Elsevier

The Lancet

Volume 368, Issue 9548, 11–17 November 2006, Pages 1706-1728
The Lancet

Series
Sexual behaviour in context: a global perspective

https://doi.org/10.1016/S0140-6736(06)69479-8Get rights and content

Summary

Research aimed at investigating sexual behaviour and assessing interventions to improve sexual health has increased in recent decades. The resulting data, despite regional differences in quantity and quality, provide a historically unique opportunity to describe patterns of sexual behaviour and their implications for attempts to protect sexual health at the beginning of the 21st century. In this paper we present original analyses of sexual behaviour data from 59 countries for which they were available. The data show substantial diversity in sexual behaviour by region and sex. No universal trend towards earlier sexual intercourse has occurred, but the shift towards later marriage in most countries has led to an increase in premarital sex, the prevalence of which is generally higher in developed countries than in developing countries, and is higher in men than in women. Monogamy is the dominant pattern everywhere, but having had two or more sexual partners in the past year is more common in men than in women, and reported rates are higher in industrialised than in non-industrialised countries. Condom use has increased in prevalence almost everywhere, but rates remain low in many developing countries.

The huge regional variation indicates mainly social and economic determinants of sexual behaviour, which have implications for intervention. Although individual behaviour change is central to improving sexual health, efforts are also needed to address the broader determinants of sexual behaviour, particularly those that relate to the social context. The evidence from behavioural interventions is that no general approach to sexual-health promotion will work everywhere and no single-component intervention will work anywhere. Comprehensive behavioural interventions are needed that take account of the social context in mounting individual-level programmes, attempt to modify social norms to support uptake and maintenance of behaviour change, and tackle the structural factors that contribute to risky sexual behaviour.

Section snippets

Cross-national comparisons

We compare data for entire countries (panel 2 and table 1) and in so doing we pay less attention to the substantial variability within countries. Our choice of indicators shows a concern with sexual health and human rights, but is also determined by availability of comparable data. Age at sexual initiation is of public health interest, since early initiation is more likely to be non-consensual and to be subsequently regretted,31, 32, 33 less likely to be protected against unplanned pregnancy

Explanations for the variation

The regional variation in sexual behaviour underlines the powerful role of environmental factors in shaping behaviour and its consequences for sexual health. Through the interplay between demographic and structural factors, social norms, and public policies, spatial differences can be properly understood. One of the most notable features of the data, for example, is the striking gender difference in sexual behaviour. Women might be disadvantaged in protecting their sexual health if their

Interventions to improve sexual health

With the diversity of sexual behaviour, a range of preventive strategies are needed to protect sexual health. And in view of the importance of the broader determinants on sexual behaviour, approaches focusing exclusively on expectations of individual behaviour change are unlikely to produce substantial improvements in sexual-health status. They are especially inappropriate to poor country circumstances, where sex is more likely to be tied to livelihoods, duty, and survival,78 and where

Conclusions

This is the first time an attempt has been made to bring together comprehensive survey data for sexual behaviour from around the world. The data show perhaps less change over time than might have been supposed. People who fear a tide of youthful promiscuity might take heart from the fact that trends towards early and premarital sex are neither as pronounced nor as prevalent as is sometimes assumed. Similarly, the apparent absence of an association between regional variations in sexual behaviour

References (161)

  • T Barnett et al.

    HIV AIDS: sex, abstinence, and behaviour change

    Lancet Infect Dis

    (2005)
  • E Lesch et al.

    Mothers, daughters and sexual agency in one low-income South African community

    Soc Sci Med

    (2005)
  • AB Roberts et al.

    Exploring the social and cultural context of sexual health for young people in Mongolia: implications for health promotion

    Soc Sci Med

    (2005)
  • P van Empelen et al.

    Effective methods to change sex-risk among drug users: a review of psychosocial interventions

    Soc Sci Med

    (2003)
  • S Bernstein et al.

    Public choices, private decisions: sexual and reproductive health and the Millennium Development Goals

  • E Slaymaker

    A critique of international indicators of sexual risk behaviour

    Sex Transm Infect

    (2004)
  • M Collumbien et al.

    Non use and use of ineffective methods of contraception

  • AM Miller et al.

    Sexuality, Human Rights, and Health

    Health Hum Rights

    (2004)
  • Demographic and Health Surveys. MEASURE DHS, 1984–present

  • P Mufune

    Changing patterns of sexuality in northern Namibia: implications for the transmission of HIV/AIDS

    (2003)
  • S Simon et al.

    Sexual risk attitudes and behaviours among young adult Indonesians

    Cult Health Sex

    (2004)
  • RG Parker et al.

    Structural barriers and facilitators in HIV prevention: a review of international research

    AIDS

    (2000)
  • MA Smith et al.

    The rationale and methods of the Australian Study of Health and Relationships

    Aust N Z J Public Health

    (2003)
  • N Beltzer et al.

    Les Connaissances, Attitudes, Croyances et Comportements Face au VIH/sida en Ile de France - Evolutions 1992, 1994, 1998, 2001, 2004

    (2005)
  • RM Groves et al.

    Plan and operation of cycle 6 of the National Survey of Family Growth

    Vital Health Stat

    (2005)
  • EU New Encounter Module Project

  • J Herold et al.

    Reproductive health survey Albania 2002: preliminary report

    (2003)
  • F Serbanescu et al.

    Reproductive health survey Georgia 2005: preliminary report

    (2005)
  • F Serbanescu et al.

    Young adult reproductive health survey Romania 1996: final report

    (1998)
  • F Serbanescu et al.

    Reproductive health survey Moldova 1997: final report

    (1998)
  • F Serbanescu et al.

    Reproductive health survey Azerbaijan 2001: final report

    (2003)
  • A Arredondo et al.

    Estudio nacional de compotamiento sexual: primeros analisis

    (2000)
  • D Liu et al.

    Sexual behaviour in modern China: report on nationwide survey of 20 000 men and women 1997

    (1997)
  • A Biddlecom

    Trends in sexual behaviours and infections among young people in the United States

    Sex Transm Infect

    (2004)
  • UN Population Division. World population prospects: The 2004 revision population database,...
  • SL Curtis et al.

    Measuring sexual behaviour in the era of HIV/AIDS: the experience of Demographic and Health Surveys and similar enquiries

    Sex Transm Infect

    (2004)
  • M Carael et al.

    Clients of sex workers in different regions of the world: hard to count

    Sex Transm Infect

    (2006)
  • EH Ayiemba

    The effect of health education programmes on adolescent sexual behaviour: a case study of Nairobi city adolescents

    (2001)
  • D Wight et al.

    Extent of regretted first intercourse among young teenagers in Scotland: a cross sectional survey

    BMJ

    (2000)
  • N Dickson et al.

    First intercourse: age, coercion and later regrets reported by a birth cohort

    BMJ

    (1998)
  • SJ Genuis et al.

    Adolescent behaviour should be priority [commentary]

    BMJ

    (2004)
  • A Harrison et al.

    Early sexual debut among young men in rural South Africa: heightened vulnerability to sexual risk?

    Sex Transm Infect

    (2005)
  • J Giesecke et al.

    Sexual behaviour related to the spread of sexually transmitted diseases: a population based survey

    Int J STD AIDS

    (1992)
  • Panel on transitions to adulthood in developing countries

  • BS Mensch et al.

    The changing context of sexual initiation in sub-Saharan Africa. Policy Research Division working paper

    (2005)
  • The world's youth 2000

    (2000)
  • S Clark

    Early marriage and HIV risks in sub-Saharan Africa

    Stud Fam Plann

    (2004)
  • E Lagarde et al.

    Knowledge, attitudes and perception of AIDS in rural Senegal: relationship to sexual behaviour and behaviour change

    AIDS

    (1996)
  • Cited by (0)

    View full text