Too far, too young (Part 2)

A dearth of data on sexual activityAnecdotally, we know that young people are becoming sexually active at increasingly early ages, but hard facts are difficult to come by. There is a dearth of data. "People are becoming sexually active at around 15 or 16 years," says one 16-year-old boy, "but there aren't many in my class - only about three or four. If they were, they would be boasting about it."

Two years ago, however, Alliance, the Centre for Sexual Health, Cork, carried out a survey - What on Earth Are They Doing? - among young people aged between 15 and 24 years. The survey found that 30 per cent of girls and 45 per cent of males in the 15-to-17 age group have had sexual intercourse. Over one quarter of the boys and almost one in 10 girls have had between three and five partners.

Most young people, though, tend to have one or two sexual partners over a 12-month period. Some 60 per cent of the age group report using condoms, while 14 per cent of boys and 27 per cent of girls admit using no contraceptives on the last occasion they had sex.

The most common reasons the young people give for not using contraceptives are that they were not available at the time or that they were overly influenced by alcohol. Almost one-third of 15- to 17-year-olds say that they would find it difficult to buy condoms, while a further 12 per cent report being unsure.

"In our work," says Deirdre Seery, Alliance's director, "we find that there are huge differences between young people. Some people are very comfortable talking about sex, others are not. A lot of people are protecting themselves by either not having sex or by using condoms."

She identifies a further group of young people, who are simply not ready to be sexually active and feel that there is something wrong with them because they feel this way. "They feel pressured that they should be having sex," she says. "This pressure is dangerous - they go off and get drunk and then have sex - often unsafe sex."

It's important that youngsters be aware that their lack of interest in sex is also normal, says Seery. "Some people aren't ready to have sex when they're 18. We try to advise people not to have sex until they feel ready for it."

Very young teenagers who are sexually active don't come to family planning clinics, says Dr Sheila Jones, medical director of the Irish Family Planning Association (IFPA). However, "we are seeing increasing numbers of teenagers coming in for the morning after pill. They're usually aged from 15 up, but occasionally we get younger people." She points to the need for greater information for young people.

"They have very sketchy knowledge of sexuality and contraception," says Jones. "There is a great need for good relationship and sexuality education."

A recent IFPA survey of young people in Dublin showed that 60 per cent of respondents have no knowledge of services giving advice on sexual health. They are reluctant to visit GPs. Girls, in particular, say that they find visiting the family GP embarrassing and fear reproach or a breach of confidentiality. Most girls would prefer a female GP.

Many youngsters report a basic knowledge of contraception and all of them are aware of the condom. However, some young people report being unsure about how to use them.

The IFPA highlights the need for a young people's health service in Dublin. "In Britain there are special clinics for young people and we need something like that here," Jones says. "We need centres where they can get advice on contraception and general health issues - smoking, diets, drugs and sexually transmitted diseases." There's anecdotal evidence, too, that the incidences of sexually transmitted diseases (STDs) are increasing among young people. Between 1989 and 1994, the number of cases of STDs in the general population, notified to the Department of Health, almost doubled. In 1996, 247 STD incidents were reported in people under 20 years of age. Ano-genital warts accounted for 91 of the cases, while 20 cases of chlamydia and 11 cases of genital herpes simplex were also reported.

"We are particularly concerned about the rise of STDs among young people," says Alliance's Deirdre Seery. "A lot of young people know nothing about STDs. If people know that they have them they can be treated but, when they don't know, they suffer in silence and pass them on."

Chlamydia, notes a doctor working in an STD clinic, is a major problem since if left unattended it can lead to infertility, chronic pelvic pain and ectopic pregnancy. There's evidence, too, that sexual intercourse from a very young age can contribute to cervical cancer in women.

"If you start your sex life young you will increase your opportunities to have multiple partners," says Seery. "Because young people are involved in one relationship at a time they don't see it like that."

Interestingly, despite the extra sexual activity among teenagers, the birth rate to young teenage mothers has remained relatively constant over the past decade or so. In 1987, for example, 50 births were registered to under 15-year-olds and 144 births to 16-year-olds.

In 1997, meanwhile, 56 births were registered to under 15-year-olds and 207 births to 16-year-olds. "I don't get the impression that the number of births to teenage mothers is increasing," says Dr Peter McKenna, master of the Rotunda Hospital, Dublin. "The teenage pregnancies we see are mostly from less advantaged families. But that doesn't mean it reflects in the sexual activity of young people. They could be using contraception or going for termination."

British statistics show that in 1987, 556 abortions were carried out on Irish women who were under 20 years of age. By 1995, that figure had risen to 698. However, since it's widely accepted that many women do not give Irish addresses, these figures could be considerably higher.