PROMOTING SEXUAL HEALTH

AND WELLBEI NG
SUMMARY

Sexualhealthisastateofphysical,emotional,mentalandsocialwellbeingrelatedtosexuality;itisnot
merelytheabsenceofdisease,dysfunctionorinfirmity.Sexualhealthrequiresapositiveandrespectful
approachtosexualityandsexualrelationships,aswellasthepossibilityofhavingpleasurableandsafe
sexualexperiences,freeofcoercion,discriminationandviolence.Forsexualhealthtobeattainedand
maintained,thesexualrightsofallpersonsmustberespected,protectedandfulfilled.1

Impact and scale of the issue

Sexualhealthisinfluencedbyacomplexweboffactorsrangingfromsexualbehavior,attitudesand
societalfactorstobiologicalriskandgeneticpredisposition.2Theavoidanceofnegativeoutcomesis
importanttotrack,butisonlyonecomponentofacomprehensiveunderstandingofsexualhealth.
Whilenegativehealthindicatorsarereadilyavailableastheyrepresentmeasurablepublichealth
concerns,thereisnonationaldataonnonnegativehealthoutcomes,suchassexualpleasure.3

Ageoffirstsexualintercourse

Theaverageageoffirstsexualintercoursereportedbyyouthaged1519yearsandyoung
adults2029yearswasbetween16and17years4with27%reportingtheyhadsexual
intercourseforthefirsttimebeforeaged16.5
75.4%ofpeopleinEasternHealthregionreportedhavingsexforthefirsttimebetweenthe
agesof1519yearsCCHS2009comparedto77.1%inNL.4
In200937%ofyouthand24%ofyoungadultsreportedhavingsexwithmorethanonepartner
comparedto29%and18%in19961997.5

TeenagePregnancy

In2005,thepercentageofteenmothersinCanadawas4.1%;inNewfoundlandandLabrador
thepercentagewas5.8%.6
WithinEasternHealthregionthebirthrateper1,000forfemalesaged1519yearshasbeen
steadilyincreasingfrom12.9per1,000in2006to15.3per1,000in2010;forNewfoundland

HEALTH PROMOTION STRATEGIC FRAMEWORK 2012-17: PROMOTING SEXUAL HEALTH AND WELLBEING

andLabradorthebirthrateper1000forfemalesaged1519yearswas16.6per1,000in
2006and21.9per1,000in2010.6
Teenpregnancyisassociatedwithbothphysicalandsocioeconomicrisksforteen
mothersandtheirchildren.5

Exposuretosexuallytransmittedinfections

Mostyoungpeopleexperience10to20yearsofsexualactivitypriortocommittingto
theirlifepartnerincreasingexposuretosexuallytransmittedinfections(STIs)and
unplannedpregnancy.7
TheincidenceratesofSTIsinNewfoundlandandLabradorarelowerthanthenational
average.However,therehavebeenslight,butsteady,increasesintheratesof
Chlamydia,HIV,GonorrheaandSyphilisintheEasternHealthregionoverthepastfive
years.8
ThehighestnumbersofcasesofChlamydiaintheEasternHealthregionareseenwithin
the2024yearoldpopulationwith118casesin2009,179casesin2010and193cases
in2011.9
Canadiansundertheageof30continuetohavethehighestreportedratesof
Chlamydia.5
STIshavebeenlinkedtopelvicinflammatorydisease(PID),ectopicpregnancies,
miscarriages,andlowbirthweightbabiesandassociatedwithvarioustypesofcancers
includingcervical,anal,andpenile.5

Safersexpractices

Youngadultsinvolvedincasualsexualrelationshipsarelesslikelytoperceiveanythreat
totheirrelationshipbyrequestingcondomuseandarethereforemorelikelytousea
condom.10
Seventyfivepercentof1519yearoldsand58%of2029yearoldsinCanada,notina
monogamous,marriedorcommonlawrelationshipusecondoms.5
IntheEasternHealthregion,59.4%ofsexuallyactivemalesandfemalesaged1549
whowerenotinamonogamous,marriedorcommonlawrelationshipreportedusinga
condomatlastsexualintercoursecomparedto57.2%forNewfoundlandandLabrador.4
Asurveyofgrades9toLevelIIIstudentsinNewfoundlandandLabrador,foundthat
61.2%ofstudentsreportedusingacondomatthetimeoflastsexualintercourse.
Condomusewaslowerforfemales54.8%thanmales68.5%.11
Sexualminorityyouthfrequentlyreporthigherratesofriskysexualbehaviorsthantheir
heterosexualpeersincludinglowerratesofcondomuse.5

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Drugandalcoholmisuse

Earlieralcoholuseisassociatedwithearlieronsetofsexualactivityandisamarkerof
latersexualrisktaking,includinglackofcondomuse,multiplesexualpartners,sexually
transmittedinfectionandteenagepregnancy.Sexualassaultisstronglycorrelatedwith
alcoholusebybothvictimandperpetrator.12
35.3%ofstudentsinNewfoundlandandLabradorwhohadsexualintercoursereported
havinghadunplannedsexualintercourseundertheinfluenceofasubstanceonatleast
oneoccasioninthecourseoftheyear.FortysixpercentoflevelIIIstudentsreport
havingdonesocomparedto27.1%ingrade9.11

Accesstosexualhealtheducationandsexualhealthservices

Sexualhealtheducationinschoolsisstronglysupportedbybothparentsand
students.13Over85%ofparentsagreedwiththestatementSexualhealtheducation
shouldbeprovidedinschools.14
AsurveyofCanadianhighschoolyouthfoundthat92%ofstudentsagreedthatSexual
healtheducationshouldbeprovidedinschools.14
Barrierstoeffectiveschoolbasedsexualhealtheducationprogramsincludeallotted
timeorteachingmaterials,somelevelofcommunityresistance,andsometeachers
reportinguneasinesswiththetopic.15
In2008asurveyofNewfoundlandandLabrador,juniorhighteachersidentifieda
numberofkeyissuesaffectingschoolbasedsexualhealtheducation.Theseincludeda
generalabsenceofpreserviceandinservicetraining;outdatedcurricularresources;
undercoverageoftopicsassociatedwithpleasure,satisfaction,behavior,andaseeming
lackofawarenessofsexualdiversityintheclassroomandresponsetoitdespite
apparentacceptanceofandcomfortwiththetopic.13
Evidencehighlightstheimportanceofaccesstogoodinformationtoprovideyoung
peoplewithknowledgeandskillstomakegoodchoicesabouttheirsexualhealthand
relationships.7
Researchintohealthandaccessissuesamongadolescentsinruralurbancomparison
identifieddistance,infrequentpublictransportandcostoftraveltonearestserviceas
potentialbarrierstoservices.16
AccesstosexualhealthservicesvarieswithintheEasternHealthregion.InSt.Johns,
residentscanaccessservicesthroughEasternHealthsSTIclinic,PlannedParenthood
SexualHealthCentreandAIDSCommitteeofNewfoundlandandLabradoraswellas
nursepractitionersandcommunityphysicians.OutsideSt.Johnssexualhealthservices
areonlyavailablethroughnursepractitionersandcommunityphysicians.

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Degree of Health Inequality

Populationgroupsthatalreadyexperienceinequalitiesrelatedtogender,culturalbackground,
sexualorientation,disability,andotherfactorsareparticularlyvulnerabletosexualand
reproductiveillhealth.16

Groupsinsocietythathaverelativelylittlepowerbecauseoftheirgender,raceoreconomic
status,tendtohavepoorersexualhealth,oftenasaresultoftheirpooraccesstoinformation,
servicesandlegalredress.Povertyandeconomicinequalityareintrinsicallylinkedtopoor
sexualandreproductivehealthoutcomes.Marginalizedandvulnerablecommunities
experienceworsesexualandreproductivehealththanmoreaffluentcommunities,andpoor
sexualandreproductivehealthcanitselfcontributetopoverty.1

Innovativeoutreachapproachesmaybeneededtoensurethatatriskpopulationshaveaccess
tohealthcareandvariousimmunizationprograms.Streetinvolvedyouthareparticularly
vulnerabletosexualhealthriskssuchashigherratesofSTIsandgreatersusceptibilityto
HepatitisBvirus(HBV)andHepatitisC(HCV)infections.AlthoughpubliclyfundedHBV
vaccinationprogramsareschoolbased,manystreetinvolvedyouthattendschoolerratically
andthereforemisstheopportunitytobeimmunized.5

Therearelinksbetweensexualrisktakingbehaviorswithboredom,alcohol,limitededucation,
employmentandrecreationalopportunitiesinruralcommunities.Structuralfactorsspecificto
localcommunitiescancompoundthesocialfactors.Financialbarriersandthelimitedchoicesof
healthcareprovider,includingthesexoftheproviderallimpactruralsexualhealth.Froma
sexualhealthperspective,thekeyfactorsarelikelyserviceavailabilityandaccessissues.16

Evidence that health promotion and prevention action can bring

about change
Researchhasconsistentlyshownthatwelldevelopedsexualhealtheducationprogramming
thattargetscontraceptionandsafersexpracticescanhaveapositiveimpactonadolescent
behavior.Maintainingandenhancingaccesstobroadlybasedsexualhealtheducationand
relatedservicesisessentialforcontinuedimprovementinindicatorsofsexualhealthamong
Canadianyouth.17Researchshowsthatthemorechildrenandyouthlearnaboutsexualhealth,
themorelikelytheyaretopostponesexualactivityand/orengageinsafersexualpractices.14

Evaluationsshowthatcommunitybasedprogramshavebeeneffective,particularlyifthey
involvedmanyorganizationsandindividuals,includingparentsandmentoringadults.5

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Overthelongterm,schoolbasedinterventionscanbecosteffectiveespeciallyconsideringthe
higheconomicandsocialimpactofnegativesexualhealthoutcomessuchasHIVandAIDS,
otherSTIsandunplannedpregnancies.14Inschooleducationalprogramsthatcombine
addressingteenpregnancywithpreventingSTIshavebeeneffectiveincontributingtothe
declineinteenpregnancies.5

Effortsthataddresssexualriskandprotectivefactorsaswellasnonsexualfactorsin
combinationaremorelikelytopositivelyinfluencebehaviors.Publichealthinterventionsthat
encouragecondomuseaswellasfewersexualpartnersaremoreeffectiveatreducingthe
spreadofSTIsandbloodborneinfectionswhenenhancedviaintersectoralcollaborations.5
Suchpartnershipsarelikelytoincludeschools,youthservices,healthservices,localcouncils,
diversitygroups,disabilityservices,multiculturalservices,womenshealthservices,mental
healthservices,drugandalcoholservicesandclinicalservices.16

Youthengagedinextracurricularandcommunityactivitiesarelesslikelytoengageinrisky
behaviors.Adolescentswithstrongconnectionstotheirparentsandpositiveschool
experiences,includingrelationshipswithteachersandpeers,demonstratelessrisktaking.5

Programs that work:

Accordingtothereport,EmergingAnswers2007:ResearchFindingsonProgramstoReduce
TeenPregnancyandSexuallyTransmittedDiseases,asubstantialmajorityofthe
comprehensivesexeducationprogramsreviewedwereeffectiveatpromotingpositivesexual
healthoutcomesincludingdelayingtheinitiationofsex,reducingthefrequencyofsex,
reducingthenumberofsexualpartnersandincreasingcondomorcontraceptionuse.18

AsystematicreviewofyouthSTIandHIVpreventionprogramsascitedintheReportofthe
StateofHealthinCanada2011identifiesfourkeyareasforreducingriskysexualbehaviors:

Targetthosebehaviorsthataremostamenabletochanges,forexampleencouraging
theuseofcondomsduringsex.
Tailorprogramsforthetargetpopulation.
Usetheorytoguideprogramdevelopment.
Addressmorethanjustthesexualriskininterventionsforexamplebroaderbased
contentsuchasproblemsolving,decisionmakingskills,capacitybuilding,socialskill
buildingandenhancinggenderandethnicpride.5

TheFourthRisacomprehensiveschoolbasedinterventiontoaddressviolence,substance
useandunsafesexdevelopedinOntario.Theevaluationofthisinterventionfoundthat
studentswhoparticipatedinthisprogramshowedgainsinknowledge,skillsandattitudesas

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HEALTH PROMOTION STRATEGIC FRAMEWORK 2012-17: PROMOTING SEXUAL HEALTH AND WELLBEING

comparedtostudentsincontrolschoolswhohadparticipatedinregularhealthclasslessons.
ProgramparticipantsalsohadlowerreporteddatingviolencetwoyearsfollowingtheGrade9
program.TheFourthRhassincebeenexpandedandimplementedinmorethan800Ontario
schoolsandadaptedinnineotherprovincesinCanada.5Todatethisprogramhasnotbeen
implementedinNewfoundlandandLabrador.

Opportunities and capacity to address the issue

TakeCareDownThereDownProject
SexualHealthEducationCurriculum,DepartmentofEducation,NL
EasternSchoolDistrictpolicyonschoolbasedsexualityeducationprogramsand
condomdispensingmachines
Grants,e.g.HealthySchoolsGrants,EasternHealthWellnessCoalitionandAvalonEast
CommunityGrantPrograms
ComprehensiveSchoolHealthFramework
ProvincialSexualandReproductiveHealthCommittee
EasternHealthCondomGuidelines
EasternHealthPromotionResourceCenters
LGBTQCoalition/PlannedParenthood
ViolencePreventionInitiative,GovernmentofNewfoundlandandLabrador
RegionalSexualHealthandWellbeingCommittee

Stakeholder Support

DepartmentofHealthandCommunityServices
DepartmentofEducation
EasternSchoolDistrict
GeorgeStreetAssociation
Localbarsandtaxis
PostsecondaryInstitutions,e.g.MemorialUniversity,CollegeoftheNorthAtlantic,
MarineInstitute
CommunityYouthNetworks
PlannedParenthood
LGBTQCoalition
AIDSCommitteeNewfoundlandandLabrador

AcompletelistofreferencescanbeobtainedfromthebackgroundpaperWorkinginHealth
PromotingWays:WhereweLive,Work,LearnandPlaywhichisavailableontheIntranet
(EasternHealthemployeesonly)orwww.easternhealth.ca

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