Youth and Sexuality
LITERATURE SUMMARY
Contents
Contents ...................................................................................................................................................1
Liang et al. – The state of Adolescent Sexual and Reproductive Health .........................................................2
Graaf et al. – Seks onder je 25e. Seksuele gezondheid van jongeren anno 2023 .............................................5
Cacciatore et al. – The Steps of Sexuality – A developmental, emotion-focused, child-centered model of sexual
development and sexuality education from birth to adulthood .....................................................................7
Vanwesenbeeck - Doing gender in sex and sex research ........................................................................... 13
Buss & Schmitt – Evolutionary psychology and feminism .......................................................................... 20
Renström & Bäck – Manfluencers and young men’s misogynistic attitudes: the role of perceived threats to
men’s status ........................................................................................................................................... 26
Naezer & Van Oosterhout – Only sluts love sexting: youth, sexual norms and non-consensual sharing of digital
sexual images.......................................................................................................................................... 29
Van de Bongardt et al. – Romantic relationships and sexuality in adolescence and young adulthood: The role
of parents, peers, and partners ................................................................................................................. 31
Zaneva et al. – What is the added value of incorporating pleasure in sexual health interventions? A systematic
review and meta-analysis ......................................................................................................................... 34
Vanwesenbeeck – Comprehensive sexuality education ............................................................................ 35
Crooks et al. – Preventing gender-based violence among adolescents and young adults: Lessons from 25 years
of program development and evaluation ................................................................................................... 40
Covers et al. – Development of multidisciplinary sexual assault centers in the Netherlands ........................ 46
Muehlenhard et al. – The complexities of sexual consent among college students: A conceptual and empirical
review ..................................................................................................................................................... 48
Brown et al. – A bioecological theory of sexual harassment of girls: Research synthesis and proposed model
............................................................................................................................................................... 56
Cup et al. – Mental health disparities between both-, other- and same-sex attracted adolescents: The role of
bullying victimization, gender, and age ...................................................................................................... 62
Goldbach & Gibbs – A developmentally informed adaptation of minority stress for sexual minority adolescents
............................................................................................................................................................... 63
Cramwinckel et al. – Interventions to reduce blatant and subtle sexual orientation- and gender identity
prejudice: Current knowledge and future directions ................................................................................... 65
Mereish et al. – Subtle and intersectional minority stress and depressive symptoms among sexual and gender
minority adolescent of color: Mediating role of self-esteem and sense of mastery ....................................... 65
1
,Liang et al. – The state of Adolescent Sexual and Reproductive Health
Adolescence in a changing world
Adolescence represents the transition between childhood and adulthood and is characterized by significant
physical and psychosocial changes that bring risk and opportunities for influencing the life prospects of young
people. Issues that affect adolescents have long-term health and social implications and require explicit
attention.
New demographic realities
The adolescence population is increasing. In 2019 there were 1.2 billion adolescents worldwide. In Sub-
Saharan Africa, the population increased, but in Asia, Europe, and Northern America there was a decline.
Overall, there was a greater increase in boys than in girls.
Adolescents are living in smaller households and have better health and longevity. There is an overall reduction
in the total fertility rate from 3.0 children per woman to 2.5. Changes in fertility have coincided with improved
health and longevity. Life expectancy in sub-Saharan Africa is still 11.5 years behind the global average.
Adolescents live in a world that has become increasingly both urban and mobile. Across the world, a
disproportionate number of young people are clustered in urban areas, drawn by a global decline in economic
opportunities in the agricultural sector and the potential for better livelihoods in urban centered.
The proportion of the global population that has migrated internationally has increased only marginally.
Changing burden of illness
There has been a significant shift in the burden of disease faced by adolescents. The prevalence of anemia
decreased over time for all adolescent health country groups. The prevalence of anemia remains high in
multiburden countries.
There is an increase of 120% in the prevalence of adolescents who are overweight or obese. This adversely
affects many outcomes for lifelong health, including sexual and reproductive health. This increase occurred in
all continents but was particularly prominent among adolescent girls living in countries with a high burden of
communicable, maternal, and nutritional conditions.
The prevalence of tobacco uses among adolescents decreased, expect among females in in multiburden
countries, where a small annual increase has occurred. Daily smoking prevalence is higher among males than
females. It was highest among countries with higher rates of injury and noncommunicable diseases. The
prevalence of binge drinking changed, but females in multiburden countries had higher annual increases.
The share of disability-adjusted life years (DALY) attributable to depressive disorders, anxiety disorders, and
conduct disorders increased only marginally. Conduct disorders are disproportionately pronounced among
boys, whereas anxiety, depressive disorders, and panic disorder are more common among females.
New social context
Youth are most likely to be connected through social media. Connecting to the internet brings social,
educational, and employment opportunities, but social media have also given rise to new and emerging forms
of bullying, exploitation, and predation.
Inequalities in digital access reinforce other inequalities. Growing up in poverty remains the least likely to
access and develop digital skills, and the odds worsen for girls or someone with a disability. Better digital
infrastructure, new protective regulations and a revolution in both access and professional use of digital skills
will be essential to bring marginalized youth into the information age.
Educational attainment and decent work exert powerful influence on the likelihood that individual adolescents
will experience poor SRHR outcomes. Sustained school enrollment for girls may affect the age at first sex and
first marriage, the likelihood of using contraception and the likelihood of becoming pregnant and acquiring
STI’s.
Enrollments in education have increased significantly at all education levels. In sub-Sharan Africa there is a
near doubling of enrollments in secondary school, but enrollment remains the lowest of all regions. Most of the
2
,region’s countries also achieved large gains in school completion, and yet such levels remain low. Disparities
by sex, geographic location and wealth remain.
The global share of young, employed people living below the poverty line declines. Sex disparities in
unemployed have widened slightly, with young women more likely to be unemployed than young men.
Economic gains for young people are below those recorded for the population older than 25 years. Young
people remain disproportionately affected by economic shocks, structurally weak labor markets, and the lack
of job opportunities offering a decent wage. Although young people struggle with unemployment in some
countries, in others, they contend with working poverty.
The shifting demographic, health and social changes reflect extraordinarily positive trends in development,
including for most adolescents. These trends have also led to major gains in the SRHR of adolescence.
Trends in adolescent sexual and reproductive health and rights since 1994
Age at first sex
As young people stay in school longer, marrying later, and using contraception, marriage and sexual are
increasingly delinked: marriage does not always precede sexual activity, and neither sexual activity nor
marriage necessarily leads to pregnancy and childbirth.
Adolescent girls in most countries have delayed sexual initiation. Only in Latin America the proportion of girls
having sex before age 15 remained static or increased, with in Colombia the largest increase.
Sexual activity among young adolescents is highest across sub-Saharan Africa compared with other regions,
reflecting the higher rates of child marriage in the region. In some countries, progress has been meagre.
Among adolescents, there was an overall decrease in sexual encounters with a nonmarital, non-cohabiting
partner and an increase in using a condom at the sex.
Age at first marriage
The proportion of women aged 20-24 years who were married before the age of 18 decreased in the past 25
years, but the absolute number of girls has increased slightly. Northern Africa and Western and Southern Asia
have witnessed the largest declines in child marriage. In Southern Asia, a girl’s risk of early marriage declined
by more than 40%.
Wide variations are found both within and across countries. The prevalence of child marriage is significantly
lower for males than females. Even in countries where rates of child marriage among females are high, early
marriage among boys is rare.
Female genital mutilation
Female genital mutilation (FGM) is a violation of the human rights of girls and women and has garnered explicit
attention in the sustainable development goals. FGM carries lifetime consequences for obstetric risk,
psychological trauma, and sexual experience.
FGM prevalence among girls aged 15-19 years has declined from 35% to 25% in sub-Saharan Africa and from
92% to 74% in Northern Africa. Despite progress, FGM is driven by deeply entrenched norms in many
communities.
Data shows that a daughter’s likelihood of being cut is significantly higher when her mother supports the
practice.
Violence against adolescent girls and young women.
Worldwide, many young people experience violence that harms their health and dignity and erodes their well-
being. 18% of ever-partnered women and girls aged 15-49 yeas have experienced physical and/pr sexual
violence from a current or former intimate partner in the preceding 12 months.
More attention is paid to the gender dynamics underlying violence against women, including gender
socialization. This shapes attitudes and behaviors during adolescence that underpin sexual and reproductive
rights.
3
, Adolescent contraceptive use
More than 21% of adolescent girls, married or in union, are using a modern contraceptive. This is double the
rate of 10 years ago. The rate of contraceptives use is much higher among unmarried sexually active adolescent
girls than among married or in union adolescent girls. The pill and injectable together account for more than
70% of total modern method use, but with notable regional variations.
Adolescent pregnancy and childbirth
Since the early 1990s early childbearing has become less common. Adolescent birth rates in sub-Saharan
Africa and Latin America and the Caribbean remain the highest worldwide. In Latin America and the Caribbean,
the proportion of births to adolescent mothers still accounts for 20%, the highest regional proportion in the
world.
The adolescent birth rate differs by household wealth. Early childbearing in the most disadvantaged groups
further increases their vulnerabilities over the life course, reinforcing social and economic inequalities.
Closely spaced pregnancies among young mothers present further risk for both the mother and the child.
Pregnancy-related morbidity and mortality
Up-to-date information is lacking. Although data are sparse, pregnancy and childbirth complications are
estimated to be the leading cause of death among 15- to 19-years-old girls worldwide. Adolescents aged 15-17
have greater maternal health risks than women just a few years older, reflecting multiple compounding
vulnerabilities, both social and biological.
The point estimate for maternal mortality among 15- to 19-year-olds is 260 per 100.000 live births. This is higher
than the estimate for those aged 20-24 years, but lower for those aged 35 years and older. Africa has the highest
maternal mortality ration.
Data on the levels and trends in abortion measures that are specific to adolescents are scarce, particularly
among developing countries. Adolescent abortion rates in developed countries are low and have been trending
downward. Comparable trend data are unavailable for developing regions. It is however generally accepted
that unsafe adolescent abortion rates are high in developing countries.
Barriers to access to health care constitute a key reason for the many adverse outcomes of adolescents in
many low- and middle-income countries who attend antenatal care at least one time but tend to seek care late,
have fewer visits, and receive fewer components of care than older first-time mothers.
Despite progress, lack of quality care during pregnancy and delivery still largely contributes to maternal deaths
and many of which are adolescent mothers.
Sexually transmitted infections
The global prevalence of all STIs except for chlamydia, has increased among adolescents. Genital herpes is the
most common STI. The highest prevalence is in Africa and followed by the Americas. Prevalence rates of
gonorrhea are also highest in Africa. The prevalence of all STIs is higher among females than males, although
differentials vary by region and over time.
HIV/AIDS
Of all STIs, no epidemic has led to greater devastation than HIV and AIDS in the past 25 years. During these 25
years, AIDS-related deaths total and estimated 773.000 among 10- to 19-year-olds. It has been most
pronounced in sub-Sharan Africa, where it remains the number one cause of DALYs lost for both males and
females.
Globally, the number of 10- to 19-years old living with HIV increased from 920.000 to 1.6 million. This reflects
both the spread of new infections and the availability of treatment that has allowed people to live longer with
HIV.
Adolescents acquire HIV through various modes. A mother-to-child transmission may account for 56% of
infections among 10- to 14- year-old (in Kenia).
More than half of new HIV infections occurred among key populations and their sexual partners.
4
LITERATURE SUMMARY
Contents
Contents ...................................................................................................................................................1
Liang et al. – The state of Adolescent Sexual and Reproductive Health .........................................................2
Graaf et al. – Seks onder je 25e. Seksuele gezondheid van jongeren anno 2023 .............................................5
Cacciatore et al. – The Steps of Sexuality – A developmental, emotion-focused, child-centered model of sexual
development and sexuality education from birth to adulthood .....................................................................7
Vanwesenbeeck - Doing gender in sex and sex research ........................................................................... 13
Buss & Schmitt – Evolutionary psychology and feminism .......................................................................... 20
Renström & Bäck – Manfluencers and young men’s misogynistic attitudes: the role of perceived threats to
men’s status ........................................................................................................................................... 26
Naezer & Van Oosterhout – Only sluts love sexting: youth, sexual norms and non-consensual sharing of digital
sexual images.......................................................................................................................................... 29
Van de Bongardt et al. – Romantic relationships and sexuality in adolescence and young adulthood: The role
of parents, peers, and partners ................................................................................................................. 31
Zaneva et al. – What is the added value of incorporating pleasure in sexual health interventions? A systematic
review and meta-analysis ......................................................................................................................... 34
Vanwesenbeeck – Comprehensive sexuality education ............................................................................ 35
Crooks et al. – Preventing gender-based violence among adolescents and young adults: Lessons from 25 years
of program development and evaluation ................................................................................................... 40
Covers et al. – Development of multidisciplinary sexual assault centers in the Netherlands ........................ 46
Muehlenhard et al. – The complexities of sexual consent among college students: A conceptual and empirical
review ..................................................................................................................................................... 48
Brown et al. – A bioecological theory of sexual harassment of girls: Research synthesis and proposed model
............................................................................................................................................................... 56
Cup et al. – Mental health disparities between both-, other- and same-sex attracted adolescents: The role of
bullying victimization, gender, and age ...................................................................................................... 62
Goldbach & Gibbs – A developmentally informed adaptation of minority stress for sexual minority adolescents
............................................................................................................................................................... 63
Cramwinckel et al. – Interventions to reduce blatant and subtle sexual orientation- and gender identity
prejudice: Current knowledge and future directions ................................................................................... 65
Mereish et al. – Subtle and intersectional minority stress and depressive symptoms among sexual and gender
minority adolescent of color: Mediating role of self-esteem and sense of mastery ....................................... 65
1
,Liang et al. – The state of Adolescent Sexual and Reproductive Health
Adolescence in a changing world
Adolescence represents the transition between childhood and adulthood and is characterized by significant
physical and psychosocial changes that bring risk and opportunities for influencing the life prospects of young
people. Issues that affect adolescents have long-term health and social implications and require explicit
attention.
New demographic realities
The adolescence population is increasing. In 2019 there were 1.2 billion adolescents worldwide. In Sub-
Saharan Africa, the population increased, but in Asia, Europe, and Northern America there was a decline.
Overall, there was a greater increase in boys than in girls.
Adolescents are living in smaller households and have better health and longevity. There is an overall reduction
in the total fertility rate from 3.0 children per woman to 2.5. Changes in fertility have coincided with improved
health and longevity. Life expectancy in sub-Saharan Africa is still 11.5 years behind the global average.
Adolescents live in a world that has become increasingly both urban and mobile. Across the world, a
disproportionate number of young people are clustered in urban areas, drawn by a global decline in economic
opportunities in the agricultural sector and the potential for better livelihoods in urban centered.
The proportion of the global population that has migrated internationally has increased only marginally.
Changing burden of illness
There has been a significant shift in the burden of disease faced by adolescents. The prevalence of anemia
decreased over time for all adolescent health country groups. The prevalence of anemia remains high in
multiburden countries.
There is an increase of 120% in the prevalence of adolescents who are overweight or obese. This adversely
affects many outcomes for lifelong health, including sexual and reproductive health. This increase occurred in
all continents but was particularly prominent among adolescent girls living in countries with a high burden of
communicable, maternal, and nutritional conditions.
The prevalence of tobacco uses among adolescents decreased, expect among females in in multiburden
countries, where a small annual increase has occurred. Daily smoking prevalence is higher among males than
females. It was highest among countries with higher rates of injury and noncommunicable diseases. The
prevalence of binge drinking changed, but females in multiburden countries had higher annual increases.
The share of disability-adjusted life years (DALY) attributable to depressive disorders, anxiety disorders, and
conduct disorders increased only marginally. Conduct disorders are disproportionately pronounced among
boys, whereas anxiety, depressive disorders, and panic disorder are more common among females.
New social context
Youth are most likely to be connected through social media. Connecting to the internet brings social,
educational, and employment opportunities, but social media have also given rise to new and emerging forms
of bullying, exploitation, and predation.
Inequalities in digital access reinforce other inequalities. Growing up in poverty remains the least likely to
access and develop digital skills, and the odds worsen for girls or someone with a disability. Better digital
infrastructure, new protective regulations and a revolution in both access and professional use of digital skills
will be essential to bring marginalized youth into the information age.
Educational attainment and decent work exert powerful influence on the likelihood that individual adolescents
will experience poor SRHR outcomes. Sustained school enrollment for girls may affect the age at first sex and
first marriage, the likelihood of using contraception and the likelihood of becoming pregnant and acquiring
STI’s.
Enrollments in education have increased significantly at all education levels. In sub-Sharan Africa there is a
near doubling of enrollments in secondary school, but enrollment remains the lowest of all regions. Most of the
2
,region’s countries also achieved large gains in school completion, and yet such levels remain low. Disparities
by sex, geographic location and wealth remain.
The global share of young, employed people living below the poverty line declines. Sex disparities in
unemployed have widened slightly, with young women more likely to be unemployed than young men.
Economic gains for young people are below those recorded for the population older than 25 years. Young
people remain disproportionately affected by economic shocks, structurally weak labor markets, and the lack
of job opportunities offering a decent wage. Although young people struggle with unemployment in some
countries, in others, they contend with working poverty.
The shifting demographic, health and social changes reflect extraordinarily positive trends in development,
including for most adolescents. These trends have also led to major gains in the SRHR of adolescence.
Trends in adolescent sexual and reproductive health and rights since 1994
Age at first sex
As young people stay in school longer, marrying later, and using contraception, marriage and sexual are
increasingly delinked: marriage does not always precede sexual activity, and neither sexual activity nor
marriage necessarily leads to pregnancy and childbirth.
Adolescent girls in most countries have delayed sexual initiation. Only in Latin America the proportion of girls
having sex before age 15 remained static or increased, with in Colombia the largest increase.
Sexual activity among young adolescents is highest across sub-Saharan Africa compared with other regions,
reflecting the higher rates of child marriage in the region. In some countries, progress has been meagre.
Among adolescents, there was an overall decrease in sexual encounters with a nonmarital, non-cohabiting
partner and an increase in using a condom at the sex.
Age at first marriage
The proportion of women aged 20-24 years who were married before the age of 18 decreased in the past 25
years, but the absolute number of girls has increased slightly. Northern Africa and Western and Southern Asia
have witnessed the largest declines in child marriage. In Southern Asia, a girl’s risk of early marriage declined
by more than 40%.
Wide variations are found both within and across countries. The prevalence of child marriage is significantly
lower for males than females. Even in countries where rates of child marriage among females are high, early
marriage among boys is rare.
Female genital mutilation
Female genital mutilation (FGM) is a violation of the human rights of girls and women and has garnered explicit
attention in the sustainable development goals. FGM carries lifetime consequences for obstetric risk,
psychological trauma, and sexual experience.
FGM prevalence among girls aged 15-19 years has declined from 35% to 25% in sub-Saharan Africa and from
92% to 74% in Northern Africa. Despite progress, FGM is driven by deeply entrenched norms in many
communities.
Data shows that a daughter’s likelihood of being cut is significantly higher when her mother supports the
practice.
Violence against adolescent girls and young women.
Worldwide, many young people experience violence that harms their health and dignity and erodes their well-
being. 18% of ever-partnered women and girls aged 15-49 yeas have experienced physical and/pr sexual
violence from a current or former intimate partner in the preceding 12 months.
More attention is paid to the gender dynamics underlying violence against women, including gender
socialization. This shapes attitudes and behaviors during adolescence that underpin sexual and reproductive
rights.
3
, Adolescent contraceptive use
More than 21% of adolescent girls, married or in union, are using a modern contraceptive. This is double the
rate of 10 years ago. The rate of contraceptives use is much higher among unmarried sexually active adolescent
girls than among married or in union adolescent girls. The pill and injectable together account for more than
70% of total modern method use, but with notable regional variations.
Adolescent pregnancy and childbirth
Since the early 1990s early childbearing has become less common. Adolescent birth rates in sub-Saharan
Africa and Latin America and the Caribbean remain the highest worldwide. In Latin America and the Caribbean,
the proportion of births to adolescent mothers still accounts for 20%, the highest regional proportion in the
world.
The adolescent birth rate differs by household wealth. Early childbearing in the most disadvantaged groups
further increases their vulnerabilities over the life course, reinforcing social and economic inequalities.
Closely spaced pregnancies among young mothers present further risk for both the mother and the child.
Pregnancy-related morbidity and mortality
Up-to-date information is lacking. Although data are sparse, pregnancy and childbirth complications are
estimated to be the leading cause of death among 15- to 19-years-old girls worldwide. Adolescents aged 15-17
have greater maternal health risks than women just a few years older, reflecting multiple compounding
vulnerabilities, both social and biological.
The point estimate for maternal mortality among 15- to 19-year-olds is 260 per 100.000 live births. This is higher
than the estimate for those aged 20-24 years, but lower for those aged 35 years and older. Africa has the highest
maternal mortality ration.
Data on the levels and trends in abortion measures that are specific to adolescents are scarce, particularly
among developing countries. Adolescent abortion rates in developed countries are low and have been trending
downward. Comparable trend data are unavailable for developing regions. It is however generally accepted
that unsafe adolescent abortion rates are high in developing countries.
Barriers to access to health care constitute a key reason for the many adverse outcomes of adolescents in
many low- and middle-income countries who attend antenatal care at least one time but tend to seek care late,
have fewer visits, and receive fewer components of care than older first-time mothers.
Despite progress, lack of quality care during pregnancy and delivery still largely contributes to maternal deaths
and many of which are adolescent mothers.
Sexually transmitted infections
The global prevalence of all STIs except for chlamydia, has increased among adolescents. Genital herpes is the
most common STI. The highest prevalence is in Africa and followed by the Americas. Prevalence rates of
gonorrhea are also highest in Africa. The prevalence of all STIs is higher among females than males, although
differentials vary by region and over time.
HIV/AIDS
Of all STIs, no epidemic has led to greater devastation than HIV and AIDS in the past 25 years. During these 25
years, AIDS-related deaths total and estimated 773.000 among 10- to 19-year-olds. It has been most
pronounced in sub-Sharan Africa, where it remains the number one cause of DALYs lost for both males and
females.
Globally, the number of 10- to 19-years old living with HIV increased from 920.000 to 1.6 million. This reflects
both the spread of new infections and the availability of treatment that has allowed people to live longer with
HIV.
Adolescents acquire HIV through various modes. A mother-to-child transmission may account for 56% of
infections among 10- to 14- year-old (in Kenia).
More than half of new HIV infections occurred among key populations and their sexual partners.
4
