Youth sexual health improvement in Estonia, 1990-2009: the role of sexuality education and youth-friendly services.

Objectives A new school curriculum was introduced in Estonia in 1996 comprising for the first time sexuality education (SE) topics. The first youth counselling centres (YCCs) addressing sexual health matters were set up in 1991-1992. This study describes the development of school-based SE and YCCs in 1992-2009, and explores the concurrent changes in sexuality-related knowledge, behaviour, and sexual health indicators. Methods The analyses are based on 12 population-based surveys. Data on births, abortions and sexually transmitted infections, including HIV, are taken from national registers. Results By the middle of the past decade SE was well established. There has been a trend towards younger age at first sexual intercourse, and increased usage of condoms and reliable contraceptive methods. The abortion rate among 15-19-year-olds declined by 61% and their fertility rate by 59%. The annual number of registered new HIV cases among 15-19-year-olds dropped from 560 in 2001 to 25 in 2009, new syphilis cases from 116 in 1998 to two in 2009, and gonorrhoea cases from 263 in 1998 to 20 in 2009. Conclusions This study documents considerable improvements in sexual health indicators of youths, and indicates that these run parallel to the development of school-based SE and YCCs.