Rejected teenage pregnancy

Data and facts on youth sexuality

Teenagers and pregnant?

Cosima Brucker

from korasion No. 3, October 2001

Rapporteur: Christiane Schaefer

According to the professional association of paediatricians, at least 10,000 girls under the age of 18 become pregnant each year in Germany. The abortion statistics published by the Federal Statistical Office show a total of 6,327 abortions in underage girls for the year 2000. This was reported by Prof. Dr. med. Cosima Brucker on the occasion of an information event of Grünenthal GmbH on June 27, 2001 in Munich.

Changed contraceptive behavior

The changed societal and social structures as well as the liberal handling of the topic of “sexuality” in the media have contributed to the fact that the young people's first sexual contacts are made earlier and earlier. As a result, the contraceptive behavior of teenagers in Germany has changed significantly over the past few decades.

The Federal Center for Health Education (BzgA) has examined the attitudes and behavior of young people with regard to sexuality and contraception and published a trend comparison for the years 1980 and 1998: Today 38% of 14 to 16 year old girls and 29% of boys have experienced coitus; the age at first sexual intercourse has decreased. However, there is a consistently large group who have not had sexual intercourse at the age of 17. This proportion is around a third for girls and 46% for boys.

Condoms are the preferred form of contraception the “first time”. 68% of girls and 55% of boys stated that this was the first time they had sexual intercourse. 16% of boys and girls each relied on the pill the "first time" alone. Chemical and other contraceptives play a minor role. But: 16% of the boys and 11% of the girls did not use any contraceptive precautions during their first sexual intercourse with their partner. That is significantly less than at the beginning of the 1980s, when 29% of girls and 20% of boys experienced their first intercourse unprotected. Unfortunately, no further decrease in the numbers is to be expected; the trend towards greater spontaneity is against it.

With increasing experience, contraception shifts from the condom to the pill; There is also a tendency to combine the pill and condom: 40% of the girls and 52% of the boys stated that they had used a condom for the last time they had sexual intercourse. 73% of the girls and 75% of the boys stated that their last sexual intercourse was protected by the pill. Only 1% of girls and 3% of boys failed to take contraceptive measures.

Familiarity with the sexual partner is of great importance for contraceptive behavior: the numbers for unprotected sexual intercourse skyrocket the less boys and girls know their partner.

Education and advice

C. Brucker reported that parents are increasingly taking on the task of educating young people about contraceptive behavior: since 1980, intrafamily counseling has doubled, and sex education is the second most common source of sexual knowledge. Nevertheless, there is a lack of knowledge of basic biological facts. Among adolescents with sexual experience and among all 17-year-olds, only every second boy and three out of four girls stated that they knew the exact time of conception. When asked, however, it turned out that about a third of the girls and boys who thought they knew the right time were wrong with their answer.

When young girls present themselves to the gynecological consultation, thorough contraceptive advice is therefore of particular importance. Individual needs and characteristics should be taken into account. The question of already known or preferred methods leads directly to the topic. The young people's ideas of the various methods with their advantages and disadvantages should be discussed so that the young people can orient themselves.

Contraception in adolescents

C. Brucker described oral hormonal contraception with the pill as the cheapest form of contraception for adolescents - mainly because of its high level of safety. Since bone growth is approximately 98% complete in healthy girls by the age of 14
is not expected to have an adverse effect on bone growth. In young patients with polycystic ovary syndrome in particular, it is advisable to start taking the pill early in order to prevent the known long-term effects of polycystic ovary syndrome (sterility, metabolic syndrome, type 2 diabetes, cardiovascular diseases). In these cases, the pill may already be indicated if there is no need for contraception.

Systemically effective long-term contraceptives also offer the possibility of safe contraception and are less compliance-dependent than the pill. In contrast to the pill, however, these contraceptives only contain progestins. For long-term contraceptives, too, there is not yet sufficient data with regard to a possible risk of osteoporosis in this age group, which must be taken into account when prescribing to young girls.

Intrauterine devices can be considered the method of choice because of the increased risk of sexually transmitted diseases in unstable partner relationships among young people. In a mutually monogamous relationship and without the risk of STDs from the partner, however, they can be used if no abdominal inflammation has previously occurred and other methods are not suitable or are not accepted.

The use of a diaphragm or the sole use of condoms is less recommended due to their lower efficiency. There are also significant compliance problems. This is because the condom also protects against sexually transmitted diseases to a high degree, but the impairment of sexuality can lead to its use not being performed. In this context, it is important to provide information about the possibility of using the morning-after pill.

Legal aspects of prescribing contraceptives

C. Brucker reminded that children under 14 years of age are considered children. According to Section 176, Paragraph 3 of the Criminal Code, cohabitation with a child under the age of 14 is punished as a particularly serious case of sexual abuse. It is therefore advisable to obtain the written consent of both parents for prescribing contraceptives to adolescents under 14 years of age.

For adolescents between the ages of 14 and 16, at least one parent should have a declaration of consent. If this is rejected, the prescribing doctor must convince himself of the psychosexual maturity and the ability of the adolescents to give consent. In the case of older adolescents between the ages of 16 and 18, a parent should only be called in if, in the opinion of the prescribing doctor, the ability to give consent is not given.

Rapporteur:

Christiane Schaefer
Ratingen