Sex education, teenage pregnancy and the abortion debate

There has been a lot of debate in recent weeks about the Minister for Health and Ageing's statements that 100,000 abortions a year in Australia is a tragedy. The Democrats agree that the number of terminations in this country is far too high, and we should examine how we might reduce them, without limiting women's access to safe, legal and affordable pregnancy terminations.

There are some other statistics that are available, particularly with a focus on the young, that are less well known than the much repeated figure of 100,000 abortions a year.

UNICEF put out a report on teenage birth rates in 2001, which found that in 1996 at least 1.25 million teenagers worldwide became pregnant each year in the 28 OECD nations that were reviewed. It said that half a million teenagers will seek an abortion and about three quarters of a million will become teenage mothers.

In Australia approximately 25 per cent of 15-year-olds and 50 per cent of 17-year-olds have had sex. There is evidence that the age of first sexual intercourse is getting younger and that this sexual activity is resulting in pregnancies.

It is true to say that the teenage birth rate in Australia has dropped enormously over the last 30 years, down from 50.9 in 1970 to 20 per 1000 teenagers, but that is still a very high rate. There are 20 teenage girls in 1000 having babies, and a further 24 girls in every 1000 have terminations. At 44 pregnancies in every 1000 teenage girls in Australia, our rate is high, but it is not the worst. The United States' figure is 85.8 - almost one in 10 teenagers getting pregnant. But at the other end of the scale, the Netherlands, Japan, Spain and Italy have just over 10 per 1000 teenagers. In other words, Australia's rate is four times as high as theirs.

If we just look at births, our rate is six times higher than Korea and three times that of Japan, Switzerland, the Netherlands and Sweden. Of course, teenage pregnancy and birth are not equally distributed within society. Australia's highest teenage birth rates are among Indigenous women. In 1999, 21.3 per cent of Indigenous births were to teenagers, compared with 4.2 per cent of non-Indigenous births. Australian women in socio-economically disadvantaged groups and in certain geographical areas are also more likely to be teenage mothers.

Giving birth while a teenager is strongly associated with disadvantage later in life, as teenage mothers are more likely to drop out of school, have low levels of qualifications, be unemployed and low paid, live in poor housing conditions, suffer from depression and live on welfare. Children of teenagers are more likely to live in poverty, to grow up without a father, to become a victim of neglect or abuse, to become involved in crime and abuse, drugs and alcohol, and eventually to become teenage parents themselves, beginning the cycle all over again. Having said that, it should be acknowledged that there are many teenage mothers who do a great job of parenting and who do not suffer from those disadvantages, but they are in the minority and, for the most part, their lives are a hard slog.

The 2002 results of the 3rd National Survey of Australian Secondary Students, HIV/AIDS and Sexual Health found that, in their most recent sexual encounter, 9.4 per cent, of Australian secondary school students did not use any form of contraception, while a further 11.8 per cent used withdrawal. On average, young people delay seeking prescription contraception for a whole year after initiating sexual activity. Teenagers are the most frequent users of emergency contraception at Australian family planning clinics: 45 per cent of sexually active Australian high school students do not use condoms consistently, and 31 per cent use condoms without any other form of contraception.

Another problem with unprotected sex is sexually transmitted disease, and 3.5 per cent of sexually active students have been diagnosed with a sexually transmitted infection. Chlamydia is one of the most common notifiable diseases in Australia, and most infections occur in the under 25-years-of-age group. Adolescent rates of chlamydia have been estimated to be as high as 28 per cent. Of course, chlamydia is associated with pelvic inflammatory disease, which may lead to tubal infertility, chronic pelvic pain and ectopic pregnancy.

The picture for Australia's young people and their reproductive health is not rosy, and it is not likely to be improved while the debate centres on terminations, and aims to simply instil fear and shame in women about terminations. As in all health matters, prevention is better and so much cheaper than cure, and at the centre of our thinking should be the idea of giving parents the choices necessary to plan the timing and the number of their children. We have just not made the same progress in reducing teenage pregnancies and births, most of which are not planned, as many other OECD countries.

For example, Austria and Germany, both of which had higher rates than Australia three decades ago, have reduced their teenage birth rate to well below ours, and there are many other countries that have achieved substantial reductions in their teenage birth rates. Norway has reduced its teenage births by 72 per cent. This is despite a number of almost global factors in the past three decades which could be expected to increase teenage birth rates, such as what some might describe as a weakening of traditional models of sexual behaviour and increased sexual pressures on young people.

The UNICEF report suggests that those countries that have taken steps to equip their young people to deal with these social changes are the countries that have been the most successful in containing teenage birth rates, while those that have undergone the socio-sexual transformation but have done little to prepare their young people still have very high, and sometimes climbing, teenage birth rates.