Half of sexually active girls having unprotected sex - Health Behaviour Study

Sexual activity among teenagers, particularly among boys, has decreased over the past decade, but more are using contraception according to the results of the Health Behaviour in School-aged Children (HBSC) study, an international school-based survey conducted in 2022.

Despite the increase in the reported use of contraception over the past decade, a substantial proportion of sexually active young people, especially girls, are still having unprotected sex.

While only 40% of 15-year-old girls reported using a condom during their last intercourse, that percentage rises to 62% among males.

MaltaToday compared the results of the latest HBSC report with similar surveys conducted in 2014 and 2018, revealing a decrease in sexual activity particularly among boys, and an overall increase in the use of contraception.

But the high incidence of unprotected sexual activity adds urgency to calls for an update to Malta’s outdated sexual health policy – which is still being drafted.

Girls report lower use of condoms

The comparison shows that the percentage of 15-year-old boys who reported having sex decreased from 25% in 2014 and 2018 to 17% in 2022. However, the percentage who reported using a condom during their last sexual intercourse increased from 41% in 2014 to 62% in 2022.

In contrast, the percentage of girls of the same age having sex has remained the same as five years ago (15%), but down from 19% ten years ago; while the percentage who reported using the contraceptive pill during their last sexual experience shot up from 6% in 2018, to 25% in 2022. The percentage of girls reporting condom use during their last sexual intercourse increased from 33% in 2018 to 40% in 2022 but remains a percentage point lower than in 2014.

The 2022 survey shows that 53% of sexually active 15-year-old girls and 28% of boys of the same age reported that they or their partner did not use a condom during their last sexual intercourse. Moreover, 10% of boys and 6% of girls could not recall whether they or their partner had used a condom on the same occasion.

Additionally, 40% of girls and 28% of boys reported not using either a condom or a contraceptive pill during their last sexual intercourse.

How Malta compares to others

The study shows that the percentage of Maltese 15-year-old girls having sex tallies with the average in the 42 countries surveyed by HBSC (15%), while boys (17%) are having less sex than the international average of 20%.

But while the percentage of sexually active boys using a condom is slightly above the international average (62% vs 61%), the percentage of sexually active girls using condoms is far below the international average (40% vs 57%). This might suggest that the use of condoms in Malta remains a greater taboo among females.

The percentage of females who neither used a condom or the contraceptive pill during the last time they had sex is also nine points higher than the international average of 40%.

The percentage of boys having sex in Malta (17%) is slightly lower than that in Italy and Germany (19%), Spain and Sweden (20%), and Denmark (23%). The percentage of Maltese girls having sex (15%) is substantially lower than that in Italy and Germany (19%), Spain (22%) and Sweden (25%).

Overall, in all countries surveyed, boys were more likely than girls to report condom use during their last sexual intercourse (61% among boys versus 57% among girls). The largest differences between genders were observed in Albania (37 percentage points) and Malta (22pp).

The gender difference was significant in 12 of the 42 countries and regions. Of these, boys were more likely to report condom use in eight countries, while girls were more likely to report it in the remaining four countries (Lithuania, Poland, Serbia, and Slovenia).

Condom use among girls was lowest in Albania (24%) and highest in Serbia (81%) and in Moldova (75%). For boys, the lowest rate of condom use was reported in Sweden (43%), while the highest rate was reported in Switzerland (77%). No clear geographical pattern was evident, but the lowest condom use overall was reported in Albania, Greenland, Kyrgyzstan, Sweden, and Scotland.

Girls from well-off families have more sex

The study also throws light on class differences and inequalities.

When it comes to sexual behaviour the survey shows that while only 14% of females hailing from less affluent families have had sexual intercourse, the figure rises to 21% among those from higher-income families.

But among boys the picture is completely different. While 25% of boys from lower-income backgrounds have had sex, the percentage falls to 17% among the most affluent. The study does not provide a breakdown by social class for the use of contraception due to an insufficient sample size.

The HBSC survey

The Health Behaviour in School-aged Children (HBSC) study is a large school-based survey conducted every four years in collaboration with the WHO Regional Office for Europe.

HBSC data are used at national, regional, and international levels to gain new insights into adolescent health and well-being, understand the social determinants of health, and inform policy and practice to improve young people’s lives. The survey relies on the self-reported replies of respondents, which may not always accurately reflect real activity.

The report describes the current sexual health status of adolescents by analysing their sexual initiation, contraceptive pill and condom use (or non-use) during their last sexual intercourse, the role of gender, age, and social inequality, and how adolescent sexual behaviour has changed over time.

The study specifically calls for sustained educational and health interventions “to promote condom use, combined with other highly effective contraceptive methods”.

Schoolteachers should also receive additional training to enable them to provide high-quality sexuality and relationships education and help their students to develop skills in these areas.

Crucially, reproductive health services should be youth-friendly, tailored to young people’s “developmental, cultural and logistical needs” and available to young people “without any gatekeeping measures” like requiring parental permission for referral to medical practitioners being imposed.

Moreover, sex education should include the discussion of topics such as “consent, respect, gender equality, and lesbian, gay, bisexual, transgender, intersex, queer/questioning and asexual diversity”.