Recent and alarming American statistics about the rates of pregnancies and sexually transmitted infections (STIs) in teenage girls have re-ignited the highly charged debate about access to health care and sex education in the United States. A Centers for Disease Control (CDC) report showed that about 25% of all girls between the ages of 14 and 19 in the US were infected with at least one of the most common STIs. These included human papillomavirus (HPV), chlamydia, herpes simplex virus, and trichomoniasis. The spread of all these diseases, some of which cannot be cured with antibiotics, can be reduced with safer sex practices.
�The problem isn�t promiscuity,� says Kim Martyn, a Toronto-based sex educator. �It comes down to poverty and access to health care and education.� The report also showed black teen girls had much higher rates of infection than white girls, which Martyn says proves her point. �In the US, there is a huge gap in terms of health care access between the white and black population.�
Martyn says opportunity, or lack thereof, also has an influence on behaviour. �If you have a vision of yourself going to university, you are more motivated to not get pregnant. You are more likely to be responsible,� adding that these attitudes are reflected in statistics about the age at which teens first have sex.
Abstinence-only sex education
According to Martyn, the other component to these alarming statistics has to do with sex education. During this current decade, the US government has denied funding for so-called �comprehensive� sex education, which includes information about birth control and safe sex, and instead has exclusively funded �abstinence-only� sex education. Abstinence-only education focuses on getting teens to delay sexual activity, ideally until marriage, and does not provide information about birth control or safe sex practices.
�Across the board, all legitimate research shows these programs don�t work,� says Martyn, acknowledging that this is a view some parents do not want to accept. �What people need to know is comprehensive programs do not encourage people to have sex. But it is a harm reduction model, so we say �however if� and inform them how to protect themselves.�
The Canadian experience: not perfect either
While in Canada, comprehensive sex-education is more widely available and access to health care is much less an issue than in the US, there are still problems.
�Our incidence for chlamydia and gonorrhoea are on the increase as well,� says Cathy Maser, advance practice nurse in adolescent medicine at Toronto�s SickKids hospital. �The good news is teen pregnancy is down, which together means more teens are on oral contraceptives but condom use is inconsistent.� In addition, Maser says sex education is, at times and in places, lacking in Canada. �It�s not standardized and it depends on the teacher and what they are comfortable with teaching. It also depends on the school.� She says Catholic school boards are less likely to have comprehensive sex education. Additionally, any parent can pull their child out of sex education class.
While the situation in Canada may be better than in the United States, comparison of statistics between the two countries has problems. �Genital herpes and HPV aren�t reportable to Public Health so we don�t know the true incidence of these things,� Maser notes, adding Canadian statistics tend to lump 15- to 24-year-olds in the same reports. For the most part, the CDC report only looked at 14- to 19-year-olds.
Better screening needed
Regardless of what side of the border one lives on, testing for sexually transmitted infection is a means to improve the situation. Unfortunately, screening for STIs needs to be improved both in Canada and around the United States.
Two studies in the CDC report showed what amount to �missed opportunities.� For example, while data revealed that more than 80% of American females aged 15 to 24 in one study received either birth control or STI services, fewer than 40% received both. The other study examined STI screening rates among young women seeking emergency contraception, which is highly suggestive of recent unprotected sex. Only 27% of these women were screened for chlamydia or gonorrhoea. Moreover, 12% of the women who were tested had a positive test result.
�The same problem exists in Toronto and the rest of Canada,� say Martyn, who has been part of a campaign to get physicians and other health care providers to do STI screening when women come in for pregnancy tests, at minimum. �We even went as far as to suggest that if a patient came in with a headache and they were in the target group, the doctor should ask if they will consent to an STI test.�