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REVIEW

Improving adolescent sexual and reproductive health. A view from Australia: learning from world’s best practice

Henrietta Williams A B C and Sandra Davidson B
+ Author Affiliations
- Author Affiliations

A Family Planning Victoria, 901 Whitehorse Road, Box Hill, Vic. 3128, Australia.

B Department of General Practice, Monash University.

C Author for correspondence; email: hwilliams@fpv.org.au

Sexual Health 1(2) 95-105 https://doi.org/10.1071/SH03023
Submitted: 10 December 2003  Accepted: 30 March 2004   Published: 24 June 2004

Abstract

There is increasing awareness worldwide of the importance of sexual and reproductive health in adolescents. Australia's high rates of teenage pregnancy and increasing rates of sexually transmitted infections in young people reflect a failure to prioritise adolescent sexual and reproductive health on the public health agenda. This paper reviews adolescent sexual and reproductive health in Australia in comparison with international data, and examines the systemic, social and cultural factors that influence it. Based on comparisons with international best practice, recommendations are included for improvement in adolescent sexual and reproductive health within the Australian context.


References


[1] WHO. The second decade: improving adolescent health and development. Geneva: World Health Organisation; 1998.

[2] Social Exclusion Unit. Teenage pregnancy. London, UK: The Stationary Office; 1999.

[3] Bayley O. Improvement of sexual and reproductive health requires focusing on adolescents. Lancet 2003; 362(9386): 830–1.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[4] UNICEF. A league table of teenage births in rich nations. Innocenti report card. Florence: UNICEF; 2001.

[5] Blumer C,  Roche P,  Spencer J,  Lin M,  Milton A,  Bunn C, et al. Australia’s notifiable diseases status, 2001: annual report of the National Notifiable Diseases Surveillance System. Commun Dis Intell 2003; 27(1): 1–78.
PubMed |

[6] Westenberg L,  van der Klis KA,  Chan A,  Dekker G,  Keane RJ. Aboriginal teenage pregnancies compared with non-Aboriginal in South Australia 1995–1999. Aust N Z J Obstet Gynaecol 2002; 42(2): 187–92.
PubMed |

[7] WHO. Gender and reproductive rights. Considerations for formulating reproductive health laws Ref. WHO/RHR/00.1. Geneva: World Health Organisation; 2000.

[8] Ford J , Nassar N , Sullivan E , Chambers G , Lancaster P . Reproductive health indicators, Australia, 2002. Sydney: AIHW National Perinatal Statistics Unit; 2002.

[9] Yusuf F,  Siedlecky S. Legal abortion in South Australia: a review of the first 30 years. Aust N Z J Obstet Gynaecol 2002; 42(1): 15–21.
PubMed |

[10] van der Klis KA,  Westenberg L,  Chan A,  Dekker G,  Keane RJ. Teenage pregnancy: trends, characteristics and outcomes in South Australia and Australia. Aust N Z J Public Health 2002; 26(2): 125–31.
PubMed |

[11] Fraser AM,  Brockert JE,  Ward RH. Association of young maternal age with adverse reproductive outcomes. N Engl J Med 1995; 332(17): 1113–7.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[12] Hoffman SD. Teenage childbearing is not bad after all... or is it? A review of the new literature. Fam Plann Perspect 1998; 30(5): 236–43.
PubMed |

[13] Mellanby AR,  Pearson VA,  Tripp JH. Preventing teenage pregnancy. Arch Dis Child 1997; 77(5): 459–62.
PubMed |

[14] Hotz V . The impacts of teenage child bearing on the mothers and the consequences of those impacts for government. Washington D.C.: Kids having kids; 1997.

[15] Grogger J,  Bronars S.. The socioeconomic consequences of teenage childbearing: findings from a natural experiment. Fam Plann Perspect 1993; 25(4): 156–61.
PubMed |

[16] Donovan B. Rising prevalence of genital Chlamydia trachomatis infection in heterosexual patients at the Sydney Sexual Health Centre, 1994 to 2000. Commun Dis Intell 2002; 26(1): 51–4.
PubMed |

[17] Public Health Division, Department of Human Services Victoria. Chlamydia strategy for Victoria 2001–2004. 2001.

[18] Fleming DT,  McQuillan GM,  Johnson RE,  Nahmias AJ,  Aral SO,  Lee FK, et al. Herpes simplex virus type 2 in the United States, 1976 to 1994. N Engl J Med 1997; 337(16): 1105–11.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[19] Stamm WE. Chlamydia trachomatis infections: progress and problems. J Infect Dis 1999; 179 S380–3.
PubMed |

[20] Laga M,  Manoka A,  Kivuvu M,  Malele B,  Tuliza M,  Nzila N, et al. Non-ulcerative sexually transmitted diseases as risk factors for HIV-1 transmission in women: results from a cohort study. AIDS 1993; 7(1): 95–102.
PubMed |

[21] Fleming DT,  Wasserheit JN. From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm Infect 1999; 75(1): 3–17.
PubMed |

[22] Philpot CR. Impact of chlamydia and herpes infections on the community. Aus Microbiol 1986; 7 11–7.


[23] Smith AMA,  Rissel CE,  Richters J,  Grulich AE,  de Visser RO. Sex in Australia: the rationale and methods of the Australian study of health and relationships. NZ J Public Health 2003; 27(2): 106–17.


[24] Lindsay J , Smith A , Rosenthal D . Secondary students, HIV/AIDS and sexual health. Melbourne: La Trobe University; 1997.

[25] Rissel CE,  Richters J,  Grulich AE,  de Visser RO,  Smith AMA. First experiences of vaginal intercourse and oral sex among a representative sample of adults. NZ J Public Health 2003; 27(2): 131–7.


[26] Smith A , Aguis P , Dyson S , Mitchell A , Pitts M . Secondary students & sexual health. Results of the 3rd national survey of Australian secondary students, HIV/AIDS and sexual health. Melbourne: La Trobe University; 2002.

[27] Cowan FM. Adolescent reproductive health interventions. Sex Transm Infect 2002; 78(5): 315–8.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[28] Kirby D. Effective approaches to reducing adolescent unprotected sex, pregnancy, and childbearing. J Sex Res 2002; 39(1): 51–7.
PubMed |

[29] Kirby D,  Resnick MD,  Downes B,  Kocher T,  Gunderson P,  Potthoff S, et al. The effects of school-based health clinics in St. Paul on school-wide birthrates. Fam Plann Perspect 1993; 25(1): 12–6.
PubMed |

[30] Aral SO , Holmes KK . Social and behavioral determinants of the epidemiology of STDs: industrialized and developing countries. In: Holmes KK, Sparling PF, Mardh P, et al., editors. Sexually transmitted diseases. 3rd ed. McGraw-Hill; 1999.

[31] Holtgrave DR,  Crosby RA. Social capital, poverty, and income inequality as predictors of gonorrhoea, syphilis, chlamydia and AIDS case rates in the United States. Sex Transm Infect 2003; 79(1): 62–4.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[32] Kirby D. Antecedents of adolescent initiation of sex, contraceptive use, and pregnancy. Am J Health Behav 2002; 26(6): 473–85.
PubMed |

[33] Smith T. Influence of socioeconomic factors on attaining targets for reducing teenage pregnancies. BMJ 1993; 306(6887): 1232–5.
PubMed |

[34] McPherson A,  Macfarlane A. Contraception in general practice before teenage pregnancy. Ambition may be best contraception. BMJ 2001; 322(7282): 363.
PubMed |

[35] Sex and America’s Teenagers. New York: Alan Guttmacher Institute; 1994.

[36] Rademakers J . Sex education research in the Netherlands. European Study Tour 1998. Leiden, Netherlands; 1998

[37] Wellings K,  Wadsworth J,  Johnson AM,  Field J,  Whitaker L,  Field B. Provision of sex education and early sexual experience: the relation examined. BMJ 1995; 311(7002): 417–20.
PubMed |

[38] Wellings K,  Nanchahal K,  Macdowall W,  McManus S,  Erens B,  Mercer CH, et al. Sexual behaviour in Britain: early heterosexual experience. Lancet 2001; 358(9296): 1843–50.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[39] Anonymous . Abstinence, monogamy, and sex. Lancet 2002; 360(9327): 97.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[40] Kirby D,  Short L,  Collins J,  Rugg D,  Kolbe L,  Howard M, et al. School-based programs to reduce sexual risk behaviors: a review of effectiveness. Public Health Rep 1994; 109(3): 339–60.
PubMed |

[41] UNAIDS/WHO. Sex education does not lead to earlier or increased sexual activity in youth. Geneva: World Health Organisation Global Program on AIDS; 1998.

[42] Mellanby AR,  Phelps FA,  Crichton NJ,  Tripp JH. School sex education: an experimental programme with educational and medical benefit. BMJ 1995; 311(7002): 414–7.
PubMed |

[43] DiCenso A,  Borthwick VW,  Busca CA,  Creatura C,  Holmes JA,  Kalagian WF, et al. Completing the picture: adolescents talk about what's missing in sexual health services. Can J Public Health 2001; 92(1): 35–8.
PubMed |

[44] Feldmann J,  Middleman AB. Adolescent sexuality and sexual behavior. Curr Opin Obstet Gynecol 2002; 14(5): 489–93.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[45] UNAIDS/WHO. Learning and teaching about AIDS in school. Geneva: World Health Organisation; 1997.

[46] Dyson S . Don’t ask don’t tell: hidden in the crown. Documenting the links between sexuality and suicidal behaviours among young people. Melbourne: Australian Research Centre in Sex, Health and Society, La Trobe University, Australia; 2003.

[47] Blake SM,  Ledsky R,  Lehman T,  Goodenow C,  Sawyer R,  Hack T. Preventing sexual risk behaviors among gay, lesbian, and bisexual adolescents: the benefits of gay-sensitive HIV instruction in schools. Am J Public Health 2001; 91(6): 940–6.
PubMed |

[48] Berne L , Huberman B . European approaches to adolescent sexual behavious and responsibility. Washington DC.: Advocates for youth; 1999.

[49] Ketting E,  Visser AP. Contraception in The Netherlands: the low abortion rate explained. Patient Educ Couns 1994; 23(3): 161–71.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[50] Landry D. Factors associated with the content of sex education in US public secondary schools., 35 (6): 261–269). Perspect Sex Reprod Health 2002; 35(6): 261–9.


[51] Donovan P. School-based sexuality education: the issues and challenges. Fam Plann Perspect 1998; 30(4): 188–93.
PubMed |

[52] Blake SM,  Ledsky R,  Goodenow C,  Sawyer R,  Lohrmann D,  Windsor R. Condom availability programs in Massachusetts high schools: relationships with condom use and sexual behavior. Am J Public Health 2003; 93(6): 955–62.
PubMed |

[53] Darroch J , Singh S . Why is teenage pregnancy declining? The roles of abstinence, sexual activity and contraceptive use. New York, USA: The Alan Guttmacher Institute; 1999.

[54] Rosenthal SL,  Von Ranson KM,  Cotton S,  Biro FM,  Mills L,  Succop PA. Sexual initiation: predictors and developmental trends. Sex Transm Dis 2001; 28(9): 527–32.
PubMed |

[55] Dunt D,  Day N,  Pirkis J. Evaluation of a community-based health promotion program supporting public policy initiatives for a healthy diet. Health Promot Internation 1999; 14(4): 317–20.
Crossref | GoogleScholarGoogle Scholar |

[56] Coenen AJ,  Berends R,  Van der Meijden WI. The organization of STI control in the Netherlands - an overview. Int J STD AIDS 2002; 13(4): 254–60.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[57] Ketting E. Contraception and fertility in the Netherlands. Fam Plann Perspect 1983; 15(1): 19–25.
PubMed |

[58] Ketting E . The family planning and sexual health revolution in the Netherlands. Utrecht: NISSO; 1995.

[59] Kantor LM. Scared chaste? Fear based educational curricula. SIECUS Rep 1992; 21(2): 1–5.


[60] Brown JD. Mass media influences on sexuality. J Sex Res 2002; 39(1): 42–5.
PubMed |

[61] Diclemente RJ. Predictors of HIV-preventive sexual behavior in a high-risk adolescent population: the influence of perceived peer norms and sexual communication on incarcerated adolescents' consistent use of condoms. J Adolesc Health 1991; 12(5): 385–90.
PubMed |

[62] Trussell J,  Leveque JA,  Koenig JD,  London R,  Borden S,  Henneberry J, et al. The economic value of contraception: a comparison of 15 methods. Am J Public Health 1995; 85(4): 494–503.
PubMed |

[63] Lindsay J,  Smith AM,  Rosenthal DA. Conflicting advice? Australian adolescents’ use of condoms or the pill. Fam Plann Perspect 1999; 31(4): 190–4.
PubMed |

[64] Hillier L,  Harrison L,  Warr D. ‘When you carry condoms all the boys think you want it’: negotiating competing discourses about safe sex. J Adolesc 1998; 21(1): 15–29.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[65] Warr D,  Hillier L. ‘That’s the problem with living in a small town’: privacy and sexual health issues for young rural people. Aust J Rural Health 1997; 5(3): 132–9.
PubMed |

[66] Rosenthal D,  Smith AMA. Adolescents, sexually transmitted diseases, and health propotion: information sources, preferences, and trust. Health Promot J Aus 1995; 5(3): 38–44.


[67] Ethier KA,  Kershaw T,  Niccolai L,  Lewis JB,  Ickovics JR. Adolescent women underestimate their susceptibility to sexually transmitted infections. Sex Transm Infect 2003; 79(5): 408–11.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[68] Alaszewski A,  Horlick-Jones T. How can doctors communicate information about risk more effectively? BMJ 2003; 327(7417): 728–31.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[69] Pidgeon N , Hood C , Jones D , Turner B , Gibson R . Risk perception. Risk: analysis, perception and management. London: Royal Society; 1992. p. 89–134.

[70] Calman KC,  Bennett PG,  Coles DG. Risks to health: some key issues in management, regulation and communication. Health Risk Soc 1999; 1 107–16.


[71] Blum RW,  Stark T. Cognitive development in adolescence. Clinical cues and implication. Semin Adolesc Med 1985; 1(1): 25–32.
PubMed |

[72] Robinson AJ,  Rogstad K. Adolescence: a time of risk taking. Sex Transm Infect 2002; 78(5): 314–5.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[73] Warren C,  Neer B. Perspectives on internatinal sex practices and American family sex communication relevant to teenage sexual behavior in the US. Health Commun 1992; 4 121–36.


[74] Wilson D . Intergenerational communication within the family. Washington, DC: International Centre for Research on Women; 1995.

[75] Kaiser Family Foundation survey on teens and sex. what they say teens teens today need to know and who they listen to. Menlo Park, CA: Kaiser Family Foundation; 1996.

[76] Ford CA,  Millstein SG,  Halpern-Felsher BL,  Irwin CE. Influence of physician confidentiality assurances on adolescents' willingness to disclose information and seek future health care. A randomized controlled trial. JAMA 1997; 278(12): 1029–34.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[77] Hopkins A,  Gabbay J,  Neuberger J. Role of users of health care in achieving a quality service. Qual Health Care 1994; 3(4): 203–9.
PubMed |

[78] Veit FC,  Sanci LA,  Coffey CM,  Young DY,  Bowes G. Barriers to effective primary health care for adolescents. Med J Aust 1996; 165(3): 131–3.
PubMed |

[79] Hock-Long L,  Herceg-Baron R,  Cassidy AM,  Whittaker PG. Access to adolescent reproductive health services: financial and structural barriers to care. Perspect Sex Reprod Health 2003; 35(3): 144–7.
PubMed |

[80] Lafferty WE,  Downey L,  Holan CM,  Lind A,  Kassler W,  Tao G, et al. Provision of sexual health services to adolescent enrollees in Medicaid managed care. Am J Public Health 2002; 92(11): 1779–83.
PubMed |

[81] Walker ZA,  Townsend J. The role of general practice in promoting teenage health: a review of the literature. Fam Pract 1999; 16(2): 164–72.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[82] Donovan B,  Knight V,  McNulty AM,  Wynne-Markham V,  Kidd MR. Gonorrhoea screening in general practice: perceived barriers and strategies to improve screening rates. Med J Aust 2001; 175(8): 412–4.
PubMed |

[83] Sanci LA,  Coffey CM,  Veit FC,  Carr-Gregg M,  Patton GC,  Day N, et al. Evaluation of the effectiveness of an educational intervention for general practitioners in adolescent health care: randomised controlled trial. BMJ 2000; 320(7229): 224–30.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[84] Temple-Smith M,  Hammond J,  Pyett P,  Presswell N.. Barriers to sexual history taking in general practice. Aust Fam Physician 1996; 25(9 Suppl 2): S71–4.
PubMed |

[85] Temple-Smith MJ,  Mulvey G,  Keogh L. Attitudes to taking a sexual history in general practice in Victoria, Australia. Sex Transm Infect 1999; 75(1): 41–4.
PubMed |

[86] Mulvey G,  Temple-Smith MJ,  Keogh LA. Sexually transmissible diseases–knowledge and practices of general practitioners in Victoria, Australia. Genitourin Med 1997; 73(6): 533–7.
PubMed |

[87] Wray L,  Law C,  Barrie SC. A general practitioner STD training programme: meeting education and service provision needs. Int J STD AIDS 1998; 9(12): 731–5.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[88] McDonald G , Mullins J . Best practice in delivering sexual and reproductive health services to young people in Victoria. Melbourne: Family Planning Victoria, Australia; 2002.

[89] Health Insurance Commission Data. Australia; 2002.

[90] Cromer BA,  McCarthy M. Family planning services in adolescent pregnancy prevention: the views of key informants in four countries. Fam Plann Perspect 1999; 31(6): 287–93.
PubMed |

[91] Delbanco S,  Lundy J,  Hoff T,  Parker M,  Smith MD. Public knowledge and perceptions about unplanned pregnancy and contraception in three countries. Fam Plann Perspect 1997; 29(2): 70–5.
PubMed |

[92] Rimsza ME. Counseling the adolescent about contraception. Pediatr Rev 2003; 24(5): 162–70.
PubMed |

[93] Rosenthal SL,  Cotton S,  Ready JN,  Potter LS,  Succop PA. Adolescents’ attitudes and experiences regarding levonorgestrel 100 mcg/ethinyl estradiol 20 mcg. J Pediatr Adolesc Gynecol 2002; 15(5): 301–5.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[94] Peterson LS,  Oakley D,  Potter LS,  Darroch JE. Women's efforts to prevent pregnancy: consistency of oral contraceptive use. Fam Plann Perspect 1998; 30(1): 19–23.
PubMed |

[95] Templeman CL,  Cook V,  Goldsmith LJ,  Powell J,  Hertweck SP. Postpartum contraceptive use among adolescent mothers. Obstet Gynecol 2000; 95(5): 770–6.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[96] Omar H,  Fowler A,  D'Angelo S. Improved continuation rate of depot-medroxyprogesterone acetate in adolescent mothers. Int J Adolesc Med Health 2002; 14(2): 149–52.
PubMed |

[97] Emans SJ,  Grace E,  Woods ER,  Smith DE,  Klein K,  Merola J. Adolescents’ compliance with the use of oral contraceptives. JAMA 1987; 257(24): 3377–81.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[98] Polaneczky M,  Slap G,  Forke C,  Rappaport A,  Sondheimer S. The use of levonorgestrel implants (Norplant) for contraception in adolescent mothers. N Engl J Med 1994; 331(18): 1201–6.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[99] Zink TM,  Shireman TI,  Ho M,  Buchanan T. High-risk teen compliance with prescription contraception: an analysis of Ohio Medicaid claims. J Pediatr Adolesc Gynecol 2002; 15(1): 15–21.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[100] Potter L,  Oakley D,  de Leon-Wong E,  Canamar R. Measuring compliance among oral contraceptive users. Fam Plann Perspect 1996; 28(4): 154–8.
PubMed |

[101] Yusuf F,  Siedlecky S. Contraceptive use in Australia: evidence from the 1995 National Health Survey. Aust N Z J Obstet Gynaecol 1999; 39(1): 58–62.
PubMed |

[102] Webb AM. Emergency contraception. BMJ 2003; 326(7393): 775–6.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[103] Glasier A,  Baird D. The effects of self-administering emergency contraception. N Engl J Med 1998; 339(1): 1–4.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[104] WHO. Improving access to quality care in family planning. Geneva: World Health Organisation; 2000.

[105] Delbanco SF,  Mauldon J,  Smith MD. Little knowledge and limited practice: emergency contraceptive pills, the public, and the obstetrician-gynecologist. Obstet Gynecol 1997; 89(6): 1006–11.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[106] Grimes DA. Switching emergency contraception to over-the-counter status. N Engl J Med 2002; 347(11): 846–9.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[107] Camp SL,  Wilkerson DS,  Raine TR. The benefits and risks of over-the-counter availability of levonorgestrel emergency contraception. Contraception 2003; 68(5): 309–17.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[108] Anon. Improving access to emergency contraception. Contracept Technol Update 2000; 21(8): 93–4.
PubMed |

[109] Scholes D,  Stergachis A,  Heidrich FE,  Andrilla H,  Holmes KK,  Stamm WE. Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection. N Engl J Med 1996; 334(21): 1362–6.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[110] Egger M,  Low N,  Smith GD,  Lindblom B,  Herrmann B. Screening for chlamydial infections and the risk of ectopic pregnancy in a county in Sweden: ecological analysis. BMJ 1998; 316(7147): 1776–80.
PubMed |

[111] Atkins D. First new screening recommendations from the third US preventative services task force. BMJ 2001; 1 187–90.


[112] Counahan M,  Hocking JS,  Fairley CK. Enhanced chlamydia surveillance indicates more screening needed. Med J Aust 2003; 178(10): 523.
PubMed |