Parallel to the economic revolution in China is a sexual revolution, particularly among youth, which is having far-reaching consequences on their health and quality of life. Since feudal times, sex has been a taboo subject in China. Even today, despite progress in many areas, many Chinese, especially the older generations, consider sex shameful or dirty and refuse to talk about it. Young people's opinions differ greatly from those of their parents. At the same time, boys and girls are becoming sexually mature at a younger age.

An increasing number of Chinese adolescents are engaging in premarital and unprotected sexual activity. As a result, unwanted pregnancies, abortions and sexually transmitted infections, including HIV/AIDS, are on the rise. China is now in the early stages of a major HIV/AIDS epidemic.

It is estimated that more than 240 million people in China are between 15 and 24, and that some 20 million more people enter adolescence every year. Such a significant segment of the population needs to be informed about sexual matters. A survey conducted by the State Family Planning Commission among 7,000 people, ages 15 to 49, found that 89.2 percent of respondents in cities and 74.6 percent in the countryside agreed that high schools should offer sex education courses. Yet, only in recent years have the first textbooks on sex education been published and distributed in schools.

Not only is the rate of underage pregnancies growing, but the age at which adolescents become pregnant is declining. In some hospitals, up to 40 percent of those receiving abortions are unmarried mothers.

Worldwide, an estimated 14 million adolescent girls give birth every year, while about 4.4 million girls have abortions. The 2001 edition of the Almanac of China's Health reports that approximately 10 million induced abortions are performed annually in China -- with 20 to 30 percent done on unmarried young women.

Under Chinese law, a parent or guardian must approve an abortion performed on a girl of 18 or younger. Thus many pregnant girls who fear their family's reaction go to back-street abortionists or quacks that may endanger a girl's life.

Some risk factors increase the probability of adolescent pregnancy, such as familial instability, the adolescent pregnancy of a sister, a mother with a history of adolescent pregnancy, pressure from friends, low socio-economic status, ignorance of one's own physiology and the use of contraception, poor communication with parents and a lack of discussion of sexual problems.

Unwanted pregnancy in adolescents can have devastating effects because it delays or halts an adolescent's personal development. There is loss of autonomy and more dependence on parents. Group relations are interrupted since pregnant adolescents cannot continue their normal activities at school or work.

In addition to abortions following unwanted pregnancies, forced abortions are still practiced in China, despite its having been prohibited by the central government in Beijing, as a way of enforcing the government’s one-child policy.

Education continues to be one of the most powerful ways to teach young how to develop an optimal state of physical and mental health. To be effective, educational materials about sexual issues must be reviewed periodically and their message adapted to the various social and cultural groups they address.

Because sex has been a taboo subject for so long in Chinese society, some parents themselves should be educated not only about sexual topics but also on how to maintain a productive dialogue with their children and how to keep the communication channels open with them.

At the same time, the mass media could help remove the taboo regarding adolescent sexuality by helping to redefine social norms and modifying attitudes. There should be constant discussion among parents, teachers, and health and social workers in programs that involve adolescents’ well being.

Cesar Chelala, M.D., Ph.D., is the author of the Pan American Health Organization publication Health of Adolescents and Youth in the Americas.