Elsevier

The Lancet

Volume 358, Issue 9296, 1 December 2001, Pages 1843-1850
The Lancet

Sex at the Millennium
Sexual behaviour in Britain: early heterosexual experience

https://doi.org/10.1016/S0140-6736(01)06885-4Get rights and content

Summary

Background

Relatively high rates of teenage conception and sexually transmitted infection among young people in Britain have focused attention on early sexual behaviour and its determinants. We report the results of the second National Survey of Sexual Attitudes and Lifestyles (Natsal 2000)

Methods

We did a probability sample survey between 1999 and 2001, of men and women aged 16–44 years in Britain. Participants were interviewed using a combination of computer-assisted face-to-face and self-completion questionnaires, and asked questions regarding first heterosexual intercourse, communication about sex, pregnancy, and sexually transmitted infections (STIs).

Findings

We recruited 11161 men and women to the survey (4762 men, 6399 women). The proportion of those aged 16–19 years at interview reporting first heterosexual intercourse at younger than 16 years was 30% for men and 26% for women; median age was 16 years. The proportion of women reporting first intercourse before 16 years increased up to, but not after, the mid-1990s. There has been a sustained increase in condom use and a decline in the proportion of men and women reporting no contraceptive use at first intercourse with decreasing age at interview. Among 16–24 year olds, non-use of contraception increased with declining age at first intercourse; reported by 18% of men and 22% of women aged 13–14 years at occurrence. Early age at first intercourse was significantly associated with pregnancy under 18 years, but not with occurrence of STIs. Low educational attainment was associated with motherhood before 18 years, but not abortion.

Interpretation

The increase in the proportion of women reporting first intercourse before age 16 years does not appear to have continued throughout the past decade. Only a small minority of teenagers have unprotected first intercourse, and early motherhood is more strongly associated with educational level than with family background. Factors most strongly associated with risk behaviour and adverse outcomes have considerable potential for preventive intervention.

Introduction

Interest in the sexual behaviour of young people increased in the second half of the 20th century, fuelled partly by concern for their sexual health. In the 1960s and 1970s, unease surrounding rates of conception among young unmarried people provided the impetus to research, whereas in the 1980s and 1990s, the focus shifted to the risk of HIV transmission among young people. By the end of the 20th century, the UK had the highest rate of teenage births in western Europe,1 and an upward trend in rates of sexually transmitted infections (STIs) among young people.2 Attention has now focused on risk behaviour in the context of both unplanned conception and sexually transmitted infection.3

The timing and conditions of sexual initiation are of substantial interest in the context of public health. Early age at first intercourse is associated with subsequent sexual health status.4, 5 Following the steep decrease in age at first intercourse among women up to and including the 1970s, in many countries, there is evidence of subsequent stabilisation.6 In several European countries this stabilisation occurred in the early 1980s.6 In the USA, it occurred in the late 1980s.7 In Britain8, 9 and New Zealand,10 however, heterosexual intercourse continued to occur at earlier ages throughout the 1980s.

Factors associated with early age at first intercourse are well documented and include early menarche,11 early school leaving age, family disruption and disadvantage,12 and poor educational attainment.6, 13, 14 Less attention has been paid to factors associated with the circumstances of first intercourse.

From analysis of the first National Survey of Sexual Attitudes and Lifestyles (Natsal 1990) we reported a decline in age at first intercourse in successive age-groups, and a significant increase in condom use among the youngest age cohort, born between 1971 and 1976.9 Here we report results from the second National Survey of Sexual Attitudes and Lifestyles done in 1999–2001 (Natsal 2000), focusing on early heterosexual intercourse and the circumstances surrounding that event, the extent of risk reduction practices, and the prevalence of those outcomes of sexual activity which, from a public-health perspective, may be regarded as adverse. We also explore factors associated with these outcomes.

Section snippets

Participants and procedure

We did a probability sample survey of men and women aged 16 to 44 years living in Britain. Details of the methods are described elsewhere.15 Participants were interviewed using a combination of computer-assisted face-to-face and self-completion questionnaires. Parental permission was requested for the participation of respondents aged 16–17 years.

We asked participants their age at first occurrence of heterosexual intercourse using a showcard in the face-to-face component of the questionnaire.

Risk behaviour and risk reduction practice

We recruited 11 161 participants to the study (4762 men, 6399 women). The response rate was 65·4%. The median age at first intercourse was 17 (10th, 90th centile: 15, 21) years for women aged 25–44 years at interview, and 16 (14, 20) years for women aged 16–24 years at interview (becoming sexually active after 1990). For men, it was 17 years (14, 21) for those aged 20–44 years, and 16 years (14, 19) for those aged between 16 and 19 (table 1). 0·66% (34 of 5257) of men and 0·46% (24 of 5159)

Discussion

Several important trends have been identified in these data from Natsal 2000. There seems to have been a stabilisation of the proportion having first heterosexual intercourse before age 16 years among women; a continuation of the increase in condom use and in the decrease in the proportion using no contraceptive method at first intercourse; and an increase in the importance of school in the sexual education of the young, particularly men.

These data are based on reported behaviour and so are

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