Britain now has one of the highest rates of teenage pregnancy in Western Europe. This has significant health and social consequences for our society and so the government has started to implement a two-fold national strategy for England over the next ten years: [1]

• To halve the rate of conceptions among under 18s and set a firmly established downward trend in the conception rates for under 16s by 2010.
• To increase the participation of teenage parents in education and work.

This article explores the underlying factors contributing to these statistics and offers a Christian perspective on the deep significance of healthy sexual relationships within society. It highlights how we as Christian doctors can play our part in helping teenagers think positively about their sexuality and understand Christian values.

Health statistics

• In England there are about 90,000 conceptions per year to teenagers, of which 7,700 conceptions per year are to girls under 16 and 2,200 to girls aged 14 or under.[1]
• Roughly 60% of conceptions result in live births. [1] Of about 180,000 abortions each year, about 35,000 occur in teenagers.
• Despite knowledge about contraception, teenagers are not good contraceptive users.
• Sexually transmitted diseases (STDs) are increasing. Chlamydia has increased by 61% since 1996 and is the leading cause of pelvic inflammatory disease and infertility. The highest rates of gonorrhoea are in men 20 - 24 years and women 16 - 19 years.[2]
• Cervical cancer caused by human papillomavirus type 16 is increasing.
• Young people with mental health problems carry a disproportionate burden of risk of disease associated with sexual behaviour. The most prevalent, clinical depression, is associated with increased rates of risky sex, sexually transmitted disease and early sexual experience. [3,12]

Social statistics

• The norm for girls and boys under 16 years in the UK is to be a virgin.
• Less than one third of teenagers are sexually active by the time they are 16 and half of those who are use no contraception the first time. With hindsight many young women wish they had waited. For a significant group, sex is unwanted.
• This problem affects every part of the country but conception rates are about five times higher in the poorest areas than in affluent areas. They are higher among the most vulnerable young people, including those in care and those who have been excluded from school.
• Teenage parents are more likely than their peers to live in poverty and unemployment and be trapped in it through lack of education, childcare and encouragement.[1]

Images of sexuality in our society

Sexual imagery plays a strong part in our culture today and attractive sexual images are used in nearly all areas of advertising and the media, in fashion and dress, in order to generate interest and make money. Increasingly popular advertising works by association of images, linking sexual attractiveness with 'lifestyle'. In the media, particularly on TV and in films, human relationships are often portrayed as incomplete without sex, yet these same relationships are seldom lasting ones.

With the rise of postmodernist thinking, individualism is emphasised in our culture and teenagers may well pick up in secular society that there are no universal values or norms, that rules and boundaries for sexual expression are meaningless and that they can do what they feel like.

To teenagers, sex is seen as adult and exciting, a barometer of attractiveness, as a solution to problems and never the cause of them. Yet this belies the evidence, since many teenagers have experienced break-up of the family themselves and they are familiar with statistics, which show that marriage is in decline and divorce is commonplace.

A Christian view of sexuality and marriage

As Christians, we would assert that this commoditisation of sex outside of permanent relationship is a much-distorted view of sex, and that many sexual images in popular culture are negative or manipulative, usually self-centred and focused upon 'what I can get out of it'.

Instead, we need to communicate a Christian view of what God has revealed in Scripture, affirming the positives of sex as his precious gift. It is God who made mankind and God made us male and female (Genesis 1:27). Everything God made is good (Genesis 1:31), including our sexuality. The two sexes complement one another perfectly. The biblical context of sexual intercourse is within the exclusive and life-long committed relationship of marriage (Genesis 2:23-25; 1 Corinthians 7:3-5, 39). God's design was for pleasure and enjoyment. As CS Lewis put it, 'Pleasure is God's idea, not the Devil's.' The Song of Songs celebrates sexual intimacy as a profound form of communication and being between the bride and her husband. Instead of 'what I can get', the Bible sees sex as giving of ourselves in love to another.

God gave us the clear boundary for sexual intercourse within marriage for the health and well being of both individuals and society. The Bible teaches clearly that sexual immorality is sin - both sexual intercourse outside of marriage and lustful thoughts (Matthew 5:27, 28). In 1 Corinthians 6, the Apostle Paul argues strongly that, for Christians, our bodies are a temple of the Holy Spirit and that sexual sin is an offence against our own bodies (1 Corinthians 6:18-20).

The focus in our churches upon the married family unit can leave singles feeling left out, isolated and unfulfilled. We need to affirm that celibacy within singleness is a valid expression of our sexuality.

Teenagers' needs

Teenagers are crossing the long bridge between childhood and adulthood: physical/sexual, mental and emotional maturities do not occur simultaneously. It is adults who have shaped our society and are broadly responsible for their nurture and education. Yet all too often teenagers are the ones who are blamed as being solely responsible for embarking on sexual relationships and for becoming pregnant. This happens regardless of the fact that it is adults who have exposed children of all ages to a society which is obsessed by sex, thus putting them under enormous pressure to conform.

Teenagers need and appreciate:

• Being listened to
• Being helped to explore issues
• Having their knowledge and skills recognised
• Being taken seriously
• Being valued

If we give children and teenagers the impression there is something inherently wrong with sex we will risk leaving them convinced that there is something wrong with them when they start being attracted sexually and when their emotions are swinging. Sexuality is about who we are as human beings so it is vital for their self esteem that teenagers have a positive attitude to sexuality.

What are teenagers saying?

Teenagers, even more than the rest of us, desperately need to feel loved and accepted, not least by their friends and peers. Their selfconfidence can be extremely brittle and their desire for approval can lead them to do things that they do not feel comfortable with, just because they do not have the know-how to walk away with their selfconfidence intact. [4]

A number of research studies have shown that teenagers often regret the age when they started having intercourse.[5,6,7] A comparative study of reasons cited by teenagers behind first intercourse showed marked differences between The Netherlands and the UK (See figure1). Over 40% of teenagers in the UK give peer pressure as the reason for first intercourse. It is clear that the reasons behind first intercourse are different between The Netherlands and the UK, with over 50% of teenagers in The Netherlands stating love and commitment, compared with 15% of boys and less than 50% of girls in the UK. Teenagers involved in sex education stated that 'some people only want a relationship for sex, especially males'. The teenagers expressed the idea of unwritten codes finding a balance between trying to get what you want without risking rejection. [4]

Once teenagers have experienced sex, they are very likely to have sex in subsequent relationships and often this occurs at an earlier stage in theent is now relationship. There is an addictive element to sex, which makes it hard to break this pattern.

Sex education

We need to be involved in developing communities and families where children are loved, cared for and affirmed; where relationships are seen more holistically than just sexual relationships. We need to establish that virginity is the norm in both sexes in adolescent years and that saying 'No' is OK. However, we also need to be supportive, caring and understanding to those who become pregnant.

At home

Two-way communication is essential within the home. We want teenagers to develop a healthy personality, which will enable them to cope with the challenges that life presents. We want them to have all the information they need to make choices, particularly in relation to sexual matters, which they are happy with. Compared with The Netherlands, families in this country seem reluctant to talk to their children about sex and relationships.

Boundaries are important (eg. curfew time, asking where their child is going etc) and although perhaps not perceived as such by a son/daughter, are an important indicator of parental love and responsibility.

At work and school

The DfEE issued new guidance on sex and relationships (SRE) in 2000,[8] as part of the Personal, Social and Health Education (PSHE) Framework. Within this guidance, SRE is stated as being 'lifelong learning about physical, moral and emotional development ... about the understanding of the importance of marriage for family life, stable and loving relationships, respect, love and care. It is also about the teaching of sex, sexuality, and sexual health. It is not about the promotion of sexual orientation or sexual activity - this would be inappropriate teaching.' The three main elements of SRE are to be: attitudes and values, personal and social skills, and knowledge and understanding. All schools are now required to have an effective SRE policy, which is regularly inspected and reviewed. Schools are encouraged to work with parents and with the wider community (eg. health professionals, social workers, youth workers) when planning and delivering sex and relationship education.

All health professionals need to be aware of those at risk of risky sexual activity. We need to be proactive in asking pertinent questions, perhaps using the HEADSS mnemonic - Home, Education, peer Activity, Drugs, Sexuality, Suicide. 9 Time needs to be given to those who have become pregnant to listen to them, whatever the outcome. Time is essential in order to listen to those who have come to attention, eg. through overdoses, where relationship issues have been the trigger. Those who have a concern for children and teenagers perhaps need to consider becoming involved with schools as governors or as professionals offering input/resources/examples of good practice, eg. A PAUSE (Added Power And Understanding in Sex Education).[10] All primary care trusts have had to put together a teenage pregnancy strategy and their strategy groups may well welcome such examples of good practice.

At church

How often in church youth clubs do we hear why God's plan was for sex in the context of a life-long relationship of marriage - that it was for our health and well being? Many teenagers feel that sexual sins are put on a much higher pedestal than others - they feel that sexual sin is the unforgivable sin. Sexual issues too often are taboo and teenagers feel they cannot talk about relationships, sex, their anxieties and mistakes for fear of being criticised or condemned, or perhaps because they do not feel adults know what they are going through. Teenagers may well feel too guilty to talk about their mistakes or to ask for help if they feel trapped in an addictive cycle.

We need churches that are supportive and caring of teenagers and parents - evenings for debating issues and sharing the breadth of Christian resources and books that are available.[11,12,13]

God's ideal

Teenagers are not yet mature in all areas of their life - they are crossing the long bridge between childhood and adulthood. They need affirmation from peers, family and friends - they like belonging to a crowd. We want them to have accurate information and to develop the skills they need to make choices and to be confident enough to stand up for what they believe in. Children and teenagers in the Christian community need to know that our sexuality was created by God and is good and to be celebrated. God gave us clear guidance for living so that we can live life to the full, whether married or single. All of us fall short of God's standards and sin, and yet we can know forgiveness through the Lord Jesus Christ. Let us not be afraid to stand up and get involved and share God's ideal for relationships.