Tuesday, 17 March 2015

Sexual health and Canadian youth: How are we doing?

Sexual health is multidimensional and involves the achievement of positive outcomes such as mutually rewarding interpersonal relationships and desired parenthood as well as the avoidance of negative outcomes such as unwanted pregnancy and STI/HIV infection (Public Health Agency of Canada, 2008). Trends in teen pregnancy, sexually transmitted infections, age of first intercourse, and condom use are often used to generally assess the status of the sexual health of Canadian youth. With respect to teenage pregnancy, it can be assumed that a large proportion of teen pregnancies, particularly among younger teens, are unintended.

Teen pregnancy rates are therefore a reasonably direct indicator of young women’s opportunities and capacity to control this aspect of their sexual 
and reproductive health. In Canada, the pregnancy rate (live births/induced abortions/fetal loss) for both younger (age 15-17) and older (age 18-19) teenage women has fallen significantly over the last several decades (McKay, 2006). More recently, the pregnancy rate among 15-19 year-old females declined from 47.6 per 1,000 in 1995 to 29.2 per 1,000 in 2005 (Statistics Canada, 2009). The recent decline in teen pregnancies has been most pronounced among younger teens aged 15-17, for whom the pregnancy rate declined from 28.5 per 1,000 in 1995 to 15.8 per 1,000 in 2005 (Statistics Canada, 2009). Sexually transmitted infections (STI) pose a significant threat to the health and well-being of Canadian youth and the prevalence of common

1. Sexual health and Canadian youth: How are we doing? (continued)

STI such as Chlamydia and Human papillomavirus (HPV) is highest among youth and young adults. Chlamydia is of particular concern because, if left untreated, it can have serious long-term consequences for the reproductive health of women (Public Health Agency of Canada, 2006). Reported rates (the number of positive test reports made to public health agencies) of Chlamydia have been increasing steadily in recent years (Public Health Agency of Canada, 2009). However, it is important to recognize that reported rates are not a measure of prevalence (the percentage of the population that is infected) and that much of the increase in the reported rate of Chlamydia is likely due to the increasing use of more sensitive testing technologies and a greater number of young people being tested (McKay & Barrett, 2008). Nevertheless, small scale prevalence studies in Canada have found rates of Chlamydia infection ranging from 3.4% among young women tested at family physician’s offices (Richardson, Sellors, Mackinnon, et al., 2003) to 10.9% among female street youth (Shields, Wong, Mann, et al., 2004). In sum, the prevalence of Chlamydia infection among youth and young adult Canadians is unacceptably high. For a majority of Canadians, first sexual intercourse occurs during the teenage years (Maticka-Tyndale, 2008: Rotermann, 2008).

Overall, the percentage of Canadian youth who report ever having had sexual intercourse has declined since the mid-1990’s (Rotermann, 2008; Saewyc, Taylor, Homma, & Ogilvie, 2008). For example, data from the Canadian Community Health Survey indicates that the percentage of 18/19 year-olds who had ever had intercourse declined from 70% in 1996/1997 to 65% in 2005 (Rotermann, 2008). Research from both Canada and the United States indicates that oral sex is about as common as intercourse and typically occurs at about the same time as intercourse, although up to a quarter of teens may begin having oral sex before starting to have intercourse (Maticka-Tyndale, 2008). The percentage of sexually active Canadian youth who report using a condom at last intercourse has increased in recent years (Rotermann, 2008; Saewyc, et al, 2008). For example, among the participants in the B.C. Adolescent Health Survey, condom use rose from 64.6% in 1992 to 74.9% in 2003 (Saewyc et al., 2008). Short-term trends are encouraging as well: For teens aged 15-19 participating in the Canadian Community Health Survey condom use at last intercourse rose from 72% in 2003 to 75% in 2005 (Rotermann, 2008). While condom use among sexually active Canadian youth has clearly increased overall, there is also a persistent trend for the relatively high rates of condom use among younger sexually active teens to decline as teens get older (Rotermann, 2008; Saewyc et al., 2008). For example, among Canadian Community Health Survey participants aged 15-19, 81% of sexually active 15-17 yearolds reported using a condom at last intercourse compared to 70% of 18-19 year-olds (Rotermann, 2008). This pattern of condom use declining with age among sexually active young people has been clearly evident in other surveys of Canadian youth (Boyce, Doherty, Fortin, & MacKinnon, 2003; Saewyc et al., 2008).

The propensity for older sexually active teens and young adults in Canada to discontinue consistent condom use is a clear indication that many young people in Canada underestimate their risk for sexually transmitted infection (Chlamydia reported rates are highest among 20-24 year-olds). On basic indicators of sexual health, Canadian young people have made progress in many respects. Rates of teenage pregnancy have declined steadily, the percentage of teens who have had intercourse has also declined in recent years, and rates of condom use among sexually active young people have increased. However, there are important challenges that remain to be adequately addressed.

The prevalence of sexually transmitted infections among Canadian young people is unacceptably high and poses a significant threat to their current and long-term health and well-being. Many gay, lesbian, bisexual, and questioning youth receive insufficient sexual health education relevant to their needs (For full discussion of the range of sexual health challenges facing Canadian youth see Maticka-Tyndale, 2008). In order to effectively promote the sexual health and overall well-being of our young people, Canadian families, schools, health care providers, public health agencies, governments, and communities must share in the responsibility to provide high quality sexual health education and services. 


Post a Comment