The most common age for young people in Australia to have their first experience of sexual intercourse is around 16 or 17. That means that they are beginning to be sexually active at a time in the Teenage Decade when they are also likely to be actively taking risks, pushing boundaries and pursuing new experiences. Despite how it may feel for many caring parents, that risk-taking is not something teenagers do simply to defy, scare or hurt the adults around them. Instead, it is a normal part of how teenagers learn and practice to be independent adults.

Risk-taking in the Teenage Decade may be inevitable, but the damage caused by risks is preventable. When it comes to sexual health, those risks include sexually transmitted infections (STIs) which can have long-term health implications, and unplanned pregnancies which can lead to long-term social disadvantage. 

Condoms are one of the most accessible ways for young people to protect themselves against both unplanned pregnancies and STIs. According to the Second Australian Study of Health and Relationships, more than four in five Australian teenagers reported using a condom the first time they had vaginal intercourse. Over subsequent sexual experiences, condom-use declined.

In Australia, rates of unplanned teenage pregnancies and births continue to decline overall, but remain significant in remote regions, among Aboriginal and Torres Strait Islander teenagers, and in poorer communities. 

Rates of STIs, on the other hand, are on the rise, with teenage girls impacted more significantly than any other population group. There are some biological reasons for this, including the fact that young women have lower immunity than older women. But it’s also because teenage girls are more likely than adult women to have multiple short-term partners, and to move from one partner to the next quite quickly. STIs typically don’t show symptoms for several months, and for that reason often go untreated, and shared.
 

• Risk-taking is a normal part of adolescence that helps teenagers learn and practice how to be independent adults. The risks are inevitable, but the damage they can cause is preventable. We need to support teenagers to protect themselves against the negative impacts of sexually risky behaviour so they have every opportunity to enjoy long-term physical and social health as adults.

• After the relative freedom of childhood, adolescence is a time when many teenagers experience gendered expectations and constraints. We need to promote concepts of gender equality and ethical sexual citizenship to protect teenagers against limiting and potentially detrimental constraints.

• Teenage pregnancies and birth carry significant social and health risks for young women and their children. In Australia, teenage birth rates are highest for young women in remote regions, poor regions, and among Indigenous women. There are almost ten times as many teenage births in the least advantaged communities compared to the most advantaged communities around the country. We must ensure that vulnerable young women have an equal opportunity to protect themselves against the negative impacts of unplanned teenage pregnancies and birth.

• Rates of sexually transmitted infections (STIs) are on the rise, and teenage girls are disproportionately affected. The reasons are both biological and behavioural. We need to find ways to support safe sex behaviours among teenagers so that teenage girls are not burdened by the long-term health impacts of STIs.

Quality sex education

Comprehensive Sexuality Education (CSE) is currently being implemented in countries around the world and the evidence is showing that young people who have access to CSE, along with opportunities to connect to sexual health services, are more likely to engage in safe sex behaviours. At the same time, they are not any more likely to have more sex, or to have sex earlier.

CSE aims to empower teenagers to have safe, fulfilling, respectful and productive romantic relationships, now and in the future. It goes beyond a birds-and-bees approach to get young people thinking about informed decision-making, gender equality and an ethics of care for themselves and for others. It’s about raising sexual health literacy among teenagers, and encouraging ethical sexual citizenship across a generation of young people. 

For school-based CSE to succeed, school teachers need to be supported with relevant professional development. Research is showing that when CSE is delivered poorly, young people are more inclined to seek information online where the quality of that information can be questionable. Parents support the idea of quality sex education in schools, provided it is accurate and age-appropriate.

School-based interventions for STIs

The success of the HPV vaccination program raises the possibility of using school-based interventions to protect teenagers against other sorts of STIs, while also reducing their stigma. In Australia, schools and health services have been working together since 2007 to deliver the HPV vaccination program, achieving greater rates of coverage than in countries where programs have been delivered through GPs and other health clinics. As a result of over a decade of vaccination, genital warts (once common) are now rarely seen among the vaccinated age groups and abnormal cervical smears and cervical precancers have declined. 

SOURCES

• Australian Bureau of Statistics. (2017). Births, Australia, 2016. Retrieved from Canberra.
• Australian Institute of Health and Welfare. (2018). Teenage mothers in Australia 2015. Retrieved from Canberra.
• Carmody, M. (2009). Sex and Ethics: Young people and sexual ethics. Melbourne: Palgrave Macmillan.
• Centers for Disease Control and Prevention. (2018a). Sexually Transmitted Disease Surveillance 2017. Retrieved from Atlanta, U.S.
• Lindberg, L. D., & Maddow-Zimet, I. (2012). Consequences of Sex Education on Teen and Young Adult Sexual Behaviors and Outcomes. Journal of Adolescent Health,, 51(332-338). 
• Patel, C., Brotherton, J. M., Pillsbury, A., Jayasinghe, S., Donovan, B., Macartney, K., & Marshall, H. (2018). The impact of 10 years of human papillomavirus (HPV) vaccination in Australia: what additional disease burden will a nonavalent vaccine prevent? Eurosurveillance, 23(41), 1700737. doi:10.2807/1560-7917.ES.2018.23.41.1700737
• Rissel, C., Heywood, W., de Visser, R. O., Simpson, J. M., Grulich, A. E., Badcock, P. B., . . . Richters, J. (2014). First vaginal intercourse and oral sex among a representative sample of Australian adults: the Second Australian Study of Health and Relationships. Sexual Health, 11(5), 406-415. doi:http://dx.doi.org/10.1071/SH14113
• Robinson, K. H., Smith, E., & Davies, C. (2017). Responsibilities, tensions and ways forward: parents’ perspectives on children’s sexuality education. Sex Education, 17(3), 333-347. 
• Seiffge-Krenke, I. (2003). Testing theories of romantic development from adolescence to young adulthood: Evidence of a developmental sequence. International Journal of Behavioral Development, 27(6), 519-531. doi:10.1080/01650250344000145.