Sexual relations among young people in developing countries: evidence from WHO case studies

This document reviews various studies on the sexual relations of young people in developing countries. Produced by the World Health Organization (WHO), it aims to identify patterns of behaviour with regard to various aspects of sexual and reproductive health among unmarried youth in a range of socio-cultural settings. The paper focuses in particular on unsafe sexual practices, discussing their causes (misinformation, lack of decision-making power, coercion) and what can be done to address them.

The document starts by describing the context of relationships among youth, notably the magnitude of sexual activity and the extent to which sexual activity is safe and consensual. The next section discusses adverse health consequences of risky sexual behaviours including sexually transmitted infections (STIs), unwanted pregnancies and unsafe abortions. The third section focuses on the extent to which youth are fully informed of healthy sexual practice, and their sources of information, and then goes on to highlight the enormous gender imbalances that persist in sexual attitudes and decision-making among youth. The last section summarises the main findings and recommendations that emerge for policy and research.

After establishing that a considerable proportion of youth engage in pre-marital sexual activities, the paper finds that:

• Most of these activities tend to be unsafe as the practice of contraception and condom use is often erratic and having multiple partners and/or contact with sex workers is not uncommon. Unwanted pregnancies and unsafe abortions are therefore observed in many settings.
• Sexual relations are not always consensual: force and coercion are far from unknown. Although there is considerable variation, in the majority of case studies, between five per cent and 15 per cent of young females report a forced or coerced sexual experience.
• Awareness of safe sex practices seems to be superficial, and misinformation regarding the risks and consequences of unsafe sex is widespread. Misconceptions such as "condoms are unsafe" or "you can tell when a person is infected with STD or HIV" are quite common.
• There are wide gender-based differences in sexual conduct and in the ability to negotiate sexual activity and contraceptive use.

Various programmatic and research recommendations can be drawn from the above findings:

• There is a global need for youth-friendly sexual and reproductive health services as well as an urgent need to build negotiation skills among young people in order to enable safe and informed choices, address double standards and gender disparities, and raise awareness of sexual force and coercion, and equip youth to counter them.
• Information on safe sexual practices needs to be made more accessible in order to dispel myths and misconceptions.
• More research is needed to investigate the gender roles and life skills that affect the health situation of young people, and the respective social meanings that females and males attribute to relationships, as well as to look at the ways in which sexually active youth deal with risks of unwanted pregnancies and sexually transmitted infections.
• More research is also needed to explore issues of sexual coercion, force and violence concerning both married and unmarried youth.