Teen Sex: Lessons From Europe (Again)

LONDON -- Well, here's something to pop your eyes open in case you can't quite shake that post-election torpor. A county in the U.K. has just authorized pharmacies to distribute birth control pills to girls as young as 13, without parental consent.

It's a pilot project in the Isle of Wight, best known as a British tourist destination for its ye olde worlde charm. Under the project, teenagers who approach a pharmacist for the morning-after pill will also be able to get a month's supply of the contraceptive pill without seeing a doctor or informing their parents. After that month is up, girls must make an appointment with their general practitioner or sexual health nurse in order to get any additional supplies.

The campaign is aimed at reducing unwanted pregnancies, which have crept up on the island in recent years. According to Jennifer Smith of the local branch of the National Health Service, which approved the project: "I would suggest that what we're doing is being entirely responsible by providing [contraception to] these most vulnerable women, for whom, for the most part, pregnancy is not a good outcome. We are linking them with people most able to support them in further decision-making and appropriate behavior in the future."

The project follows on the heels of an announcement last month that the BBC will air an hour-long documentary on the link between oral sex and rising occurrence of mouth and throat cancer among young Britons. Oral cancer has gone up by 50 percent in men since 1989 and is rising by 3 percent a year in women, even as smoking, once thought to be the major cause, declines. The main culprit is the human papilloma virus, which is spread through sexual contact, including oral sex.

Meanwhile, in other news, a prominent British health care watchdog organization is advocating that pre-natal clinics be set up in schools to counsel teens who are already pregnant and frequently fail to get proper advice and treatment.

It's tempting to just write all of this off as yet another chapter in the Department of Can You Imagine This Happening in the U.S.? (I write a lot of those pieces.) Like so many of their European brethren, the Brits have a more open, realistic and pragmatic approach towards dealing with teen pregnancy than their cousins on the other side of the Atlantic.

But, of course, we all know that teen sex and teen pregnancy are hardly limited to the European continent. Although teen birth rates appear to be dropping in recent years, the U.S. still boasts the highest teen pregnancy rate in the industrialized world. According to the Centers for Disease Control, one-third of girls get pregnant before the age of 20. American teens also use condoms and birth control pills considerably less than their counterparts in other industrialized countries, have more abortions and considerably higher rates of HIV and STDs.

Oh, yes, you say. But what about that other kind of sex? You know, the kind that -- according to The National Survey of Sexual Health and Behavior -- shows teenagers engaging in with quite a bit of enthusiasm? (Sixty-one percent of boys and girls have performed oral sex by the time they graduate from high school.)

Turns out that oral sex is intimately linked (so to speak) to intercourse. A study out earlier this week tracking the sexual activity of 600 high school students in California found that teens who had oral sex by the end of ninth grade had a 25 percent chance of having intercourse by the end of that same grade level and a 50 percent chance by the end of 11th grade. Or as Gawker put it, oral sex is the "gateway drug" to vaginal sex. Which means that oral sex also puts teens at risk for sexually transmitted diseases and pregnancy (as the British data suggest).

So . . . what do we do with all this information?

In an ideal world, as my colleague Bonnie Erbé has argued regarding the controversial new morning after pill (Ella), we could start by separating out religious mores from public policy in the United States. Then we might be able to think about combating teen pregnancy and sexual disease on a scientific, not moral, basis. But that doesn't look feasible, at least in the short run.

For the moment, the Health and Human Services agency has decided not to include contraception in its list of "essential" preventative health care services that are exempted from co-payments or deductibles, at least until it has given the issue further study. While it's impossible to know the rationale behind this decision, conservative groups such as the Heritage Foundation as well as the National Abstinence Education Association -- not to mention the Catholic Church -- lobbied strongly against including contraception in the preventative health category.

But perhaps we can at least begin by being more frank and open with our youngsters about different kinds of sex and different kinds of risks, as my colleague Suzi Parker advocated recently, echoing former Surgeon General Joycelyn Elders. That sort of approach certainly seems to be working in the Netherlands. There, particularly with regard to (gasp) sleepovers with your boyfriend/girlfriend in your parents' home -- respect for and acceptance of teenage sexuality appears to have produced healthy attitudes and results, especially when compared with those in the U.S.

I don't know about you, but I think I'd rather take my cues on this topic from the Dutch than from the likes of Christine O'Donnell.

Just sayin'. .
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