Sigmund Freud’s, “’Three Essays on the Theory of Sexuality” stirred great controversy when it was published decades ago. It still remains controversial, more so as new evidence countering or supporting his childhood sexual theories emerge.
On the sidelines of the International Conference on Family Planning(ICFP) meeting in Kigali Rwanda, last week, global debate around sex and contraceptives access buzzed. In the US, president Trump’s cut of funding for such services and its ramifications downstream also featured.
Closer home, Tanzania and now Kenya’s move to curtail ads around “pro-choice” activities seem to be starting.
As doctors, the sentiments around the topic are divisive even amongst us. Our stands are ultimately influenced by both the medical and moral hats we wear. The latter drawn from our religious persuasions or lack thereof.
Family planning discussions revolve around macroeconomics, moral or legal angles as well as the health effects of unintended pregnancy: abortion and maternal morbidity. The confluence of these three spheres creates an explosive arena with no easily amicable solution.
The biggest concern presently, is the worrying trend of teen sex and its implication on both teen pregnancy and sex-associated morbidities.
In clinics, both rural and urban, more teenagers are walking in for contraceptive services. It is in itself a good thing. On the flip side though, the number of teenage pregnancies is also worrying. Family planning advocates argue that this is why access to contraceptives should continue. Others see it differently.
Evidence on the health benefits of planned pregnancies is overwhelming. It shows babies born at birth interval less than 2 years, mothers under 18 or over 40 years, a high birth order (four or more children) are at a higher risk of neonatal and under 5 mortalities.
The young age in sexual debuts isn’t just a local occurrence, but a global phenomenon. It is estimated that every decade onset of menarche reduces by half a year. Thus since 1960 girls are now entering puberty three years earlier than teens in 1960. Extrapolated it is anticipated that by 50 years perhaps this onset will be as low as 11 years.
Freud’s arguments are that sexual thoughts are present even in children and get reinforced by surroundings. No doubt the present culture and society have an impact on the juvenile minds and we must accept that our children are now “sexually aware” earlier.
Governments globally are now lowering ages of consensual sex. In Mexico it is 15 and a few others hover around 16. Inaction however spells doom. For instance, if contraceptive failure rates are at five percent and with the youth making a majority of the population, just this translates to 250,000 live births from teenage contraceptive failures in the next five years.
The moral dilemma medics face is whether 12- year olds are mature enough to decide on their sexual health. The best recourse is for parents to have sex education talks earlier with teenagers.