Over the last few years I’ve written quite a lot on the subject of teenage pregnancy, abortion and related issues, much of which has been prompted by the dull-witted and willful ignorance of a single MP – Nadine Dorries, of course.
If there’s one pertinent observation that crops up in comments more than any other, when discussing these issues, it is the fact that while the UK has amongst the highest teeenage pregnancy and abortion rates in Western Europe – and the US, from where Dorries is getting her ideas, the worst of any Western industrialised country, the Netherlands has the lowest such rate of any comparable nation. The question, which I think is a very good one, is that of what are Dutch doing that we aren’t because, quite obviously, their approach to dealing with adeolescent sexuality is, in very obvious empirical terms, far superior to our own.
It’s a question I’ve been wanting to answer properly for quite some time without ever hitting on a source of information that would permit me to put up a solid answer with resorting to writing a 15-30,000 word dissertation – until the other day when I ran across a 2004 paper by Amy Schalet of – at the time – the Center for Reproductive Health Research & Policy, University of California at San Francisco* entitled ‘Must We Fear Adolescent Sexuality?’ and, luckily, managed to locate a full pdf copy of the paper, which I recommend you download and digest at length.
*Dr Schalet has since moved on from UCSF to the University of Massachusetts, Amhearst, where she’s an assistant professor of sociology.
Schalet’s paper asks the question of why two countries (the US and the Netherlands) that are broadly similar in wealth, education and access to reproductive technologies produce such divergent outcomes in terms of the prevalence of teenage pregnancy, abortion, STIs infection rates, etc. and provides answers that are wholly relevant to our own situation in the UK and, in particular, to the efforts of Nadione Dorries and others to move UK policy on sexual health and access to reproductive technologies closer to that of the US, answers which I am going to quote here at some length.
That said, there are, as I have pointed out, a number of precepts that underlie the normalization of adolescent sexuality in the Netherlands, and these could, and I believe should, be adapted to fit American healthcare practices regarding adolescent sexuality. The first pertains to the self regulation, and more fundamentally, self-determination of sexuality. To instill adolescent self determination requires treating adolescents as the owners of their own bodies and the agents of their own sexual behavior and to commit to providing them access to the information and resources they need to exercise this rightful ownership over their bodies and agency over their sexual behaviors. Concretely, this means giving teenagers the right to full knowledge about their anatomy and about the contraceptives that exist to protect them against unwanted and dangerous consequences of sexual intercourse. A vast majority of American parents want their children to receive this information in their public school sex education classes. But bowing to political pressures, schools and governmental agencies are increasingly shying away from teaching consistent and effective contraceptive use, emphasizing instead the dangers of sex, the failure rate of contraceptives, and no-sex-until-marriage as the way to be safe. Ironically, abstinence-only-until-marriage, touted as the only full-proof safe sex, leaves young people unprepared to take precautions when they do have sex before marriage.
One of the key differences between American and Dutch attitudes to adolescent sexuality that Schalet notes the the tendancy for American parents to dramatise tenage sexual behaviours, where Dutch parents normalise the same behaviours:
We have seen that 3 themes guide American constructions of adolescent sexuality and explain their near-universal strong opposition to the sleepover: the perils of raging hormones, the costs of the battle between the sexes, and the logic of “not under my roof.” By viewing the sexual maturation of teenagers through these 3 cultural lenses, American parents dramatize adolescent sexuality — they highlight the dramatic and conflicted aspects of sexuality, forces that overwhelm the individual, conflicts that put girls and boys at odds, and the radical break between parents and teenagers that is required before parents accept their children’s sexual relationships as legitimate.
Three different themes guide the Dutch constructions of adolescent sexuality: the importance of self recognition and self-regulation, the embedding of sex in relationships, and the celebration of normal and non-secretive sexuality. By viewing adolescent sexuality through these 3 cultural lenses, Dutch parents, normalize teen sexuality — they emphasize teenagers’ capacity to determine their own pace of sexual development and to prevent adverse consequences, their proclivity to want sex in the context of relationships that are mutual and loving, and the ease with which sexuality can be discussed, and adolescent relationships integrated, within the parental home.
There is an interesting paradox here – America defines itself in terms of its presumed culture of robust individualism and independence with a strong, if not overbearing, emphasis on the virtues of self-sufficiency and personal responsibility and yet its prevailing cultural attitudes toward sex and sexuality appear to have entirely the opposite effect of inhibiting and infantilising adolescent intellectual, emotional and moral development. The Dutch, on the other hand, take a liberal view of the emergence of adolescent sexual behaviour, treat is a normal part of growth towards adulthood and are, as a result, significantly more successful in raiseing children to become healthy, well-adjusted, independent and responsible moral agents.
Why should this be the case?
Personally, I think its because conservative religious morality has an infantilising effect on individual moral development and, in particular on the development of personal moral agency, but that’s too big an issue to debate here. Suffice to say, I think the Dutch are doing well because their approach to adolescent sexuality sets out to teach young people to think for themselves and encourages parents to take an active, but non-judgemental, hand in their offspring’s moral development, while the American approach simply hands kids of bunch of absolutist rules that are entirely at odds with their natural instincts and then abandons them to try and figure out the rest for themselves.
Getting back to the main thread of Schalet’s argument after that digression, she continues on from her comment on abstinence-only education to note that:
Beyond technical knowledge, American teenagers must be given a language through which to understand their own sexual feelings and desires in positive terms. Providers must speak to young people about sexuality in terms of the whole range of behaviors and experiences that constitute sex, rather than suggesting that vaginal intercourse is the only or best way to “do it.” Adolescents should be encouraged to respect their own internal boundaries, and those of others, as they explore their sexuality. A positive, realistic language of sexuality, which advocates the gradual, self-chosen and individual nature of first sexual experiences, would form a welcome alternative to the two equally unrealistic propositions that currently govern public discourse in the United States. The no-sex-until marriage doctrine is widely preached, yet rarely practiced. But equally troubling are the images of invulnerability and conquest propagated by popular media and culture, which suggest that one can “be a sexual hero in one day.”
Schalet is, I think entirely correct in suggesting that ignorance is the real enemy here and not just in terms of fostering risk-taking sexual behaviours which result in unwanted pregnancies, abortions and the spread of STIs but in terms of attitudes towards sex and sexuality generally. Lacking access to honest and realistic information from parents and – sadly – schools, young people have no option but to base their expectations of sex on what they see in the media and in popular culture, where everything (including the news) is exaggerated for dramatic and commercial effect, not to mention raddled with outright hypocrisy.
The second implication of the Dutch case for American healthcare practice is that adolescent sexuality is not only, or even primarily, a biological phenomenon. It is necessary to recognize adolescents’ emotions, desires for intimacy, and real relationships. The notion of raging hormones is deeply ingrained in American folk and healthcare lore. They are blamed for an entire host of behaviors that are thought to be age-appropriate, if dangerous. Yet, the talk of hormones can obscure desires that are deeply social in nature. Regardless of whether or not one believes that sexual intercourse is a healthy form of closeness for a teenage couple, those who provide care to adolescents and their parents would do well to view adolescent sexuality not just as a problem but also as the expression of an age-blind desire for meaningful intimacy and connection with others.
Again, I think we can readily identify conservative religious morality as being the root cause of the problem for its unwillingness to accept that the world has changed and that sex and reproduction are no longer unavoidably connected to each other. One can have and enjoy a sexual relationship without it leading inexorably to procreation and, thanks to IVF and artificial insemination, one can even have children without the messy business of having sex with one’s reproductive partner.
The development of reliable contraceptives and other reproductive technologies has deprived conservative religionists of one of their more powerful tools of social control. One can enjoy a sexual relationship without there being any significant risk of serious consequences, which means that the risks of unwanted pregnancy and STIs are no longer an effective means of battering the masses into submission and enforcing religious morality on the general population and, as in other areas of life, where religions perceived ability to punish the sinner has diminished, so too has its ability to dictate public morality and enforce its rules and social mores on everyone else.
What Schalet’s observation here clearly implies is that, contrary to conservative religious opinion, it is entirely natural for adolescents to form and experience intimate relationships as they make their way into adulthood, even if these do not result in marriage and/or procreation.
What is entirely unnatural, and psychologically unhealthy and damaging, is the demand that they should shun sexual intimacy until such time as they are ready to commit to a life-long relationship – not that most relationship go the full course anyway.
The third implication of the Dutch case is that American families must find their version of talking “normally” about sexuality and that the healthcare profession can help. The Dutch normalization of adolescent sexuality was not a given; it was a particular response to changes in sexual behavior during and after the sexual revolution, a response, moreover, in which members of the medical establishment played a decisive role. In the United States, real-life patterns of sexual behavior have also changed drastically since the mid-1950s. Most people become sexually active before marriage and many continue after marriage. Some people form marriage-like bonds with those of their own sex. In other words, sex and marriage are not related in the way that they once were. Not having a way to talk honestly, and without shame and guilt, about these new patterns of sex and relationships is not good for the health of individuals or for the health of families.
For this current debate, this is perhaps the most important lesson and one which, in conjunction with Schalet’s other observations, shows Dorries to be not just wrong in her pursuit of the inclusion of abstinence teaching in sex education, but not even wrong.
Sex education in Dutch schools is not compulsory, but it is comprehensive, widely accepted by parents and driven by a clear understanding that its primary objectives are those of improving and protecting public health and encouraging and supporting the intellectual, emotional and moral development of young people so as to enable them to become fully-functioning, independent moral agents with the capacity to confidential make their own responsible moral choices.
It not about making anything ‘cool’ least of all abstinence – that’s just patronising crap from a MP whose own moral character is far from exemplary on several counts – its about supporting young people to make a successful transition to adulthood.
That’s enough from me, anyway – just read the full paper and make your own mind up as to the merits of Schalet’s arguments.
To finish, however, I leave you with a couple of quotes.
The first is from a response to Schalet’s paper submitted by a Doctor from Chatannoga, Tennessee, which clearly demonstrates why so many American teenagers are completely fucked up by the transition to adulthood:
To the Editor:
It was with some interest that I read Dr. Schalet’s article regarding adolescent sexuality. One very important aspect she seemed to ignore is the fact that sex outside marriage is morally wrong. The foundations of our country are based on a reliance on God. He was quite clear in the Bible in clarifying what is right and wrong. The fact that we, as humans, fail to exhibit self-control in this area (as we also often do in other areas such as lying, drinking, drug use, obesity, etc) does not mean we should give in to this behavior. I am a strong supporter of sex education. I am not afraid to tell people about contraceptives, condoms, etc. However, I do strongly feel abstinence-based education is the most appropriate and moral approach.
This approach is not “fear-based,” as Dr. Schalet stated, but based on truth and the values upon which this country was founded. We as adults are often unwilling to discipline ourselves in whatever area of weakness we have in our lives. This leads to many being unwilling to discipline or teach discipline to their children. Have you ever met an alcoholic or an obese person (or someone with any other addiction) who just gives up trying to fight the problem? It is sad to see the results of just giving up. The same would be true for sex. Sex outside marriage is immoral and we should never surrender, but always fight against that immoral behavior in our own lives as well as teach it to our children. Failure to do so will result in a moral decay and ultimate destruction of this country.
Last, but by no means least, let’s turn to the poet Phillip Larkin, whojust about nails it when it comes to the consequences of a Dorries’ style education.
They fuck you up, your mum and dad.
They may not mean to, but they do.
They fill you with the faults they had
And add some extra, just for you.
But they were fucked up in their turn
By fools in old-style hats and coats,
Who half the time were soppy-stern
And half at one another’s throats.
Man hands on misery to man.
It deepens like a coastal shelf.
Get out as early as you can,
And don’t have any kids yourself.