Doctors should not advise adolescents to abstain from sex

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7296.1244/a (Published 19 May 2001) Cite this as: BMJ 2001;322:1244
  1. Lieve Peremans, research assistant (lieve.peremans{at}ua.ac.be),
  2. Paul Van Royen, professor,
  3. Dirk Avonts, professor,
  4. Joke Denekens, professor
  1. Centre for General Practice, University of Antwerp-UA, 2610 Antwerp, Belgium

    EDITOR—In recent years rates of teenage pregnancy and abortions, and the prevalence of sexually transmitted diseases have increased in Belgium and other European countries.1 Against this background Stammers and Ingham considered whether advising should be an effective response to declining sexual health in teenagers.2 Both advocated their opinion with valid arguments, but there is insufficient evidence to justify one of the two opinions.

    To determine the needs and expectations of adolescent girls concerning contraceptive use as well as their attitude to healthcare providers we conducted qualitative research with focus groups of 17 year old girls.3 Afterwards a survey conducted among more than 700 adolescents in schools in Antwerp confirmed the results. The girls' knowledge concerning the daily use and side effects of contraceptives was insufficient. Most of them had a good relationship with their parents, especially their mothers. Nearly 50% of the girls preferred to talk to their mother about contraceptives and sexual health.

    Wellings et al also described an increased proportion of girls citing parents as the main source of information.4 Other important sources of information are female friends, sisters, and doctors. General practitioners especially play an important part in giving information about the use of contraceptives.

    More sexually experienced girls following their mothers' advice used oral contraceptives when they had their first sexual intercourse than girls who did not seek advice at home (55% v 30%, χ2=15.71; P<0.005). Girls who did not seek advice at home displayed unsafe contraceptive behaviour (17% v 9%), and used more emergency contraception (morning after pills) (69% v 31%, χ2=4.15; P<0.05). In both groups, 67% of girls used condoms. Those who followed their mothers' advice consulted gynaecologists more often (22% v 14%, χ2=10.93; P<0.025). Young et al also found that parents play an important part in communication about sexual behaviour.5

    Healthcare providers should not directly advise adolescents to abstain from sex. They can encourage girls to talk to their parents. Besides, adolescents want an open approach to sexual conduct. In our survey more than 70% of adolescents give a score of 8 or more on a visual analogue scale for the following attitudes from their doctor: the doctor is serene, listening to me, taking time, or showing respect. S/he is answering my questions, but only those I want to discuss. Sexually transmitted diseases and relationships are subjects adolescents prefer to discuss with their parents and friends. Our research supports an open approach and better communication of healthcare providers and parents.


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