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Leena Ruusuvaara M. D. , Ph. D. Finland Leena Ruusuvaara M. D. , Ph. D. Finland

Same goal Healthy young Adults Children Different approach guided by religion, culture, tradition and Same goal Healthy young Adults Children Different approach guided by religion, culture, tradition and economy

Reproductive and sexual health includes • The right to your own body • Knowledge Reproductive and sexual health includes • The right to your own body • Knowledge and education • To have the opportunity to prevent unwanted pregnancies and STD´s

Ways to reproductive health • Knowledge • Services • Non-judgemental environment Ways to reproductive health • Knowledge • Services • Non-judgemental environment

Succesful approaches to contraceptive counseling • Easy acces (i. e. Youth clinics, shool-nurse) • Succesful approaches to contraceptive counseling • Easy acces (i. e. Youth clinics, shool-nurse) • Low cost or free of charge condoms and oral contraceptives (OC´s) • Down to earth information of sexually transmitted diseases (STD: s) • Support when needed psychological

Succesful approaches to safe sex • Open attitude to sexual matters with emphasis on Succesful approaches to safe sex • Open attitude to sexual matters with emphasis on – responsibility • Balanced sex – education with emphasis on – responsibility • Contraceptive councelling with emphasis on motivation – and responsibility

 • 70% of 18 year olds are sexually active • One cannot afford • 70% of 18 year olds are sexually active • One cannot afford to ignore the needs of sexually active teenagers Advocates for youth

Our main goal (as parents, politicians and health care personnal) shoud be: ”Helping young Our main goal (as parents, politicians and health care personnal) shoud be: ”Helping young people make safe and responsible decisions about sex”

”Safe sex” or ”No sex” ”Safe sex” or ”No sex”

Media Congressionally mandated approach U. S. Just do it Just say NO Media Congressionally mandated approach U. S. Just do it Just say NO

About contraceptive practice • After a young man or a woman has accepted his About contraceptive practice • After a young man or a woman has accepted his or hers sexuality, it is much easier to cope with prevention • You are using contraception not only to avoid becoming pregnant, but because you would like to have sex

Reproductive health SOMA PSYCHE reproduction relationships therapy communication medical control own ”control” = responsibility Reproductive health SOMA PSYCHE reproduction relationships therapy communication medical control own ”control” = responsibility technical language colloquial language preventive measures preventive behaviour

Myths • Early sex-education would encourage early sexual experimentation NO – this is not Myths • Early sex-education would encourage early sexual experimentation NO – this is not supported by the relevant litterature or experiences from countries where sex-education is available

Myths • If ”morning after pill” is easily available, it would cause non-use of Myths • If ”morning after pill” is easily available, it would cause non-use of other contraceptives NO – the available data shows that a number of unwanted pregnancies and abortions are avoided – and the girl seeks for contraceptive advice

Myths • Young boys are lousy condom-users NO – the literature shows that increasing Myths • Young boys are lousy condom-users NO – the literature shows that increasing amount of teenagers rely on condom as their preventive method both against STD´s and pregnancy

Myths • Abortion on demand would cause increasing numbers of abortions NO – in Myths • Abortion on demand would cause increasing numbers of abortions NO – in countries where (legal) abortion is on demand together with family planning services, the number of abortions (and STD´s) are lowest

The number of abortions does NOT tell the number of unwanted pregnancies The number of abortions does NOT tell the number of unwanted pregnancies

The percentage of unwanted pregnancies that are terminated by abortion is influenced by many The percentage of unwanted pregnancies that are terminated by abortion is influenced by many factors • The culture of the area • Its religious make up • The availability of emergency contraception

Psychosomatic prevention of (sexual) risk behavior • Learn to identify those at risk • Psychosomatic prevention of (sexual) risk behavior • Learn to identify those at risk • Depressive behaviour • Even relatively short psychiatric intervention can have great impact

Physicians for reproductive choice and health • Declining pregnancy rates among teens is primarily Physicians for reproductive choice and health • Declining pregnancy rates among teens is primarily due to better contraceptive use, and secondarily due tu lower rates of sexual intercourse (Darroch and Singh)

Education Sex education Social situation (cultural, religion etc. ) Yes, I am ready I Education Sex education Social situation (cultural, religion etc. ) Yes, I am ready I can do it No, it is not the right time, yet

Some reasons for Scandinavian countries having low teen pregnancy and abortion rates • School Some reasons for Scandinavian countries having low teen pregnancy and abortion rates • School education for all • Sex education at schools for decades (in Sweden nearly 50 years) • Sex is not a tabu • Genders are equal • Abortion and demand – contraception counseling is free

Abortions in Finland < 20 years of age 14. 8 / 1000 Stakes 2005 Abortions in Finland < 20 years of age 14. 8 / 1000 Stakes 2005 Abortions in U. S. A. < 20 years of age 20 / 1000 Advocates for youth, 2002

History and development • Borlänge 1970 • Gustav Högberg Child and adolescent physician • History and development • Borlänge 1970 • Gustav Högberg Child and adolescent physician • Idea: combine matters relating to body and soul and to integrate these with sex education and matters relating to interpersional relationship • Abortion legislation 1975

Health on equal terms Swedish Government Committee Report SOU 2000: 91 ”There are strong Health on equal terms Swedish Government Committee Report SOU 2000: 91 ”There are strong arguments for inputs at an early state from the social, humanist, medical and econimic perspectives. Reinforced health promotion and preventive measures with the focus on mental health contains a considerable potential for societal and econimic savings. ”

Objective 11 ”national objectives for public health” ”Preventing health risks associated with sexual behaviour Objective 11 ”national objectives for public health” ”Preventing health risks associated with sexual behaviour is primarily about strengthening the individual´s identity and self-respect” Method of work: Health promotion and preventive work

School Education Teenage Pregnancy rate (birth & abortion) HIGH LOW Scandinavian Countries Japan Germany School Education Teenage Pregnancy rate (birth & abortion) HIGH LOW Scandinavian Countries Japan Germany U. K. U. S. A. Kenya India Bangladesh Adapted from into a New World, The Alan Cuttmacher Institute, May 1998

Experiences • School personnel need support • Parents need support • Grown-ups need up-to-date Experiences • School personnel need support • Parents need support • Grown-ups need up-to-date information

Casual sex • No contraception • No consequences • And – often – no Casual sex • No contraception • No consequences • And – often – no deeper feeling for each other

Prolonged adolescence • Young people do not move out • They can have their Prolonged adolescence • Young people do not move out • They can have their girlfriend / boyfriend overnight at their parent´s house • They can ”empty the refrigerator” • They use their own money for FUN • They skip the adult responsipility

”I dream of the day when all children born are welcome, all men and ”I dream of the day when all children born are welcome, all men and women are equal and sexuality is an expression of intimity, caressing and enjoyment. ” Elise Ottensen Jensen (1886 -1973) One of the first women who lectured about reproductive health