Abstract
Having sex for the first time is a major milestone in life that almost everyone reaches. In New Zealand, around 37% of secondary school students have had sex by the age of 16 years and around 46% by the age of 17 or more.1 Becoming sexually active brings both risks and rewards. Policy makers are generally most concerned with the risks, particularly the risks of early unintended pregnancy and sexually transmitted infections and the associated costs to society. Good sexual health, however, is more than not contracting a sexually transmitted infection and not being involved in an unintended pregnancy. It has both individual and public health dimensions, as indicated by the following broad definition of sexual health, developed in the US:
‘Sexual health is a state of well-being in relation to sexuality across the life span that involves physical, emotional, mental, social, and spiritual dimensions. Sexual health is an intrinsic element of human health and is based on a positive, equitable, and respectful approach to sexuality, relationships, and reproduction, that is free of coercion, fear, discrimination, stigma, shame, and violence. It includes: the ability to understand the benefits, risks, and responsibilities of sexual behaviour; the prevention and care of disease and other adverse outcomes; and the possibility of fulfilling sexual relationships. Sexual health is impacted by socioeconomic and cultural contexts—including policies, practices, and services—that support healthy outcomes for individuals, families, and their communities.’2
Supporting young people to attain sexual health as defined above is clearly not something the health system can accomplish on its own, nevertheless there is an important role for the health system in helping young people to avoid unwanted pregnancy, providing care to young pregnant women, and preventing and treating sexually transmitted infections.
This in-depth topic considers ways of improving the sexual and reproductive health of New Zealand adolescents and young adults. It focuses on the prevention of unintended teenage pregnancy but also touches on the prevention of sexually transmitted infections. It does not deal with maternity services for pregnant teenagers or services for teenage parents because a previous in-depth topic in this series of reports (2012) was entitled Services and Interventions for Women Experiencing Multiple Adversities in Pregnancy and this included a substantial section on services for teenage parents.3
It begins by summarising what is known about the sexual behaviour of young people in New Zealand. It then reviews sexuality education, sexual and reproductive health services for young people, and contraceptive options for young people (with a particular focus on long-acting reversible methods). It concludes with some recommendations for improving the sexual and reproductive health of New Zealand young people and preventing unintended teenage pregnancies.
This choice of areas for review was influenced by the 2013 report of the Health Committee (one of the select committees of the New Zealand Parliament) Inquiry into improving child health outcomes and preventing child abuse with a focus from preconception until three years of age.4 One of the major recommendations which came out of the inquiry was as follows:
‘We recommend to the Government that it develop a co-ordinated cross-sectoral action plan with the objective of giving New Zealand world-leading, best-practice evidence-based sexuality and reproductive health education, contraception, sterilisation, termination, and sexual health services, distributed to cover the whole country. The plan should be developed within 12 to 18 months of this report being published, and be matched with appropriate, sustainable resourcing. The plan should also be monitored by trends in teenage pregnancy, sexually transmitted diseases, unplanned pregnancy, and terminations.’
It should be borne in mind that in developed countries teenage pregnancy (except in the youngest teenagers) is not so much a medical problem as a social problem.5 Many of the adverse medical outcomes attributed to teenage pregnancy, such as prematurity and low birth weight, are probably mostly due to the poor socio-economic circumstances and associated risk-taking behaviours that predispose young women to early pregnancy.6,7 It should not be assumed that if women in the most deprived communities would only delay their first birth by five years or ten years, then that alone would inevitably improve outcomes for them and their children.