Northern European countries stress sexual responsibility for those who are sexually active and enable them to obtain contraceptive services and supplies. They have not reduced sexual activity among young people (159, 237, 238). Each of these countries has developed its own approach, but all have both educational programs and accessible services. For example, Denmark, Finland, and Sweden have compulsory sexual education in schools, while the government of the Netherlands sponsors outreach efforts such as informational television programs and a magazine sent to all young people (164, 237, 295). This does not mean that the government has replaced parents in educating their children. In the Netherlands 80% of 100,000 young people surveyed said that they had learned about sexuality from their parents (17, 435).

Most northern European countries provide free, convenient medical services to all residents including young adults. Sweden established special youth clinics in the 1970s, but now young people use a combination of neighborhood primary health clinics, condom distribution programs, and special youth services (237, 511). The Netherlands also has a network of youth clinics (237, 374). In Denmark students ages 14 and older go on organized visits to family planning clinics to learn about contraceptive methods. At 16, young people receive their own health insurance cards, enabling them to choose their own doctors and to obtain free and confidential services (164).

This openness with information and services does not, however, mean that young people in these countries begin having sexual intercourse at younger ages than in other countries. Danish youth, for example, receive more information about sexuality and contraception than US youth, yet in both Denmark and the US the average age at first intercourse is about 17 years (17, 164, 525). The experience of northern Europe suggests that an effective national strategy to lower pregnancy rates among young women includes enabling young people to take responsibility for their own reproductive health and giving them accurate information and helpful guidance (159, 238).

Such an approach need not be expensive. European programs have succeeded at least in part by informing young people through school programs and by providing access to the same subsidized services that adults use. Most importantly, social norms support responsible sexual behavior (295). Young people are not ashamed to ask questions and seek services, and many adults are not embarrassed to teach their children how to protect their health if they are sexually active.