S. population is estimated to be 1.5 to 6 times higher than France, Germany and the Netherlands.
Americans of all ages often lack the information and skills they need to make good sexual decisions. Surveys reveal that many are misinformed about the risks of unprotected sex, particularly the risks of oral sex; the availability and effectiveness of different contraceptives, along with how to use them; and their personal level of risk. Large-scale communications campaigns like Bedsider from the National Campaign to Prevent Teen and Unplanned Pregnancy, which focuses on increasing contraceptive usage and consistency, have begun to address this need. However, there is much more to do. We can also learn from models around the world, such as the “Sex Worth Talking About” campaign in the United Kingdom, which aims to transform the prevailing culture of “stigma shame, and embarrassment” into a “new culture: open, positive, supportive, respectful.”
Good health is important to achieve and maintain throughout life, and this includes our sexual health. We must embrace sexual health and sexuality as a natural, normal, and positive part of life, across the lifespan and in a variety of contexts. Beginning to have open and honest communication and dialogue on the subject is a step in the right direction. We need to make “sexual health” a household term, from the dinner table to the doctor’s office.
Jaclyn Fontanella, MPH