Mental health problems account for a substantial and possibly increasing share of illness among young people. This finding is significant not only because it directs increasing attention to the problems of young people who suffer from mental health problems but also because mental health problems are associated with various other behaviors, including alcohol and drug use and risky sexual behavior.


Substantial proportions of young people are sexually active at a young age in some parts of the world, most notably sub-Saharan Africa. The HIV/AIDS pandemic has made it inescapably clear that young people are sexually active. While most young women first have sex in a marital relationship, substantial proportions do not. Moreover, in areas with high HIV prevalence, marriage does not protect young women from risk. While marriage reduces the number of sexual partners, it increases the frequency of sex, decreases condom use, and virtually eliminates a girl’s ability to abstain from sex.


There has been an increase in the percentage of women having premarital sex before age 18 in many countries over the past 20 years. However, delays in the age of marriage in most countries have meant that, relative to 20 years ago, fewer young women report themselves to have been sexually active before age 18. Thus, while sex is being delayed, the context of first sexual experience is changing, with a greater likelihood relative to the past that first sex will be experienced prior to marriage.


There is increasing evidence that coercive sexual initiation is not uncommon among young people. The individuals responsible for this coercion are likely to be known to the young person and are sometimes people in authority, such as teachers. Studies suggest that those who experience coercive sex are subsequently more likely than others to engage in higher risk consensual sexual behavior.


Contraceptive use is increasing among sexually active young women, especially those who are unmarried. Rising contraceptive prevalence is most evident in Latin America and the Caribbean and in Eastern and Southern Africa. In Western and Middle Africa, the trends are variable. In other regions—the Middle East and Asia—data on contraceptive use are available only for married women in a limited number of countries. When data are available, they also indicate increases in contraception among married young people in most countries.


Condom use among sexually active young women is still relatively low but increasing rapidly in some places. Although the magnitude of the increases



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