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The use of condoms among sexually active adolescents in European countries has significantly decreased since 2014. A recent World Health Organization (WHO) report showed that the percentage of adolescents who used a condom during their last sexual intercourse decreased from 70% to 61% for boys and from 63% to 57% for girls between 2014 and 2022. In addition to the risk for sexually transmitted infections (STIs), adolescents are also exposed to the risks for unintended pregnancies and unsafe abortions.
The report attributed the decline in condom use to inadequate sex education and sexual awareness, as well as limited access to contraceptives.
The data are derived from the Health Behavior in School-Aged Children study, which surveyed 242,000 15-year-old adolescents from 42 countries between 2014 and 2022. A German study group also participated in the long-term study.
“While the results of the report are alarming, they are not surprising,” said Dr Hans Henri P. Kluge, a Belgian physician and WHO regional director for Europe. Comprehensive age-appropriate sexual education is still neglected in many countries. Kluge emphasized the importance of providing adolescents with the necessary information to halt the “cascade of negative consequences, including higher rates of STIs, increased healthcare costs, and ultimately disrupted educational and career paths for young people.”
As of 2018, about 30% of adolescents did not use condoms or birth control pills during their last sexual intercourse. Socioeconomic differences were also observed: Adolescents from low-income families were more likely to report not using condoms or birth control pills than adolescents from higher-income families (33% vs 25%). The use of birth control pills remained relatively stable between 2014 and 2022, with 26% of 15-year-olds reporting that they or their partners used birth control pills.
Lack of Knowledge
Germany’s Federal Center for Health Education (BZgA) recently conducted the Love Life Study, a representative survey that asked 4640 adolescents aged ≥ 16 years about STIs. Only 56% of respondents mentioned HIV or AIDS when asked about known STIs. Syphilis and gonorrhea were mentioned by 28%. Only 11% of respondents could spontaneously name chlamydia, which is one of the most common STIs worldwide. The human papillomavirus (HPV) was mentioned by only 6%.
However, about a quarter of the surveyed adolescents were concerned about contracting an STI, and two thirds (66%) had consulted a doctor as a result, as Medscape Medical News reported.
When asked about protective behaviors against STIs within a committed partnership or with multiple partners, only a third (38%) stated that they protect themselves against STIs during intercourse outside their current relationship. About 19% of adolescents had a conversation with their partner about STIs before having sex.
In the BZgA survey, only 37% of adolescents reported using condoms outside a committed relationship to protect against STIs. Reasons cited by adolescents for not using condoms included reduced pleasure.
The authors identified prevention efforts and education about STIs and HIV as challenges. Awareness of existing services, such as chlamydia screening and HPV vaccination, needs to be promoted, they said.
Better Sexual Education
The report’s findings prompted the WHO Regional Office for Europe to call on decision-makers, educators, and healthcare professionals to pay more attention to the sexual health of adolescents.
“Comprehensive sexual education is key to…empowering all young people to make informed decisions about sex during a particularly vulnerable phase: The transition from youth to adulthood,” said Dr András Költő, a psychologist and health promotion specialist from the University of Galway, Galway, Ireland, and the lead author of the WHO report. This education should include transparent, nonjudgmental communication and appropriate decision-making processes, he said.
The report authors advocated for investments in comprehensive sexual education to teach young people about contraceptive measures and STIs. Sexual education should also cover topics such as consent, equality, and healthy relationships, they advised. Adolescents should have increased access to age-appropriate information and safe spaces in and out of school where they can address sensitive and taboo topics. Educators and healthcare professionals should be trained in the specific needs and desires of adolescents, according to the authors.
“Our goal is to provide young people with a solid foundation for life and love,” said Kluge. “By empowering adolescents to make informed decisions about their sexual health, we ultimately protect and enhance their overall well-being.”
Finally, the reasons for the decline in condom usage need further investigation, and the content of social media platforms to which adolescents are exposed should be analyzed, said the authors.
