Risky groups, risky behaviour, and risky persons: Dominating discourses on youth sexual health

Abstract

Significant public health attention has been focused on the problems of youth sexual behaviour. Empirical public health research in this area has attempted to account for mostly negative sexual health outcomes (e.g. sexually transmitted infections and teenage pregnancies) by examining individual characteristics and risk-taking behaviour. Public health practice has followed suit, focusing primarily on modifying sexual risk behaviour and lifestyle ‘choices’. In doing so, we may be unwittingly committed to an unarticulated and unrealistic set of assumptions about the level of agency and control that is afforded to many young people. The purpose of this paper is to begin to ‘unpack’ the underpinnings to conventional approaches to public health research and service provision related to youth sexual health in Canada. Drawing on the works of Foucault to show how discourses concerning risky groups, risky behaviour and risky persons have been advanced as sanctioned discourses in Canada (particularly related to HIV/AIDS risk), the authors investigate how themes of safety and goodness have been privileged as healthy, while other, unauthorized forms of youth sexual behaviour have been marginalized. The issue of teen parenthood is examined to demonstrate how these specific discourses have helped to relegate those youth who do not or cannot implant themselves in an ‘approved reality’ to live separately from the norm in a climate of sex-based shame. Drawing on their previous work and that of others, the authors suggest an alternative approach to understanding youth sexual health, one that favours critical, reflexive public health practices and attends to sociological theory.

Keywords:

• Youth sexual health
• sexual behaviour
• risk discourse

Acknowledgements

The first author would like to acknowledge the beneficial insights received from Louise Potvin, Kate Frohlich and their group of graduate students at the Département de Médecine Sociale et Preventive, Université de Montréal. The authors are also grateful to Pam Ratner and Denielle Elliott for their careful readings of this manuscript. Dr Shoveller is supported by two career awards: one from the National Cancer Institute of Canada and another from the Michael Smith Foundation for Health Research. Dr Johnson is supported by a career award from the Canadian Institutes of Health Research.

Notes

Notes

1. The prevalence rates (per 100,000) of chlamydia and gonorrhoea infections among 15- to 19-year-olds in Canada are 59.4 and 563.3, respectively (Panchaud, Singh, Feivelson, & Darroch, 2000) and epidemiological surveillance evidence indicates that rates of STIs among young people are increasing (BC Centre for Disease Control, 2001). Moreover, the number of reported cases of STIs in Canada probably under-represents the actual cases since many instances of reportable STIs go undetected. In addition, an estimated 20–40% of chlamydia infections develop into pelvic inflammatory disease (PID), which is linked with infertility and can be a chronically painful and debilitating disease (1998/99 Canadian STDs Surveillance Report).

2. In Canada, the pregnancy rate among adolescent women was 42.7 per 1000 in 1997. In 1997, 21,233 girls aged 15 to 19 years had abortions (Dryburgh, 2000). Contrary to stereotypes (e.g. ‘they get pregnant for the apartment and the money’), approximately three-quarters of adolescent pregnancies are unintended (Montessoro & Blixen, 1996; Henshaw, 1998). Some studies have found that adolescent pregnancy can result in low birth weight infants and pre-term delivery, and higher infant mortality (Federal, Provincial, and Territorial Working Group on Adolescent Reproductive Health, 1989; Fraser, Brockert, & Ward, 1995). Adolescent parents are more likely to face problems related to educational attainment, employment and economic opportunities (Stevens-Simon & Lowy, 1995). Babies born to teenage mothers, in comparison with those aged 20 to 21 years, may be at higher risk of poorer cognitive development and are more likely themselves to become adolescent mothers (Maynard, 1996).