Must We Fear Adolescent Sexuality

The vision of out-of-control, dangerous, and immoral teenage sexual behavior hangs, as a specter, over public debate and policy about reproductive health in America. Fears of teenagers' given license to engage in promiscuous sex informed the recent decision not to make emergency contraception available over the counter. The image of teenagers having sex without parental control and protection has figured prominently in the calls for stricter regulation of the provision of contraceptive and abortion services. Finally, the notion that pregnancy and disease are unavoidable aspects of teenage sex is integral to the abstinence-until-marriage message, which often constitutes the main, and sometimes the only, tenet of sex education in American public middle and high schools. These fears of dangerous, uncontrolled, and immoral adolescent sexuality appear, on first sight, to be substantiated by reality. Even after a decade of steady declines, pregnancy, birth, and abortion rates remain very high among American adolescents. More than 8 out of 100 teenage girls become pregnant yearly and between 2 and 3 out of every 100 girls have an abortion each year. Nor is the sexual trouble of American teenagers limited to high rates of unwanted pregnancies; American teenagers acquire more than 3 million sexually transmitted infections (STIs) a year. As a demographic group, they account for more than a quarter of all STIs in the country (see footnote 1).[1-3] But if the American data appear to confirm conventional wisdom that raging hormones and peer pressures put teenagers at risk of making unwise sexual decisions, public health data from other countries challenge this commonly held knowledge. International comparison demonstrates that developed countries vary dramatically in the degree to which the sexual maturation of teenagers leads to adverse outcomes. No country forms a more stark contrast for comparison with the United States than does the Netherlands: Dutch teenagers are far less likely to either become pregnant or contract an STD than are their American peers.[4,5] American teenage girls are 3 times as likely to have an abortion, and 8 times as likely to give birth, as are their Dutch counterparts, even though both are typically 17 years old when they first have intercourse (see footnote 2).[3,6] Moreover, the sexual maturation of teenagers does not inspire the same fears among parents, providers, and policy-makers in the Netherlands as it does in the United States. Public policies do admonish young people to understand the responsibilities that come with having relationships and sex -- most notably, the responsibility to use contraception effectively (see footnote 3).[7] And indeed, there is evidence to suggest that when they do become sexually active, Dutch teens use contraceptives more frequently and more effectively, and have fewer sexual partners, than do their American counterparts (see footnote 4).[2,6] How is it possible that an essentially universal biological phenomenon -- the onset of puberty and the capacity for reproduction -- produces such disparate results in 2 countries that are similar in terms of wealth, education, and reproductive technologies? To answer this question, we need to go beyond statistics of incidence and association to investigate the cultural and institutional forces that keep the sexual maturation of teenagers in the Netherlands from becoming the psychological, medical, familial, and economic "drama" that it all too often becomes in the United States. In a series of articles, of which this is the first, I undertake exactly such a sociological inquiry, the results of which have important implications for debates, currently raging across the United States and other countries, about how best to provide care to those coming of age.