Sexual health of young people in Estonia in a social context: the role of school-based sexuality education and youth-friendly counseling services

Abstract

Noorte seksuaaltervist mõjutab lisaks individuaalsetele teguritele sotsiaalne keskkond: noorte seksuaalõiguste tunnustamine, seksuaalharidus ja noortesõbralikud terviseteenused, kuid ka domineerivad sooga ja seksuaalsusega seotud hoiakud ning üldine riskiv tervisekäitumine. Eestis viidi 1996. aastal kõigi kooliastmete õppekavasse kohustuslik inimeseõpetus, mille kaudu jõudis seksuaalharidus järgneva kümnendi jooksul enamikuni õpilastest. Paralleelselt loodi noorte nõustamiskeskuste võrgustik, mis pakub tasuta seksuaaltervisealast teavet ja nõustamist. Kas ja millist mõju on need sammud avaldanud Eesti noorte seksuaaltervise näitajatele?

Teismeliste (15–19-aastaste) raseduste võrdlev uuring Euroopa Liidus näitas, et Eestis on olnud üks kiireimaid teismeliste raseduste langusi 2001–2010. Teismeliste raseduste esinemise märgatav kõikumine riigiti on seletatav noorte seksuaaltervise teenuste, soodsate rasestumisvastaste vahendite ja seadusega tagatud turvalise abordi kättesaadavusega. Kahe küsitlusuuringu tulemused näitasid, et seksuaalhariduse saamine koolis oli 4,6 korda sagedamini seotud heade seksuaaltervisealaste teadmistega neidude ja noormeeste hulgas ning 2,7 korda sagedamini tõhusate rasestumisvastaste meetodite kasutamisega noorte naiste hulgas. Noortel naistel ilmnes seos tõhusate rasestumisvastaste vahendite kasutamise ja noorte nõustamiskeskuste külastamise vahel ning kõrge rahulolu nende teenustega. Siiski on ebatõhusate rasestumisvastaste meetodite kasutamine noorte, eriti mitte-eesti emakeelega naiste hulgas levinud – see näitab, et märkimisväärne osa naistest on ohustatud plaanimatust rasedusest. Mõlemast soost teismelistel leiti tugev seos suitsetamise ja purju joomise ning varase seksuaalelu alustamise vahel. See näitab, et varane seksuaalelu alustamine moodustab osa üldisest riskikäitumisest. Neidudel ilmnes veel seos traditsiooniliste sooga seotud hoiakutega, mis tõendab nende rolli seksuaalsusega seotud otsuste tegemise protsessis. Seega on tõenäone, et kooli seksuaalharidusel koos noorte nõustamiskeskustega on olnud märkimisväärne roll teismeliste raseduste ennetamisel Eestis.

Young people's sexual health is, in addition to individual factors, also determined by their social environment: the recognition of youth sexual rights, sexuality education, and youth-friendly health services, but also by the dominating gender and sexuality-related attitudes and by risky health behaviour in general. In Estonia, human studies was included in all levels of the school curriculum as a compulsory subject in 1996. During the following decade, sexuality education reached the majority of pupils. At the same time a network of youth-friendly counseling services was founded, which offered free sexual health related information and counseling. Have these events shaped youth sexual health indicators in Estonia, and to what extent? A comparative study of teenage (15- to 19-year-olds) pregnancies in the European Union found that one of the most rapid reductions in teenage pregnancies between 2001 and 2010 took place in Estonia. The large variation in the numbers of teenage pregnancies between countries can be explained by the accessibility of youth sexual health services, affordable contraceptives and legal and safe abortion. The results of two surveys showed that receiving sexuality education in school was 4.6 times more likely to be associated with good sexual-health knowledge among girls and boys, and 2.7 times more likely to be associated with the use of effective contraceptive methods among young women. An association between the use of an effective contraceptive method and visiting a youth-friendly service was found among young women, who also expressed high satisfaction with these services. Nevertheless the use of ineffective contraceptive methods among young women, especially those who are not native Estonian speakers, was widespread. This indicates that a significant number of women are at risk of unplanned pregnancy. A strong association between smoking and drunkenness and early sexual initiation was found for both teenage boys and girls. This shows that early sexual initiation is a part of general risk behaviour. For girls, an association with traditional gender attitudes was also discovered, which indicates their role in the process of making sexuality related decisions. Therefore it is likely that school sexuality education together with youth-friendly counseling services have played a major role in preventing teenage pregnancies in Estonia.