The Potential of Comprehensive Sex Education in China: Findings from Suburban Shanghai
Wang, Bo, Hertog, Sara, Meier, Ann, Lou, Chaohua, Gao, Ersheng, International Family Planning Perspectives
CONTEXT: More and more Chinese adolescents are engaging in premarital sexual activity. As a result, the numbers of unplanned pregnancies and sexually transmitted infections (STIs) among Chinese young adults have increased markedly.
METHODS: A comprehensive sex education program, including information on abstinence, contraception and healthy sexual behaviors, was carried out in a suburb of Shanghai. The program used six methods for providing information and services to unmarried 15-24-year-olds over a period of 20 months. Sexual behavior surveys were conducted among intervention participants and among controls in a comparable town, who did not receive a similar intervention; chi-square tests and logistic regression were used to compare the results.
RESULTS: Participation in the intervention was not associated with delayed sexual initiation, but was associated with reduced odds that youth coerced a partner into having sex (odds ratio, 0.3) and with increased odds of contraceptive use (6.2) and condom use (13.3) during the intervention period. The greater the level of participation, the larger the protective effects. Furthermore, the proportion of youth reporting pregnancy involvement during the intervention period was significantly lower in the intervention group than among controls (19% vs. 26%).
CONCLUSION: Comprehensive, community-based interventions may be effective in reaching large numbers of Chinese youth and in promoting sexual negotiation, contraceptive use, and pregnancy and STI/HIV prevention.
International Family Planning Perspectives, 2005, 31(2):63-72
A sexual revolution of sorts is under way in China, (1) particularly among youth. Whereas a generation ago, prevailing attitudes toward sex were conservative by any standard and premarital sex was almost unheard of, today young people in China are increasingly open to more liberal ideas about dating and relationships. According to the 2000 Chinese Health and Family Life Survey (CHFLS), the first nationally representative survey on sexual behaviors and attitudes, four in 10 men younger than 30 say they have had premarital sex, more than twice the proportion among those in their 40s. The same trend appears among women. Two in 10 women younger than 30 report having had sex before marriage, compared with one in 10 of those in their 40s. (2)
Further studies show that growing numbers of high school and college students in China are engaging in sexual behavior. For example, an investigation conducted in 1989 showed that 13% of male and 6% of female college students had had premarital sex; in 1999, by contrast, 24% of male and 12% of female seniors in a Guangzhou high school reported having had premarital sex. (3) The proliferation of more liberal attitudes toward sexual behavior among Chinese young people has been traced back to the early 1980s, when economic reforms commenced, (4) and is often attributed to the breakdown of traditional norms resulting from greater mobility, urbanization and the influence of mass media and Western culture. (5)
Increased sexual activity brings economic, social and, especially, health concerns. More and more Chinese youth are grappling with issues related to contraception and pregnancy, sexually transmitted infections (STIs) and HIV, and sexual coercion. According to the 2001 Almanac of China's Health, as many as 10 million induced abortions are performed annually in China, and about 20-30% are provided to unmarried young women. (6) In a study of young women in Shanghai who were engaged to be married, 27% had aborted a pregnancy. (7) Indeed, teenage pregnancy and premarital abortion have become a main public health issue in China.
China has witnessed an upsurge of STIs in recent years. (8) Surveillance data indicate that between 1990 and 1998, the incidence of syphilis increased from 0.2 to 4.3 cases per 100,000 inhabitants, and the incidence of gonorrhea from nine to 24 cases per 100,000. …