Sex and youth: misconceptions and risks: a report from the World Health Organization. (Youth).

Since the late 1980s, the UNDP/ UNFPA/WHO/WORLD BANK Special Programme of Research, Development and Research Training in Human Reproduction has supported a number of social science research initiatives on under-investigated areas of sexual and reproductive health care. Four of these initiatives--on the dynamics of contraceptive use, the determinants and consequences of induced abortion, sexual behavior and the role of men--also covered the needs and perceptions of young people.

These four initiatives comprised 146 research projects and, of these, 34 studies in 20 countries in Africa, Asia and Latin America addressed young people, including adolescents (aged 10-19) and youth (aged 15-24). Fieldwork for these case studies was conducted chiefly between 1992 and 1996. (A summary review of the studies is now available from the Programme.)

The studies cover a variety of socio-cultural settings. In some, premarital sexual activity is taboo, using contraception is forbidden among unmarried youth, and abortion is viewed as the only solution to premarital pregnancy among adolescents. In others, premarital pregnancy may be condoned, and childbearing among unmarried mothers is not unknown.

Most studies focus on unmarried youth. However, some focus on special groups such as pregnant young women or those who have terminated a pregnancy, young reproductive health seekers in general or young clients of services for sexually transmitted infections (STIs).

Many common themes emerge from these studies. In every setting, sexual activity begins during adolescence among many young people. Much of this activity is risky: contraceptive use is often erratic, and unwanted pregnancy and unsafe abortions are observed in many settings. Sexual relations may be forced. There are wide gender-based differences in sexual conduct and in the ability to negotiate sexual activity and contraceptive use. Despite this, relatively few young people think they are at risk of disease or unwanted pregnancy. Awareness of safe sex practices seems to be superficial, and misinformation regarding the risks and consequences of unsafe sex is widespread.

This article reviews these and other findings, discusses their implications for policies and programmes and highlights research gaps. For the sake of consistency, the term "youth" is used to refer to young people of all ages between 10 and 24.

A number of recommendations are offered on the basis of the summary review of these case studies. These include programmatic recommendations to build negotiation skills, dispel misconceptions, counter sexual violence, involve young people in programme design, tailor fertility regulation services to meet young people's needs, and communicate the message that every unprotected sexual act risks disease and unwanted pregnancy.

The review suggests a need for more in-depth behavioral research on the perspectives and experiences of youth in different settings. It points to the need to study positive outcomes in addition to risk assessment. It also stresses that research should explore the ways in which gender roles and power imbalances affect life skills among youth and how social constraints make young women particularly vulnerable and unlikely to exercise choices relating to their sexual and reproductive lives. Research is also needed to document how young women can exercise greater autonomy.

The Context of Young People's Sexual Relations

The 34 case studies (1) point to considerable unsafe premarital sexual activity among adolescents and youth. Each study ensured privacy and anonymity, and questions relating to sexual activity and age at debut were largely similar across studies. Despite this, caution must be exercised while drawing comparisons between females and males and across regions. In general, young males tend to over-report and young females tend to under-report their sexual experiences. Young people in highly conservative settings may also be more likely to withhold such information than youth in settings in which premarital sexual activity is more accepted.

Sexual Debut

As age at marriage rises, there are more premarital friendships and partnerships between young males and females. Dating is common among college students in Dumaguete City, Philippines, where 9% of females and 41% of males report that dates usually include sexual intercourse while 24% of both sexes report heavy petting. Among young college students in Hanoi and Ho Chi Minh City, Viet Nam, 39% of males and 47% of females report dating and close relationships. Typically, dating in these locations comprises chatting (88% females, 73% males); and for smaller numbers, it reportedly includes holding hands (8% and 17%), kissing (3% and 5%), and petting (1% and 5%), but rarely intercourse (0.1% and 1%).

For females, premarital sexual activity varies widely across regions, though within regions rates are similar. For example, rates of sexual activity are 2-11% in various settings in Asia, 12-25% in Latin America, and 45-52% in sub-Saharan Africa. A high rate was reported among about-to-be-married Chinese women in Shanghai who received their health examination prior to marriage. When marriage is imminent, premarital sex seems more likely to occur, even in conservative settings.

Between one-third and one-half of young males are sexually experienced. However, there is more variation, both across and within regions, among young males than among females. For example, 15% of male students in Viet Nam, and 24% of school-going males in Kwangju, Republic of Korea, report premarital sexual activity. In other locations in Asia, as well as in Africa and Latin America, 66-75% of males report premarital sex.

In Asia, reported rates of premarital sex are at least five times as high among males as among females, and in Latin America rates are up to twice as high among males. Some of this gender disparity may reflect cultural norms (strongest in Asia) that condone sexual activity among young males but discourage it among young females.

Correspondingly, age at premarital sexual debut was considerably lower among males than among females and somewhat lower in Asia than in Africa or Latin America. Typical ages at first sexual experience among males were 15-17 in studies in Africa, around 15 in Latin America, and somewhat higher (16-20) in Asia. Among females, corresponding ages were 15-20 in Africa and Latin America and 18-20 in Asia.

The Nature of Sexual Partnerships

Many sexually active adolescents and youth have had sex with more than one partner, though there is disparity between the sexes and between studies. In the four studies reporting multiple partners in the past year, rates range from 25-27% among young men in the border towns of Nepal to 69% among younger university students in Ilorin, Nigeria (with the number of partners ranging from 2 to 20).

Corresponding rates among females are lower. Three studies measured the number of partners of females in the recent past. Not a single rural female in the north and northeast of Thailand reported multiple partners in the previous 12 months. Some 15% of female university students in Ilorin, Nigeria, reported 2-3 partners in the past year, while 15% of female secondary students in Buenos Aires reported two or more partners in the past six months.

Up to 80% of females tend to experience sexual intercourse with a steady boyfriend, with marriage in mind. In contrast, far fewer sexually experienced males initiate sexual activity with a steady girlfriend, and over one-third in most studies report debut with a sex worker.

Several case studies--largely in Asia--document links between drinking alcohol and risky sexual behavior. Among university students in Viet Nam, 62% of females and 70% of males felt that alcohol "facilitates" casual sex. In border towns in Nepal, young men who reported drinking alcohol were almost four times more likely to have casual sex than those who did not drink. Similar associations were observed in Thailand among rural males and urban factory workers, as well as among university students in Seoul, Republic of Korea.

Case studies report that typically 30-50% of males and 10-40% of females practiced some form of contraception during their first sexual experience. School and university students were more likely than others to have practiced contraception at debut. However, contraceptive use is not consistent. While 69% of both female and male students in Dumaguete City, Philippines, had used contraceptives, only 59% of males and 53% of females used them regularly. In Lambayeque, Peru, 32% of males and 45% of females had used contraceptives at some time, but only 13% and 10% professed regular use. Only 11% and 4% had used a condom in their last three sexual contacts.

Condoms are often not used even in contacts with casual partners or sex workers. In Lambayeque, Peru, for example, only 21% of males report consistent condom use with sex workers while 41% have never used a condom. Among young factory workers in Chiang Mai, Thailand, 23% and 16% of males respectively report no or inconsistent condom use in relations with sex workers whom they visit "regularly" and "irregularly." Some 57% report no or inconsistent use when the partners were "promiscuous girls."

Some studies point to inconsistent condom use despite high levels of awareness. For example, although 90% of college students in Ilorin, Nigeria, were aware of condoms, only 19% and 44% of sexually active females and males, respectively, made use of them. While 23% of females attending night schools in San Martin de Porres, Peru, were aware of condoms, only 1% had used them. Evidence from Botswana suggests that although out-of-school adolescent females were more likely to have practiced contraception than in-school females, those still in school were more regular users.

Sexual Coercion 

Thirteen studies document the extent to which sexual activity was forced. In most, 5-15% of young females report a forced or coerced sexual experience. In several studies, the figure is higher: 21% of adolescents in Botswana; 20% among secondary school students in Lima, Cusco, and Iquitos, Peru; and 41% among young females attending urban night study centers in Lima. Among females working in an export zone in Korea, 9% report that sexual debut had been forced by factory supervisors or colleagues. In Manila, Philippines, 6% of unwed mothers report that pregnancy resulted from rape, and another 7% that it resulted from sex in exchange for money to support a drug habit.

Several studies mention the "sugar daddy" phenomenon. For example, about one in five school-going and out-of-school adolescent females in Botswana report that it is difficult to refuse sex when money and gifts are offered. In this sample girls as young as 13 have engaged in sex with "sugar daddies." A case study in a hospital setting in Dar-es-Salaam, Tanzania, reports that 28% of young women with post-abortion complications were made pregnant by men who were approximately 25 years older than themselves.

Knowledge and Belief: Information that Guides Young People's Sexual Relations

The case studies examined to some degree the levels of sexual and reproductive knowledge that youth possess and the source of such knowledge. Results suggest that while youth are generally well informed, in-depth knowledge tends to be patchy, misconceptions are widespread, and sources of information are largely informal.

Common Misperceptions

Knowledge of conception and fertility is generally poor among young people. A case study of pregnant adolescents in Mexico City states that "the vagina seemed not to exist for many." Many believe that first sexual experience or occasional sex carries no risk of pregnancy. At the other extreme, a study of youth in 13 provinces of Indonesia found that 9-13% of males and 6-7% of females believe that pregnancy can occur through physical embrace.

Condoms are widely known, but misperceptions dissuade youth from using them. A study of secondary school students in Kenya reports that most were aware of condoms and could name several brands. However, many mistrusted condoms because they though they were porous and often came off or were ineffective.

Over 80% of respondents in studies in China, Guatemala, Indonesia, Kenya, Nigeria, Peru and Thailand were aware of AIDS, but few reported working knowledge of modes of transmission. The only exceptions were about-to-be-married young women in Shanghai and students and factory workers in Bangkok.

Many youth believe that infected persons reveal outward evidence of their condition. For instance, young people in a low-income urban area in Argentina believed that individuals who are HIV-positive are emaciated. Only 5% of male university students in Ilorin, Nigeria and 7-12% of students in Viet Nam knew that carriers of sexually transmitted infections (STIs) and HIV show no outward evidence of their condition. Only among rural youth in north and north-east Thailand did most respondents recognize the asymptomatic nature of STIs/HIV.

Another dangerous misunderstanding is that STI symptoms go away of their own accord, as believed by 22% of secondary students in Kampala and 7% and 12% of male and female college students in Viet Nam.

A further misperception is that women are responsible for transmitting STIs and HIV. In an urban barrio in Buenos Aires, Argentina, for example, respondents said the male was more vulnerable to AIDS than the female because the female could infect him without becoming sick herself. Respondents perceived menstrual blood as a potent source of STI/HIV transmission.

Some youth (in Chile, Guatemala and Nigeria, for instance) stated that STIs/ HIV could be prevented by good personal hygiene. In addition, 65% of male university students in Korea reported that urination after sex gets rid of infection. Young people in Korea, Nigeria, Peru and Thailand also report that "medicines" and the use of antibiotics after sex can prevent infection with HIV.

Many young people believe that STIs and HIV can be transmitted by sharing glasses or eating utensils, using the same toilet as an infected person, poor personal hygiene and mosquito bites. Some maintained that infection was transmitted through kissing (44% of about-to-be-married women in Shanghai), touch (78% of male patients attending an STI clinic in New Delhi, India) and even being in the same room as an infected person (24% of females and 28% of males in 13 provinces of Indonesia). Young urban barrio residents in Buenos Aires, Argentina, argued that the HIV virus is transmitted through the saliva of homosexuals.

A number of case studies highlight how young people underestimate the risks they face. Although 52% of men residing in border towns of Nepal and 38% of men visiting these towns did not use condoms in their last sexual contact with a non-regular partner, only 11% and 24% considered themselves at risk of contracting AIDS. In Chile, although fewer than 20% of sexually active youth used condoms regularly, only 29% felt they were at risk. Even in a STI outpatient clinic in New Delhi, India, only a quarter of young men recognized themselves to be at risk of acquiring HIV.

Sources of Information

Information on sexuality, conception, pregnancy, contraception and disease is rarely imparted by teachers, health professionals or parents. The main sources of information are friends and the media. A study of first-time mothers in Manila, Philippines, reports that 28% learned about sex from the man who made them pregnant.

Friends are important sources of information about sex. Over 90% of college students in Viet Nam report being most comfortable discussing sexual and reproductive health with peers of their own sex; far fewer report discussion with parents. In Indonesia, peers outrank parents as the main sources of information on sexual matters for both sexes. Only in Peru (among in-school and out-of-school adolescents and night school students) are both peers and parents cited as main sources of information on sexuality. However, young women are more likely than young men to ask their parents, usually mothers, about sexual matters.

For adolescent females in secondary schools in Buenos Aires, Argentina, mothers are the main sources of information concerning menstruation (84%) and the risk of pregnancy (65%), but adolescent females are more likely to consult peers on topics such as sexual relations, contraception and ejaculation.

Young people appear to prefer obtaining information on different aspects of sexuality and sexual behavior from different sources. In some settings, the media are the predominant source of information on HIV/AIDS though this is not necessarily the case for other aspects of sexual health. Among young females in several sites in Chile and Guatemala and among adolescent factory workers in Thailand, over 70% obtained HIV/AIDS information from television and radio.

Health care providers are rarely cited as a major source of information. The one exception was a study of secondary school students in Kampala, Uganda, in which about 50% reported that their sources of information were teachers (50%) or health providers (49%).

Case studies in Argentina, Kenya, Peru and the Philippines explored young people's impressions of sex and education in schools. Most respondents (over 50% in most cases) rated the information as inadequate. Several said that teachers focused on discouraging students from sexual activity without pointing out the dangers or explaining and teaching safe sex behavior.

Generally, young people in these studies argued for a much more explicit focus on sexuality in the school curriculum. Most said they preferred health providers, rather than teachers or parents, as information sources.

Power, Vulnerability and Gender Imbalance in the Sexual Relations of Youth

A number of gender imbalances underscore perceptions of the sexual and reproductive roles of young females and males. A case study of secondary school students in Buenos Aires, Argentina, identifies three patterns of sexual debut. A "committed relationship," was experienced by 48% of all youth (just under two-thirds of the 48% were female). In this pattern, sexual debut typically occurred in a committed relationship at age 16-18, with the intention of strengthening the relationship. It happened in the home of one of the partners, and the immediate reactions were pain and fear of pregnancy. The decision to have sex was made jointly by the couple, and some method of contraception--usually withdrawal--was used.

The other two patterns characterized males rather than females. The first, labeled "impulsive," covered 26% of the sample, of which 99% were males. It was typified by early debut (15 or younger), motivated by "physical need," curiosity, or peer pressure, and the partner was usually a sex worker. The decision to have sex was made alone or among peers, and the predominant reactions were anxiety and fear of AIDS. If contraception was used, it was usually a condom.

The second pattern typical of males was labeled "occasional," comprising 26% of youth, of whom 79% were male. In this group, sexual debut occurred with a friend or casual acquaintance (usually sexually experienced). Age at initiation varied, as did the location. It was usually spontaneous, sex usually occurred without contraception, and a typical reaction was fear of being discovered. While this typology is not intended for generalization, it highlights major differences in attitudesand behavior of youth that are evident to some degree in all settings.

Generally, males are more likely than females to consider premarital sexual activity to be acceptable, and both females and males consider premarital sex to be more acceptable for males than for females. These double standards are particularly evident in case studies in Asia but are seen in Latin America as well. For example, among rural youth in Thailand, 46% of females and 32% of males hold the view that men should be virgins at marriage; in the case of females, however,these proportions increase to 71% and 63%. Among college students in Viet Nam, 8% of females agree that casual sex can be fun, but 37% of males state this opinion. Among youth attending night school in Peru, 49% of females and 68% of males agree that males should gain sexual experience before marriage, yet 73% of females and 59% of males agree that females must be virgins at marriage.

Exceptions do emerge. Some 70% of secondary school students in Kampala, Uganda and 90% in Buenos Aires, Argentina agree that premarital sexual activity is "normal" for both females and males.

Case studies suggest that young females and males accept--and in many cases justify--sexual double standards and the constraints imposed on women's sexual behavior. Males are perceived to need sexual experience and several partners while women are not, as shown by studies among adolescents attending reproductive health services in two hospitals in Argentina, among adolescent schoolgirls and factory workers in Thailand, and among university students in the Philippines.

Correspondingly, findings (in Argentina and Thailand, for example) imply that young females recognized how these double standards constrain their behavior. Young women in Argentina consider the roles of men preferable to their own because men have greater freedom and independence.

Several studies indicate that males and females engage in sexual relations with very different motives. The leading reasons expressed by females for having sex are love and the desire to strengthen a committed relationship. Although many males express a similar view, their leading motives also include curiosity, "physical need," and peer pressure.

Most females (53%) in secondary school in Argentina report that decisions on the timing of sexual debut were made jointly with their partners while only 7% reported making the decision on their own. Among males, 22% report making the decisions on their own, and 22% report making the decision along with their partner.

Among adolescents attending public hospitals for reproductive and health services in two sites in Argentina, males tend to report "satisfaction" and a sense of "winning" as motives for sex while females experience a sense of "sharing" or "feeling good with their partner."

Case studies suggest that fears of losing their partner, incurring his anger, or jeopardizing the relationship inhibit young females from choosing the timing of sexual activity or negotiating contraceptive use. In Mexico, most ever-pregnant adolescents say that sex was initiated through pressure and promises of a permanent relationship by the partner. In Botswana, women report an inability to negotiate condom use for fear of incurring their partner's anger and risking the relationship: one-third of adolescent females said they were not confident of their ability to decline sex if their partner refused to use a condom, and another 5% said that they would have sex anyway in order to maintain the relationship. In Korea, unmarried females are reluctant to insist on using condoms for fear of being thought to have "loose morals."

After an unwanted pregnancy, young females in Mexico City, Mexico, continue to leave contraceptive decisions to the male partner. Even those who had an abortion without informing their partners did not necessarily exercise informed choice--they did so out of a fear that "he would abandon me."

Many young unmarried women fear disclosure of their sexual activity, which inhibits them from seeking contraception. In Shanghi, China, a leading reason for non-use was fear or embarrassment (30%). Students and factory workers in Bangkok, Thailand, reported that they preferred contraceptive sources that offered privacy and anonymity.

There is, however, emerging evidence that females are increasingly able to say "no" to unprotected sex. In Botswana, for example, over two in five young women reported that they would refuse sex without contraception. Similarly, in Argentina, responses included: "As much as I would like children or the pleasure of being with him--these days I have to put myself first: use the condom, or nothing will happen."

Recommendations

The authors of the review of the case studies offer a number of recommendations. In broad terms, they suggest that there is a global need for: adolescent- and youth-friendly sexual and reproductive health services; counseling of youth on sexuality, pregnancy, post-abortion issues and family planning; and age-appropriate sex education sensitive to the needs of youth.

The authors recommend programmes that enable young people--especially young females--to acquire life and negotiation skills. Such skills are essential for making safe and informed choices. More specifically, they suggest that young women should be taught how to counter threats of sexual coercion and force; refuse unwanted sex; insist on condom use with their partners; and assert themselves in decisions on sexual initiation, contraceptive use, pregnancy and its outcome. Both young females and males also need to be informed about how to make informed choices about contraception, how to resist unwanted peer and social pressure, and when to seek care for reproductive health needs. Finally, programmes need to raise awareness among youth and adults of the threat of sexual violence and empower youth to protect themselves from--and take appropriate actions against--the perpetrators of sexual violence.

The review underscored a myriad of misconceptions held by youth that are rarely addressed in health programmes. Therefore, there is a huge need to understand common misconceptions in different settings and to provide not only basic information on sexually transmitted infections and contraception but also information that attempts specifically to dispel existing misconceptions. At the same time, efforts are needed to counter existing gender-related double standards and their negative consequences for young people. Double standards with regard to sexuality have been found among educational and community institutions as well as the youth themselves and their parents. Parents have a considerable role to play in assuring that their children lead healthy sexual reproductive lives. Efforts also need to be directed at parents in order to empower them to overcome inhibitions or reluctance in assuming this role.

As for information and education programmes, youth clearly have preferred sources of information for various aspects of sexual and reproductive health. These preferences need to be accommodated. With regard to the quality of services, programmes need to be reshaped to respond to concerns raised by youth about lack of privacy and confidentiality, mistrust and perceived judgmental attitudes among providers, all of which prevent appropriate and timely care reaching the youth. There is a need to tailor family planning services and delivery mechanisms so that they inspire trust among young people concerning issues of confidentiality. At the same time, providers need to be trained to respect the right of youth to privacy and confidentiality. Finally, there is a need to listen to youth and incorporate their perspectives in the design and implementation of programmes and educational strategies.

RELATED ARTICLE: Physical and social consequences of sexual relations among young people.

Sexually Transmitted Infections

Few studies have explored sexually transmitted infections (STIs) among youth. The eight case studies that did so drew samples from the population at large--educational institutions, factories and communities--rather than exclusively from high-risk populations. Results confirm that 8-12% of young men and 1-6% of young women have experienced an STI symptom. One study among university students in Ilorin, Nigeria, showed that most (89%) of the female students who experienced an STI symptom obtained treatment, about one-third of them through self-medication. In contrast, all males who experienced symptoms sought care, and relatively few (17%) attempted self-medication.

Unwanted Pregnancy

A substantial minority of sexually active unmarried young women have unplanned and unwanted pregnancies. In the studies that explored this consequence, 10-40% of young unmarried females reported having an unwanted pregnancy (40% of females about to be married in Shanghai, China; 37% of unmarried factory workers in export zones in Republic of Korea; 42% of out-of-school adolescents in Botswana; and 27% of adolescents seeking health care in Buenos Aires, Argentina).

Delays in recognizing or admitting the pregnancy are observed among adolescents at a public hospital in Mexico City. The first skipped period was typically considered a delay, the second an irregularity. Adolescents often acknowledged that they were pregnant only in the third month.

A study of the consequences of unwed motherhood in Manila, Philippines, reports negative consequences: social ostracism; threat of poverty and economic dependence; and fear of remaining single. Motherhood involved considerable personal cost to young women in that it disrupted work (27%), schooling (13%), and parental financial support (9%).

Abortion

Data on induced abortion in developing countries are difficult to gather. Even so, most young females reporting unwanted pregnancy in almost every study in every region opted for abortion. Where abortion is not restricted (e.g. China, Republic of Korea, Viet Nam), over 85% of those who had been pregnant opted for abortion.

Even where abortion is restricted, many pregnant females opt for it, e.g., college students in Ilorin, Nigeria (76%) and adolescents in Lima, Cusco and Iquitos, Peru (49-86%). The two case studies in Argentina suggest differing conclusions. In one, most ever-pregnant young females seeking health care in hospitals in the federal capital and Chubut districts choose to carry the pregnancy to term (62%). In a second, all four of the ever-pregnant secondary school students in Buenos Aires, Argentina, opted for abortion.

Among abortion-seekers, contraceptive practice tends to be irregular or incorrect, and the method of choice is largely traditional. Of young women in a Korean study, almost two-thirds who had experienced an abortion also reported use of withdrawal or rhythm. In both Korea and Tanzania, abortion-seekers reported incorrect use, such as sharing oral contraceptives with friends or taking the Pill just before or after intercourse.

Among pregnant adolescents at a public hospital in Mexico City, 72% of those with an unwanted pregnancy that was carried to full term report an average of 2.3 unsuccessful attempts at abortion. Others who did abort the pregnancy made up to four attempts before succeeding. Many attempts were self-induced--typically "strong injections" of unknown drugs and the swallowing of various infusions.

Although numbers are small, several case studies point to multiple abortions among young females. Two of the four ever-pregnant secondary school students in a case study in Kampala, Uganda, reported more than one abortion, as did 13% of ever-pregnant young women working in an export promotion zone in Korea and over 20% of women who had experienced an unwanted pregnancy in Cuba. A study of adolescents with abortion complications in Santiago, Chile, reports that 23% of abortion-seeking respondents had experienced at least one previous abortion.

Evidence suggests that complications may be more prevalent among adolescent abortion-seekers than among adults. In settings where clandestine abortions were sought (e.g. Mexico, Tanzania), complications were particularly prevalent. Even in settings where abortion is legally available, shame and lack of knowledge may combine to constrain young women from seeking timely and safe abortions. For example, 39% of abortion-seekers in the Republic of Korea reported post-abortion complications. The case study in Santiago, Chile, reports a high incidence of depression among pregnant adolescents who opted for abortion.

Family Support

Two case studies discuss perceptions and experiences of family support. Their findings diverge. Among about-to-be-married, ever-pregnant Chinese women in Shanghai, only 13% reported parents who reacted "sympathetically" to their pregnancies while others reported such reactions as indifference (40%), surprise (31%), and anger (11%). Among pregnant adolescents in hospital settings in Cuba, however, parents were reportedly extremely supportive, with 80% assisting their daughters to continue their education or in bringing up their children.

In Sichuan province, China, almost all abortion-seekers had discussed the choice of abortion with their partners, but almost 38% perceived a lack of support from family members. Among pregnant young women working in an export promotion zone in Korea, only one-third had consulted parents or relatives, and only 11% had consulted the male partner.

Lack of family support also operates at another level. In Mexico City, decision-making regarding abortion sometimes excluded the pregnant adolescent herself. In this study, mothers and partners were the two categories of people most likely to be consulted, and several young women reported being "forced" by one or the other to attempt abortion.

Lack of family support can also limit access to resources needed for a safe abortion. In the case study in Mexico City, several pregnant adolescents who would have preferred abortion carried out the pregnancy for want of financial resources.

The following article is reprinted from Progress in Reproductive Health Research, no. 53, 2000. Progress is a publication of the UNDP/UNFPA/ WHO/WORLD BANK Special Programme of Research, Development and Research Training in Human Reproduction, through the Department of Reproductive Health and Research of the World Health Organization, Geneva, Switzerland. Launched by WHO in 1972, the special programme is a global initiative of technical cooperation. It promotes, coordinates, supports, conducts and evaluates research on reproductive health with particular reference to the needs of developing countries. For more information, contact the World Health Organization, 1211 Geneva 27, Switzerland.

Note

(1.) The studies were not designed to be similar: hence, the samples, methodologies and age ranges covered vary. The findings presented in this article have been extracted from: Brown AD, Jejeebhoy SJ, Shah IH, Yount KM, Sexual relations among youth in developing countries: evidence from WHO case studies. Geneva, Department of Reproductive Health and Research, World Health Organization, 2000 (Occasional Paper Series, forthcoming).