Tanja Tyden & Maria Ekstrand


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Tanja Tyden & Maria Ekstrand

  1. 1. Sexual and reproductive health among teenagers and young adults in Sweden Tanja Tydén and Maria Ekstrand Uppsala University
  2. 2. What is sexuality? Lars Forsstedt
  3. 3. What is Sexual health ? <ul><li>A state of physical, emotional, mental and social well-being in relation to sexuality </li></ul><ul><li>Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of discrimination and violence </li></ul>
  4. 4. Sexual rights include the right of all persons to… <ul><li>Having access to sexual and reproductive health care services </li></ul><ul><li>Having access to sexuality education </li></ul><ul><li>Decide whether to be sexually active or not </li></ul><ul><li>Choose their partner </li></ul><ul><li>Decide whether or not, and when, to have children </li></ul>
  5. 5. Adolescence <ul><li>High levels of sex hormones </li></ul><ul><li>Curiosity </li></ul><ul><li>Invulnerability </li></ul><ul><li>Looking for somebody to love </li></ul><ul><li>Stretching boundaries </li></ul><ul><li>Peer pressure </li></ul><ul><li>Parents less significant than friends </li></ul>
  6. 6. In lust we trust -the Swedish approach to adolescent sexuality
  7. 7. Strategies in establishing good sexual and reproductive health <ul><li>National guidelines and public health policies concerning SRH-issues </li></ul><ul><li>National reporting system for Chlamydia - including partner notification, contact tracing, testing and free antibiotic treatment </li></ul><ul><li>Long tradition of compulsory sexual education in schools </li></ul><ul><li>Good access to sexual and reproductive health care services </li></ul>
  8. 8. Sexual and reproductive health care services <ul><li>Youth-friendly Youth clinics in all cities </li></ul><ul><li>Contraceptives – subsidized for teenagers and easily accessible </li></ul><ul><li>Counselling and STI-testing - confidential and free of charge </li></ul><ul><li>ECP sold over-the-counter and available free of charge at youth clinics on week-days </li></ul><ul><li>Abortion - free of demand until 18th week of gestation </li></ul>
  9. 9. Sexual and reproductive health in Sweden – what's it like today? <ul><li>The mean age of first sexual intercourse is 16 years </li></ul><ul><li>75% of 18 year olds have had sexual intercourse </li></ul><ul><li>Almost all boys have watched pornography and this has some negative impact on sexual health </li></ul>
  10. 10. Sexual behaviour among male and female high school students <ul><li>Males </li></ul><ul><li>70% positive with the first intercourse </li></ul><ul><li>> 90% positive with the latest intercourse </li></ul><ul><li>67% used contraception at the first intercourse </li></ul><ul><li>3% reported an STI </li></ul><ul><li>11% reported an abortion </li></ul><ul><li>Females </li></ul><ul><li>50% positive with the first intercourse </li></ul><ul><li>> 90% positive with the latest intercourse </li></ul><ul><li>75% used contraception at the first intercourse </li></ul><ul><li>8% reported an STI </li></ul><ul><li>7% reported an abortion </li></ul>
  11. 11. Fertility rate among Swedish women <ul><li>Decreased fertility rate in combination with older first time mothers - changes over time </li></ul><ul><li>Women's mean age at first baby is 29 years (2007) </li></ul><ul><li>Too few babies are born; the fertility rate is 1.9 </li></ul>
  12. 12. What are the attitudes among university students to having children? <ul><li>Nearly all students wanted children in the future (both sexes wanted 2 - 3 children) </li></ul><ul><li>Women more uncertain regarding the probability to get the desired number of children </li></ul><ul><li>Women more concerned of the status on the labor market in combination with having children </li></ul><ul><li>63% of the men and 33% of the women wanted to postpone childbearing till after the age of 30 </li></ul>
  13. 13. Sexual and reproductive health – heading in the wrong direction? <ul><li>Increased abortion rates among teenagers </li></ul><ul><li>Increased incidences of sexually transmitted infections </li></ul><ul><li>In combination with delayed parenthood </li></ul>
  14. 14. Abortions in Sweden 1975-2006 Källa: Socialstyrelsen
  15. 15. Abortion rate in the Nordic countries (per 1000 women) 1995-2002 10 12 14 16 18 20 22 24 26 1995 1996 1997 1998 1999 2000 2001 2002 Year Abortions / 1000 Norway Denmark Finland Sweden
  16. 16. Abortions in the Nordic countries (per 1000 women) 2006-2007 14.5 15.9 16.1 24.4 9.2 13.3 12.2 20.2 0 5 10 15 20 25 30 Finland Norway Denmark Sweden 15-49 15-19
  17. 17. Abortion statistics among Swedish teenage girls Number of abortions among girls aged 15-17, 1995-2004
  18. 18. Incidence of Chlamydia infection per 1000 inhabitants 1995-2006 Source: Centre of Epidemiology, Sweden
  19. 19. What's behind increased sexual risk taking? <ul><li>Underestimation of risk </li></ul><ul><li>Inconsistent contraceptive use </li></ul><ul><li>Negative attitudes towards condoms </li></ul><ul><li>Fear of hormonal contraceptives </li></ul><ul><li>Contraceptive use – (“still”) the woman’s responsibility </li></ul>
  20. 20. Underestimation of risk... Inconsisten contraceptive use... Fear of hormones... You are perfectly aware that you put yourself at risk, but still..you kind of think that nothing will happen... I thought I might be sterile. Nothing had happened before, so I was actually a bit worried that I couldn´t get pregnant... It´s hard to keep track of what the risks are really, but basically, hormones aren´t good for you...
  21. 21. I´ve only had sex while being sober once... It´s common...you get Chlamydia...condyloma... You just take penicillin and it´s gone. It´s not that serious really. I mean HIV, some people in Africa´s got it but....seriously...– it feels like it wont happen to me. I took it off once mostly because couldn´t sense anything and because it started to get soft...the worst thing that could ever happen to a man! Underestimation of risk... Inconsisten contraceptive use... Negative attitudes towards condom use...
  22. 22. Contraceptive use – “still” a girls´ issue Afterwards he said ’You’re on the Pill, right ?!? You kind of assume the girl will take morning-after-pills the day after... She´d have to bring i up if I were to use a condom. I´d never do it...
  23. 23. “ Changing up the gear” Suggestions for the future… <ul><li>Enhanced primary prevention strategies (i.e. schools, tools for teachers) </li></ul><ul><li>(Even) better ECP and contraceptive access with extended opening hours at youth clinics </li></ul><ul><li>Empowering boys/men to take greater sexual and reproductive responsibility </li></ul><ul><li>“ Male friendly” youth clinics </li></ul>
  24. 24. Important to remember… <ul><li>Teaching abstinence has never worked… </li></ul><ul><li>… and never will! </li></ul>
  25. 25. Prevention of unintended pregnancies - National Guidelines <ul><li>“… to strive towards a society where as many pregnancies as possible should be desired...” National Institute for Public Health (FHI) </li></ul><ul><li>“… ways of achieving this goal include efforts of knowledge raising, behavioural-influencing and availability of contraception and counseling.” </li></ul><ul><li>National Institute for Public Health (FHI) </li></ul>
  26. 26. Important to remember… Teaching abstinence has never worked… … and never will!