Why Are Dutch Teens So Sexually Safe?

Patrick Boyle
October 1, 2001

With lots of frank talk, free reign and contraceptives, teen birth and abortion rates are a fraction of those in the U.S.

Amsterdam, The Netherlands

When adults here talk with youths about sex, the conversation sounds nothing like the standard sex talk between grown-ups and kids in the United States.

As 11,000 Dutch youths gathered in August for a festival run by Youth for Christ, adult organizers planned to discuss sex but not to lecture the kids to abstain until marriage – even though Youth for Christ believes they should. “If we say it’s forbidden, we know that they will say, ‘Too bad for you,’” explains organizer Bram Rebergen.

When teenagers walk into the Rutgers Stichting clinic in Amsterdam to see nurse Mies Van Dam, she answers all their sex questions and gives them free condoms and birth control pills – often against the wishes of their parents, and with government funding.

When a teen named Allard first had sexual intercourse (at age 15), among the first people he told were his parents. Their reaction: “How was it?” and “Were you safe?”

Like it or not, this practical approach to adolescent sex is a key factor behind the fact that Dutch teens get pregnant and have abortions far less often than do youths in the U.S.

Empowered by a generous supply of sexual information and free reign, Dutch youth grow up visibly more comfortable than American youth in their sexual discussions and decision-making. Among the results: A teen birth rate of 4.5 per 1,000 (compared to 49.6 in the U.S.) and a teen abortion rate of 4.2 per 1,000 (compared to 28.6 in the U.S.).

Could the Dutch model work in the U.S.? America’s liberal/conservative horn-locking – with groups like Advocates For Youth (AFY) calling the Netherlands approach instructive and those like the Family Research Council (FRC) calling it a mirage – illustrates why renowned Dutch researcher Evert Ketting literally throws up his hands and exclaims, “You don’t want to change! That is my frustration!”

Politics is one difference between the two nations – along with demographics, religious influence, government philosophy and the cultural mindset – that makes it impossible to graft the Netherlands’ experience directly onto the U.S. “You do not have a multicultural, free-wheeling, individualistic society like the United States,” says Dr. John R. Diggs, Jr., an FRC board member who has visited the Netherlands.

“But we can use the experience of the Dutch, the Germans and the French to help us find a more balanced approach to adolescent sexual health,” AFY President James Wagoner wrote in a 1999 report on those countries.

After all, decades ago the Netherlands was more sexually conservative. Ketting, 45, recalls that during his childhood it was “unthinkable” to have sex before marriage. Today, it is common for Dutch girls to begin taking oral contraceptives at age 14.

“It has been a severe societal revolution,” says sociologist Willem de Regt, who pushed that revolution with research and sex education curricula.

Whether or not the U.S. wants to shift that far, that revolution offers an intriguing look at how to confront teen pregnancies, STDs and abortions.

Blame the ’60s

The Netherlands is “the first country where the sexual revolution succeeded,” says Ketting, a lanky academic, kicking back in gold shorts and blue moccasins in his book-lined home office outside the city of Utrecht. While many young people in the U.S. and other nations experimented with free love in the 1960s and carried some liberal sexual attitudes into adulthood, many also stuck with (or returned to) conservative values. The Dutch changed fundamentally and didn’t look back.

As 11,000 Dutch youths gathered in August for a festival run by Youth for Christ, adult organizers planned to discuss sex but not to lecture the kids to abstain until marriage – even though Youth for Christ believes they should.

The roots of that change stretch to World War II, says Jany Rademakers, research coordinator at the Netherlands Institute of Social Sexological Research (NISSO), based in Utrecht. The Nazi occupation left the Dutch with a particularly anti-authoritarian bent, she says. Dictates from government, churches and parents gradually gave way to citizen and youth empowerment, so by the time the social revolution hit in the 1960s the Dutch were primed to permanently absorb ideas that other people only absorbed as cultural fashion.

The results are famously evident amid the concentric canals and narrow brick streets of Amsterdam: the coffee houses that list a dozen strains of marijuana on their menus, the prostitutes who advertise topless in shop windows, the waiters who ask if a 14-year-old wants wine. But these are only the most visible and commercial aspects of the nation’s permissive culture. While whiffs of pot are common in city parks where teens gather, the average Dutchman does not routinely get stoned or buy sex. Outside Amsterdam, there is little sign that those are even options.

The real impact of the cultural shift over the past 30 years is found in Dutch homes and schools, in the way adults prepare children to make decisions about issues such as sex.

Take the reluctance of Youth for Christ to preach abstinence at its festival this summer. “We try to tell them why we believe it is better for them to be careful about sexual intercourse before marriage,” organizer Rebergen says. While religious groups drive debates over youth sexual behavior and education in the U.S., they have almost no political voice here.

“That is the big difference between us and the U.S.,” Ketting says. Church influence “decreased rapidly in the ’60s,” he says, because the national government had vastly expanded its social services after World War II, “creating a feeling of security that in other countries is provided by the church. That facilitated the church being pushed out” of social policy discussions.

And just about everything else. While Dutch towns are typically marked by the majestic spires of centuries-old cathedrals, many of those churches are more like museums than houses of worship. Only about 60 percent of the Netherlands’ 15 million people claim a religious affiliation (mostly Catholic and Protestant), compared to more than 90 percent in the U.S. About 25 percent of Dutch residents report regularly practicing their religion. Forty-four percent of Americans say they attend church weekly, according to a 1997 University of Michigan study.

Some ministers and priests do urge youths to abstain from sex until marriage. “They say it, but nobody follows it,” says Dirk, an 18-year-old Catholic, as he sits in a bar in Leiden.

So churches were not an impediment as the national government OK’d the selling of condoms from vending machines (1969), provided contraceptive coverage in the national health insurance (1971) and legalized abortion (1981). Notes Rademakers: “In 1968 over half of the Dutch adults disagreed with the statement, ‘Sex is natural – even outside marriage.’ In 1981, this had dropped to 24 percent. In the Dutch sex survey of 1990, the researchers didn’t even bother to ask the question anymore.”

Youths were not left out of this liberalization. Starting in the 1970s, the national government paid NISSO to study youth sexual behavior and help develop sexuality education materials. The government also funded Rutgers Stichting, a family planning association, to run clinics and school programs to teach youths about sex and provide sexuality services, such as pregnancy tests and contraception.

Particularly noteworthy for American onlookers is that the government gave money to Rutgers and NISSO (funded primarily through the Netherlands Department of Health, Welfare and Sport) with no pressure to steer the research or services. “There is little political interference,” says Herman Ormel, a coordinator at the Netherlands Network on Sexual and Reproductive Health.

“The government,” says Rademakers, “doesn’t interfere with the content of the material.”

The result is a strategy that she calls “restrictive permissiveness,” but which many Americans would call giving up.

Amoral Approach?

Nadia van der Linde was 10 and her brother was 12 when their parents showed them a box of condoms in a cabinet. They told the children that whenever they become sexually active, use the condoms and “do it in the house. It’s a safe place,” rather than in a car.

Today van der Linde, now 25, passes on the favor as a member of the Dutch Council on Youth and Population. Council members (ages 20 to 29) go to schools and festivals where youths gather, dispensing information like, “What are your sexual rights? If your parents don’t agree with something” you are doing sexually, “where can you go?” The council is part of the World Population Foundation, a Dutch nonprofit that advocates for sexuality education and contraceptive availability.

Empowered by a generous supply of sexual information and free reign, Dutch youth grow up visibly more comfortable than American youth in their sexual discussions and decision-making.

It is just one of the many ways that Dutch youth get information about sex. “Adolescent sexual health is considered to be a public health issue, not a moral one,” Rademakers says. The strategy is to give youths a lot of information and tell them that if they’re going to be sexually active, be safe about it.

Abstinence? “The concept of abstinence is unknown here,” Rademakers says.

The Dutch address adolescent sexuality not so much through programs as through their state of mind. The approach starts at home and extends to schools and youth-serving health facilities.

At Home

Ask people here in their teens, 20s and 30s where they learned about sex, and most say their parents began talking to them around age 10 or 12, sometimes younger. Youths rarely describe the awkward, one-shot sex talks that Americans dreadfully recall having with their own parents, but recall matter-of-fact discussions varying in detail according to age. The experience of Hilda, a 14-year-old sipping coffee with Allard at the Leiden café, is typical:

“When I wanted to know something, I just asked my parents. They said if I want to, I may do it, but they prefer that I wait. I have to do it safely.” Girls typically say they started using oral contraceptives, often provided by the family doctor, at around 14 to 16, even though some weren’t sexually active until years later.

To be sure, some parents still feel too awkward to discuss sex with their kids. Three 20-something men sitting at a table next to Hilda and Allard laughed and shook their heads when asked if their parents had told them about sex. They learned in school and from each other.

At School

Sex ed at age 5? A small but growing number of Dutch elementary schools use a curriculum designed by Sanderijn van der Doef, a researcher at the National Institute for Health Promotion and Disease Prevention, based in Woerden.

As Rademakers says, “You’re not going to teach a 5-year-old how a condom works.” The early instructions are really about being aware of and comfortable with your own body – looking at yourself naked in the mirror, drawing boys’ and girls’ bodies, reading a story about two friends taking a bath together, and discussing who wants to and who does not. “The goal,” says van der Doef, the mother of two, “is to make it easy to talk about this issue.”

It’s still not easy for adults, however. Teachers and school administrators were reluctant to take up the call, says de Regt, the sociologist who helped to craft the sex education curricula in the 1970s and ’80s. “That was one of the frustrations,” says de Regt, now a consultant at ZON, a government-funded human development organization that dispenses research funding. The curricula were distributed to schools, but “if you evaluated their use, it was 6 or 7 percent.”

The percentage gradually increased in secondary schools, thanks largely to the education ministry providing funds for schools to hire Rutgers Stichting to provide instruction on site. But the instruction varies widely among schools, with some offering the kind of bare-bones instruction that American youths would recognize. “A lot of the teachers have difficulty talking about sexuality with youngsters,” says Fre Steeng, who directs the Lions-Quest Netherlands youth program. “Not all the schools do it.”

That, says Dr. Diggs, dilutes the Dutch claim that their school-based sex ed is one reason for the low teen pregnancy figures.

While Americans who got sex ed in high school tend to recall the lessons with laughter – mechanical discussions about body parts and swimming sperm – many Netherlands youth find them, in the words of Dirk, “pretty good. They talked about using a condom, using birth control, the pill.”

Even in Allard’s Catholic high school, the discussions were frank. “They taught about taking care of yourself. One of the big points was sexual responsibility.”

But this year the national government stopped funding Rutgers Stichting, saying the schools could provide the sex ed themselves and that the Rutgers clinics could merge with other health facilities, like abortion clinics. Sex ed advocates like de Regt worry that many schools will provide little or no sexuality education.

Youth Agencies

If home and school don’t provide enough information or support, a youth in most Dutch cities can turn to clinics that offer sexual information and services for small fees. At the Rutgers clinic in Rotterdam, those under 18 pay 25 Dutch guilders (about $10), which covers everything from information to birth control pills.

While many youths simply go to their family doctors for such services, “a lot of young people don’t dare go to their GP [general practitioner] because she’s connected to their parents,” says Dr. Alide Vanvenberg of the Rotterdam clinic.

At a Rutgers Stiching clinic in Amsterdam, “they like to come here anonymously,” says nurse Van Dam. “They get condoms, talk about sex,” and get oral contraceptives. “We give a lot of morning after pills.”

The Dutch are doing on a universal scale what Americans do occasionally and with great controversy. Some U.S. high schools have an on-site sexuality counselor whom students visit to talk about sex, get condoms and get referrals for services like contraception prescriptions, pregnancy tests and abortions. The Netherlands has gone much further, funding clinics that give youths sexuality information and supplies (like birth control pills) even if it’s knowingly against parents’ wishes.

This is an especially touchy issue for dealing with immigrant youths. Because of cultural and religious differences, many of their parents (especially Muslims) do not accept the Dutch approach to sexuality – causing a culture clash that challenges the Dutch strategy toward teen sexuality. (See story, page 37).

Sex educators also reach youth through youth media. Humor-laced mass media campaigns – with slogans like “Your condom or mine?” and “Double Dutch,” encouraging people to use condoms and birth control pills – have been a hit. Many of the teen magazines run columns on sex. One of the most influential is van der Doef’s question-and-answer column in the monthly Yes, geared toward girls. The most common questions, van der Doef says: “I don’t know how to do it. It still hurts. When can we have sex without a condom? They ask about STDs, pregnancy, using the pill.”

How have Dutch youth responded to all of this information and freedom?

Empowered Youth

“The cultural objective of this strategy,” Ketting says, “is to strengthen young people to make their own decisions of their own free will, but in a responsible way. What you can do is help them gain control over their own intimacy, their own bodies. Your are able to produce adolescents who are able to say what they want.”

Here is what Dutch youth want:

  • They want to wait. The average age of first intercourse is 17.7, compared to 15.8 in the U.S.
  • They do not want babies. One of the striking findings in talking to teenage mothers in the U.S. is that many feel that the baby fills a void in their lives, and they do not see the baby as causing them to sacrifice a major life dream, like a career. Dutch girls tend to feel very strongly about careers and see a baby as a threat to that goal.

Young men say they do not want to be saddled with the responsibility of fatherhood so young.

“You’re better off without the baby,” van der Linde says, reflecting the view of Dutch youth.

It must be noted, however, that Dutch teens apparently felt that way well before the sexual revolution. The teen birth rates in the 1950s and 1960s were about what they are now, Rademakers says, although they did rise for a while in between. The contemporary Dutch approach has basically held births in place as teen sexual activity increased, rather than bringing down a troublingly high birth rate.

The Dutch address adolescent sexuality not so much through programs as through their state of mind. The approach starts at home and extends to schools and youth-serving health facilities.

The “baby would mess up my life” factor fits in with research, such as an analysis of the National Longitudinal Study of Adolescent Health published last month by the Allan Guttmacher Institute. “The most powerful protective factors for many teens are the perceived personal and social costs of having sex, getting pregnant or causing a pregnancy,” Guttmacher said.

Girls and boys shake their heads when asked if boyfriends often press girls to have sex. The girls appear confident about asserting themselves. A study cited by Rademakers at NISSO asked teens if they “ever have the feeling you have to slow your partner down” sexually. Six percent of girls and 8 percent of boys said yes. Asked if they tell their partner what they want or do not want sexually, 66 percent of 16- and 17-year-old girls said yes, while 47 percent of the boys said yes.

While Rademakers says the results show that youths will act responsibly if given responsibility for their own choices, there is clearly more to it.

For one, Dutch youth tend to be significantly more independent than American youths. Van der Linde notes that it is common for Dutch youth to move out of the family home right after high school. Teens do not depend so much on their parents to shuttle them around. In a society where trains and bicycles are the dominant modes of transportation, youths get used to riding trains or biking around towns and cities themselves.

Also, Dutch youth do not always take the healthiest approach when given choices. Smoking and drinking are widespread. According to the Netherlands Institute of Mental Health and Addiction, more than half of secondary school students have smoked, and 14 percent smoke daily. In 1999, 54 percent of secondary pupils reported consuming alcohol “recently,” with the average pupil spending one-quarter of his monthly income on alcohol. (Exact comparisons to the U.S. are not possible because of differences in age groups studied.) Advertising posters at train stations here urge youths not to drink.

So while not having a baby is a major motivation behind youths’ sexual behavior, the far-off health risks of smoking and drinking are not equivalent deterrents.

In fact, putting off birth is not just a youth phenomenon here. Dutch women wait a long time to have babies: The average age of first birth here is about 29. The U.S. figure, according to the Department of Health and Human Services, is 23.

It is just one more way in which Dutch culture is different from that of the United States – making it more complex to apply Dutch lessons.

Caroline Borolla contributed to this report. Patrick Boyle can be reached at pboyle@youthtoday.org.

Boyle, Patrick. "Why Are Dutch Teens So Sexually Safe?" Youth Today, October 2001, p. 1

©2000 Youth Today. Reprinted with permission from Youth Today. All rights reserved.