During the period 2000/2001–2006/2007, the proportion of adolescents reporting sexual intercourse at least 10 times continued to increase (from 41.5% to 47.8%) (Table 2). The proportions of those reporting at least three sexual partners (from 30.7% to 30.3%), or no contraception at last intercourse (from 19.1% to 18.6%) did not change. The results were similar for both sexes.
A shift to an earlier age of starting sexual activity was observed in the 1990s, when the proportion of teenagers reportedly engaged in sexual activities increased. At the same time, the use of effective contraception decreased, and, on average, the adolescent population had more partners and more coital events. In light of these results, the increase in the abortion rate is no surprise.
The years 2001–2002 were a turning point for the decline in the number of adolescents with sexual experience and those who had not used effective contraception. As could be expected, this was reflected in a declining abortion rate. However, contrary to expectations, the number of coital events in the total population, when measured by the proportion of those reporting sexual intercourse at least 10 times, remained steady. Furthermore, the sexual activity of those reporting intercourse was more intense when measured by the above-mentioned number of coital events. Further studies are needed to understand this development.
By comparison, younger age at first sexual intercourse in the 1990s also has been observed and studied in other Western countries: the United Kingdom,5–8 Denmark,9 France,5,6 Latvia,5,6 and the United States.10 The more explicit treatment of sexual matters in the media, advertisements, and fashion, called overeroticization or hypersexualization,11 throughout the Western world is likely to have aroused more interest in sexual experiences12,13 and contributed to earlier sexual activity. Moreover, the greater number of partners probably reflects the same phenomenon, as does the increase in noncoital sexual experiences. Although this phenomenon contributed to the increase in the 1990s, it is common knowledge that expression of overt sexuality in the media has not diminished in the 2000s.
Decrease in sexual experiences at an early age starting in the first years of the new millennium has not been reported in other countries, thus it is not possible to conclude whether this is a country-specific phenomenon or whether a similar trend can be detected in other Western countries. Some of the explanatory factors are most likely country-specific for both periods.
The greater number of adolescents reporting no contraception in the 1990s may reflect difficulties in easy access to products. In an earlier study, we reported diminishing use of oral contraceptives among Finnish girls at the end of the 1990s.14 The use of oral contraceptives can be considered an indicator of the access to family planning services. In the 1990s, as a consequence of reorganizations and a severe economic recession, several municipalities made cutbacks in their school health service and family planning clinics, which earlier provided adolescents with easy access to contraceptive counseling.14,15 Too little is known about changes in contraceptive counseling in school health service or family planning clinics in the 2000s to draw any conclusions as to whether these contributed to the decreased abortion rate.
Sex education covering the entire age group is important in providing correct and proper information on sexual matters, including contraception and media literacy skills against the hypersexual media information. Health education, the school subject in which sex education is taught, was not compulsory in Finnish schools in the 1990s. When taught, it was integrated into other school subjects. The amendment of the Basic Education Act16 defined health education as its own compulsory school subject from 2004. The national curriculum that all schools have to follow strengthened the role of sex education.17 As a consequence of these changes and the lively discussion in the preparation phase of the legislative proposal, the number of sex education lessons increased in the 2000s compared with the 1990s.18 Well-informed teenagers acquiring their knowledge through school health education may be one of the explanations for the positive changes in sexual behavior and the abortion rate in the 2000s.
Toward the end of the 1990s, actions and media discussion of school-aged children's health in Finnish society was very active when research results showed deteriorating health and health behavior in this age group. For the first time, local research results were available to municipalities, schools, and parents (the present School Health Promotion Study). This activated health-promotion actions targeted at adolescents and likely was to activate parental care and monitoring of teenagers' activities. The growing concern about adolescent health resulted in increased activity and active discussions in the media and among health professionals, teachers, and school authorities as well as the general public and politicians.19 This may have contributed to adolescents' sexual behavior and further to the lower abortion rate.
In Finland, most abortions are performed for what are known as social reasons. These cases require written permission from two physicians. However, if a girl is younger than 17 years old at the time of conception, permission from one physician is enough.20 Abortions are performed in public hospitals in all parts of the country as part of public health care at low cost. During the 1990s and 2000s, the legislation concerning abortions has not changed and neither have the facilities where abortions are performed.
Finally, we should consider the role of alcohol use in adolescents' sexual experiences. Increased alcohol use and binge drinking among teenagers in the 1990s21 may have contributed to the increased unprotected sex and multiple partners22,23; a decrease in alcohol use and binge drinking in the 2000s21 may have had an opposite effect.
This study was based on highly comparable national surveys maintaining similar data collection methods, samples, and questions over the years. The response rates to the current surveys were high, and the 5–10% of pupils who were absent on the survey day, most often because of sickness, would hardly differ from those who responded to the questionnaire. In the analyses, we included only those schools participating in all surveys. There were only minor differences in sexual indicators between the schools joining the study at the very beginning and those joining it later. Our data may underestimate the proportion of sexually active adolescents in the population somewhat. However, if there is a small selection bias, the bias is most likely similar over time and thus has no effect on the comparisons between the surveys. The same applies to the reliability of the questions on sexual behavior. Earlier studies have shown a high repeatability of questions regarding contraception.14 Adolescents report their sexual behavior and contraceptive use reliably over a 6-month interval.24 However, the reliability of self-reported sexual behaviors decreases with the increasing duration of the recall period. If sexual behaviors were underreported in the current study, the underreporting was most likely similar over time and thus has no effect on the comparisons.
1. Sedgh G, Henshaw S, Singh S, Ahman E, Shah IH. Induced abortion: estimated rates and trends worldwide. Lancet 2007;370:1338–45.
2. Koskinen S, Aromaa A, Huttunen J, Teperi J. Health in Finland. Helsinki: STAKES; 2006. Available at: www.ktl.fi/hif
. Retrieved March 23, 2009.
5. Ross J, Wyatt W. Sexual behaviour. In: Currie C, Hurrelmann K, Settertobulte W, Smith R, Todd J, editors. Health and health behaviour among young people. Health behaviour in school-aged children. Health Behaviour in School-aged Children (HBSC) study. WHO Policy Series for Children and Adolescents. Copenhagen: World Health Organization; 2000. pp. 115–20.
6. Ross J, Godeau E, Dias S. Sexual health In: Currie C, Roberts C, Morgan A, Smith R, Settertobulte W, Samdal O, et al, editors. Young people's health in context. Health Behaviour in School-aged Children (HBSC) study: international report from the 2001/2002 survey. WHO Policy Series for Children and Adolescents, No. 4.
Copenhagen: World Health Organization; 2004. pp. 153–60.
7. Copas AJ, Wellings K, Erens B, Mercer CH, McManus S, Fenton KA, et al. The accuracy of reported sensitive sexual behaviour in Britain: exploring the extent of change 1990–2000. Sex Transm Infect 2002;78:26–30.
8. Ford NJ, Halliday J, Little J. Changes in the sexual lifestyles of young people in Somerset, 1990-1996. Br J Fam Plann 1999;25:55–8.
9. Kangas I, Andersen B, McGarrigle CA, Østergaard L. A comparison of sexual behaviour and attitudes of healthy adolescents in a Danish high school in 1982, 1996, and 2001. Popul Health Metr 2004;2:5.
10. Santelli JS, Lindberg LD, Abma J, McNeely CS, Resnick M. Adolescent sexual behavior: estimates and trends from four nationally representative surveys. Fam Plann Perspect
11. Zillmann D. Influence of unrestrained access to erotica on adolescents' and young adults' dispositions toward sexuality. J Adolesc Health 2000;27(2 Suppl):41–4.
12. Escobar-Chaves SL, Tortolero SR, Markham CM, Low BJ, Eitel P, Thickstun P. Impact of the media on adolescent sexual attitudes and behaviors. Pediatrics 2005;116:303–26.
13. L'Engle KL, Brown JD, Kenneavy K. The mass media are an important context for adolescents' sexual behavior. J Adolesc Health 2006;38:186–92.
14. Hassani KF, Kosunen E, Rimpelä A. The use of oral contraceptives among Finnish teenagers from 1981 to 2003. J Adolesc Health 2006;39:649–55.
15. Koponen P, Sihvo S, Hemminki E, E EK, Kokko S. Family planning services in Finnish health centres—organisation and women's opinions of services [Finnish]. Sosiaalilääketieteellinen Aikakauslehti 1998;35:220–8.
18. Liinamo A. Sexual education and sexual health knowledge among Finnish adolescents at pupil and school level—evaluation from the point of view of health promotion. Studies in sport, physical education and health [Finnish]. Jyväskylä: University of Jyväskylä; 2005.
20. Knudsen LB, Gissler M, Bender SS, Hedberg C, Ollendorff U, Sundström K, et al. Induced abortion in the Nordic countries: special emphasis on young women. Acta Obstet Gynecol Scand 2003;82:257–68.
21. Rimpelä A, Lintonen T, Pere L, Rainio S, Rimpelä M. Adolescent health habits 2001, changes in tobacco and alcohol use 1977–2001 [Finnish]. Helsinki: National Research and Development Centre for Welfare and Health (STAKES); 2002.
22. Baskin-Sommers A, Sommers I. The co-occurrence of substance use and high-risk behaviors. J Adolesc Health 2006;38:609–11.
23. Imamura M, Tucker J, Hannaford P, da Silva MO, Astin M, Wyness L, et al. Factors associated with teenage pregnancy in the European Union countries: a systematic review. Eur J Public Health 2007;17:630–6.
© 2009 by The American College of Obstetricians and Gynecologists.
24. Sieving R, Hellerstedt W, McNeely C, Fee R, Snyder J, Resnick M. Reliability of self-reported contraceptive use and sexual behaviors among adolescent girls. J Sex Res 2005;42:159–66.