The American Academy of Pediatrics, a national organization of pediatric healthcare providers, recently issued a position statement that advocates pediatricians not only teach teens how to use condoms but also to dispense them in the office. Intuitively, this makes sense. Used correctly and consistently, condoms decrease the risk of acquiring sexually transmitted infections (STI’s) and unwanted pregnancies. Therefore, increased availability of condoms coupled with more education should lead to decreased rates of STIs and pregnancy among teens.
However, the reality is likely to be otherwise. This is why another national pediatric organization, the American College of Pediatricians, favors, instead of dispensing condoms, the aggressive forging of family connections throughout childhood and adolescence.
As America approaches nearly four decades of condom and contraception-centered sexuality education in schools and physician offices across the nation with increased availability of condoms and contraception to teens, how have American adolescents fared? The answer is: not well. Adolescents now face a growing three-part epidemic of STIs, teen pregnancy and depression.
Sexually active adolescents and young adults under age 25 account for 50 percent of the 19 million new cases of STIs annually in the United States. One in five Americans over age 12 is infected with genital herpes, and one in four sexually active girls over age 13 is infected with at least one STI. In short, America has failed to achieve a level of condom use among teens that would come close to eliminating those STIs for which condoms are most preventive (chlamydia, gonorrhea and HIV) let alone those for which condoms are least preventive (herpes and human papillomavirus, or HPV).
Equally concerning, one in thirteen high school girls becomes pregnant each year in America. Adolescent pregnancy results in decreased educational and vocational opportunities for the mothers, increased likelihood of the family living in poverty, and significant risk for negative long-term outcomes for the children.
This paradoxical association of increased contraception and/or condom use coupled with increasing rates of STIs and in some cases, increasing rates of teen pregnancy, among adolescents is not limited to the United States. Thailand experienced an increase in STI transmission rates among its youth despite extensive promotion of condoms. Similarly, in Spain, STIs have increased despite rates of youth condom use being among the highest in Europe.
Since 2000 Britain, in addition to promoting condoms, has provided the morning after pill to teens for free. What has followed is a 5 percent increase in STIs among the under-18 age group, and a 12 percent increase among the under-16’s. At best, there has been no impact upon teen pregnancy rates; at worst, some evidence points to a small increase in the number of teenage pregnancies. There are two reasons for these trends: adolescent cognitive development and risk compensation.
The frontal cortex of the brain is responsible for executive functioning skills. In adolescents, this part of the brain is still in development and unable to consistently control actions in emotional situations. Thus, teens may repeat ad nauseum that condoms will only decrease risk of disease and pregnancy when used correctly during every single sexual act, and may prove they are skilled at applying a condom over a banana in a physician’s office, but this does not mean that they will take these precautions in the throes of passion. In fact, most cannot.
A second reason for the paradox is the phenomenon of risk compensation. Risk compensation is a theory of behavior which observes that people behave less cautiously in situations in which they feel more protected. Among those adolescents and adults who do use condoms and contraception correctly and consistently, they may end up engaging in sex more frequently and with more partners, thus negating the protection offered.
The bad news does not stop there, however. Even if physicians could guarantee that sexually active teens escape STIs and pregnancy, there is not now, nor will there ever be, a condom, contraceptive or vaccine for the heart. Teenage sexual activity is an independent risk factor for developing low self-esteem, major depression, and increased risk of suicide.
In studies that controlled for confounding factors, sexually active girls were found to be three times as likely to report being depressed and three times as likely to have attempted suicide when compared to sexually abstinent girls. Sexually active boys were more than twice as likely to suffer from depression and seven times as likely to have attempted suicide when compared to sexually abstinent boys. This is not mere coincidence.
Scientists now know that sexual activity releases chemicals in the brain that create emotional bonds between partners. Breaking these bonds can cause depression and make it harder to bond with someone else in the future. Clearly, sexual abstinence is the only way to guarantee optimal sexual and mental health for adolescents.
Studies demonstrate that parents who promote abstinence and have a history of open communication with their children are successful in delaying sexual debut. The promotion and distribution of condoms and contraception by physicians undermines the authority of parents and the strength of the abstinence message. Instead, parents and physicians must work together repeatedly offering clear, firm guidance regarding how to attain optimal health while maintaining emotional warmth and connection.
Michelle Cretella MD is the Vice-President of the American College of Pediatricians and chairs the College’s Committee on Adolescent Sexuality. She is also a member of the American Academy of Pediatrics.
For more information visit the following websites:
American College of Pediatricians: www.Best4Children.org
Medical Institute for Sexual Health – Building Family Connections: http://www.buildingfamilyconnections.org/
National Physicians Center – Prescriptions for Parents: http://www.physicianscenter.org/v1/videos.php
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