Risky Sex Is Fastest-Growing Health Concern for Young People

A major new report from the Lancet Commission finds the fastest growing risk factor for ill health in young people aged 10 to 24 years is unsafe sex. The report, which spans a 23 year period and took academics from four universities three years to put together, looked at the health and wellbeing of young people in every country in the world. All over the globe, the health of young people is more at risk from unsafe sexual behavior than ever before. In 1990, unsafe sex was the 14th riskiest behavior for males aged 15 to 19, and 11th for girls. By 2013, unsafe sex had leapt to the second riskiest behavior for boys, and the most risky of all behaviors health-outcome wise for girls.

To find out why young people are having riskier sex than ever, we spoke to Professor Susan Sawyer, a public health expert from the University of Melbourne. "There are a whole series of questions here that we still don't know the answer to," she says. "What we do know, however, is that young people and teenagers are becoming more sexually active, and that many more so are doing so outside of the social context of marriage."

While social factors are causing more young people to have sex outside of marriage, the health and education systems in many countries haven't kept pace with these changes. "Access to contraception for unmarried sexually active teenagers is highly problematic in many parts of the world." Unsurprisingly, education is the number one factor in helping to keep young people safe—and we're not just talking about teaching young people how to roll a banana onto a condom. "For every year that girls stay in secondary education, there are fewer adolescent births."

But reaching young girls outside of the educational system is also vitally important, especially given how many child brides never get the chance to go to school. "We know that many risky sexual behaviors take place within marriage, so we need to be encouraging countries to make sure that child marriage is no longer taking place, either by changing the laws around it or ensuring those laws are being implemented."

Predictably, abstinence-based approaches to sexual education are about as useful as a chocolate toothbrush. "We absolutely need to be moving away from abstinence-based approaches. It's exceptionally clear to us that there is no evidence for abstinence based sexuality programmes, and there is every evidence for comprehensive sexuality education programmes that encourage young people to delay sexual intercourse until an appropriate time, while encouraging them to access contraception when they are sexually active."

I ask Professor Sawyer to explain the current situation in the USA, where37 states require that sex education include abstinence. While the Lancet study didn't break down findings on a country-by-country basis, it's no secret that the USA has been at the vanguard of pushing scientifically worthless abstinence-based programmes on its teenagers under the rubric of religion.

According to the Guttmacher Institute, fewer teens are learning about contraception. Between 2006 to 2010 and 2011 to 2013 there were "significant declines" in teenage girls reporting that they had received formal education about birth control, consent, and sexually transmitted diseases and infections, with those in rural areas most at risk. Diplomatically, Sawyer says that the situation in the USA is "challenging."

"The disparity between different population groups is very high, so teenage pregnancies are much higher in impoverished and socially marginalised adolescents." One effective solution would be prioritizing the roll-out of long-acting reversible contraceptives such as IUDs and hormonal implants. "Unfortunately, long acting forms of contraception tend to be the most reliable in the adolescents who can least afford to pay for them."

Disturbingly, LGBTQ young people are those most at risk. "We know in countries where being gay is illegal that young people are most likely to suffer poor health outcomes. It's not only about getting the safe sex message out, but also working to reduce the stigma around sexual orientation so that young people are able to stay in school without experiencing homophobic bullying, which is a risk factor for early school departure as well as mental health issues."

Quite simply, we're failing our young people. "I remain personally disturbed by how hard a message it seems to be for adults and parents to appreciate that the message from 50 years ago—'just say no'—doesn't work." The solution? "We need to be thinking in a much more nuanced way. Ensuring that young people have access to the full suite of sexual health resources, so that when they are sexually active, they're safe."