Beyond abstinence and risk: a new paradigm for adolescent sexual health.

Two paradigms have shaped how U.S. policy makers, health professionals, and educators have approached teenage sexuality over the past several decades. The first is the abstinence-onlyuntil-marriage paradigm, according to which sex outside of heterosexual marriage is always wrong and harmful (Santelli et al., 2006). The second is the sex-as-risk paradigm, which defines adolescent sexuality in terms of risk and risk taking (Michaud, 2006). The two paradigms share a near-exclusive focus on acts of teenage sexual intercourse, conceptualize such acts as dangerous, and assume that emphasizing their risks is the way to help young people become sexually healthy. Both paradigms exemplify what I call the dramatization of adolescent sexuality: They highlight internal conflictsdbetween impulse and cognitiondand interpersonal conflictsdbetween boys and girls and between youth and parents (Schalet, 2004). But these two paradigms give us only limited tools to conceptualize and promote positive adolescent sexual development and relationships. First, by defining teenage sex as wrong or risky, they insufficiently distinguish sexual acts that are quite safe from those that are high risk. Second, by viewing sexuality as an “either/or” activity rather than a continuum, they give scant attention to the skillsdincluding those necessary to discern and communicate sexual wishes and boundariesdthat allow youth to explore sexuality in a gradual, intentional, and pleasurable fashion. Third, they do not pay enough attention to the relationshipsdwith partners and adult caregiversdthat can support positive adolescent sexual experiences. Finally, they often fail to recognize the socioeconomic deprivations that are at the root of many negative sexual health outcomes and must be addressed to foster healthy development. We see the limits of these two paradigms more clearly when we look outside our national borders at countries that have approached teenage sexuality differently. The teenage fertility rate, for example, is eight times lower in the Netherlands than it