Resistance to sex education drives decline in condom use in Europe

A report on adolescent sexual health highlights what the authors call an “alarming decline” in condom use among adolescents across Europe, which they say may increase the risk of sexually transmitted infections (STIs), unwanted pregnancies and unsafe abortions in the region.

The report by the World Health Organization (WHO) Regional Office for Europe was released last week as part of the Health Behaviour in School-Aged Children study, which surveyed more than 242,000 15-year-olds in 42 countries and regions in Europe, Central Asia and Canada between 2014 and 2022. The results showed that 20% of 15-year-old boys and 15% of 15-year-old girls reported having had sexual intercourse in 2022, a relatively stable proportion since 2014.

Among those who had sexual intercourse, 61% of boys and 57% of girls reported using a condom during their last sexual intercourse. However, in addition to about a third of adolescents (30% of boys and 36% of girls) who did not use a condom, an additional 9% of boys and 7% of girls did not know whether they or their partner had used a condom.

Condom use has declined significantly between 2014 and 2022, from 70% to 61% among boys and from 63% to 57% among girls. According to the report, the decline is “pervasive” and spans several countries and regions, although some have seen more dramatic declines than others. Contraceptive use has remained stable at around 26%.

The WHO said the high prevalence of unprotected sex points to “significant gaps in age-appropriate, comprehensive sexuality education, including sexual health education, and access to contraception.” It underlined “the urgent need for targeted interventions to address these worrying trends and promote safer sexual practices among young people,” the WHO said. In a press release, Hans Henri P. Kluge, WHO Regional Director for Europe, said the report's findings were “worrying” but “not surprising.”

“Age-appropriate and comprehensive sexuality education continues to be neglected in many countries and, where it is available, has come under increasing criticism in recent years. It is wrongly believed that it promotes sexual behaviour. In reality, however, providing the right knowledge to young people at the right time leads to optimal health outcomes associated with responsible behaviour and decision-making,” he said.

Medical news from Medscape asked the report's co-author, Margreet de Looze, assistant professor of interdisciplinary social sciences at Utrecht University in Utrecht, the Netherlands, for her assessment of the findings.

The report highlights the need for appropriate and unbiased sex education. Has the provision changed in the comparison period since 2014?

In recent years, good sex education programs have been developed and implemented in Europe. At the same time, opposition to comprehensive sex education has become more organized. One of the most common misconceptions is that sex education leads young people to have sex earlier. In fact, the opposite is true. There is a large body of scientific evidence that shows that adolescents who have received comprehensive sex education start sexual behavior later in life and, once sexually active, are more likely to use contraception.

Why the resistance to sex education?

Although misconceptions about sex education are nothing new, in recent years influential people such as politicians and online influencers have been repeating these false and misleading claims with increasing frequency. This is harmful because their words can influence the beliefs of many people. For example, parents may choose to keep their children home on days when sex education is taught at school. As a result, their children miss out on important information and the development of important skills, values ​​and attitudes that contribute to healthy, safe and enjoyable relationships.

The suspicious discourse about sex education also affects schools: for fear of parents' reactions, schools may become more hesitant to address certain topics.

Are young people themselves satisfied with the sex education they receive?

It is a misconception that sex education is well organized in most European countries. For example, while the Netherlands is internationally known for its high-quality sex education, Dutch young people are not at all satisfied with the sex education they receive at school. Recent research has shown that not even half of them feel they have received sufficient information on topics such as romantic relationships, contraception, pregnancy and sexually transmitted diseases.

In addition, societies are changing rapidly and sex education should be designed to meet the needs of today's youth. Young people indicated that they wanted a much more detailed discussion of topics such as consent, sexual media literacy and sexual pleasure. Discussion of these topics contributes to healthy sexual development and is also directly linked to young people's use of contraception.

Given the decline in condom use, it is now more important than ever to invest in the implementation of comprehensive sexuality education programmes across Europe.

What other factors could contribute to a decline in condom use?

The internet and social media may play a role. Online spaces offer incredible opportunities to reach young people and provide them with valuable information, but they can also expose them to misinformation and risks. Comprehensive sex education can help build media literacy in young people and give them the ability to distinguish fact from fiction online.

Could exposure to pornography play a role?

Research on the effects of pornography on young people is ongoing and complex. Some studies suggest potential negative effects on attitudes, behavior, and relationships. Pornography can normalize sex without a condom. This is another topic that can be covered well in sex education classes. It is crucial to have open and honest conversations with young people about pornography, media literacy, consent, and healthy sexuality.

The report found that adolescents who initiate sexual intercourse early, before age 15, may be less able to negotiate consent and contraceptive use and therefore more likely to engage in risky sexual behavior. However, there is evidence that young people today are beginning sexual behavior at a later age than previous generations. How does age at onset of sexual activity affect condom use?

Our results suggest that although the early starter group has shrunk, adolescents who are part of this group today are at higher risk for contraceptive use than early starters ten years ago. Early starters at younger ages may be even less informed about safer sex or have less access to contraceptives than they did ten years ago.

The report showed that a striking proportion of respondents of both sexes did not know whether they or their partner had used a condom or the contraceptive pill during their last sexual intercourse. What could explain this?

If boys don't know if their partner has taken the pill, or if girls don't know if a condom was used during sex, it may be an indication that they were so drunk that they can't remember. However, alcohol and drug use have not increased to a level that could explain the decline in condom use. In fact, alcohol consumption among 15-year-old boys has actually decreased over the same period.

It's very likely that they didn't have the courage to bring up the subject. If we want young people to use contraception and have safe and enjoyable sexual relationships, we need to normalize sexual communication. This can be especially difficult for girls, as stereotypes claim that girls are sluts if they talk about sex or carry condoms.

Sexuality education can provide young people with the tools to negotiate contraceptive use and build respectful and consensual relationships. It also helps reduce gender inequality in society.

How could general practitioners address these issues with their adolescent patients?

My message to GPs would be to take young people seriously, treat them confidentially and without judgement and respect their autonomy. If they have decided to come to you, it is often a big step for them, so make them feel that you value and admire them for taking that step. While you are responding to their needs, it is important that you challenge the social norms and stigmas around adolescent sexuality and promote a positive, respectful approach to sexual health that emphasises informed choice, consent, safe sex and sexual pleasure.

What other tips would you give?

• Proactively address sexual health issues during routine checkups.
• Provide clear and accurate information about contraception methods, including the correct use of condoms.
• Offer STI testing and explain the importance of regular screening.
• Find out about local, youth-friendly sexual health services you can contact.
• To ensure accessibility, services should be located in convenient locations, have flexible hours, and offer care that is free or available for a small fee.

Finally, it is important to involve young people in the design and evaluation of these services to ensure that they meet their needs and preferences.