Chlamythdia: Debunking the Danish Sex Education System
Denmark is a country known for its wealth, great education, freedom and sexual liberation, but it is also one of the front runners of chlamydia infection rates in Europe. At least, this is the impression one can easily get when looking at the news and the data over the last couple of years. Chlamydia cases are on the rise again - not only in Denmark but globally. And the rates are alarming. How come, in a country, where sex education has been praised for its quality and comprehensiveness, young people seem to have become more negligent towards sexually-transmitted diseases? And is this really the case? To understand this phenomenon, one should start with the basics.
What is Chlamydia?
Chlamydia is a common sexually transmitted disease (STD) caused by the Chlamydia trachomatis bacteria. The bacteria are usually spread through sex or contact with infected genital fluids (semen or vaginal fluid).
According to the UK’s National Health Service (NHS), most people with chlamydia do not notice any symptoms. For the few people who do experience them , they can include pain when urinating and pain in the testicles or pelvis. Once discovered, Chlamydia can easily be treated with antibiotics. However, leaving it untreated can lead to very serious consequences. The infection, for example, can spread to other parts of the body and cause to long-term health problems. This is especially the case for women, as it could lead to infertility.
In Denmark and other Nordic countries, the number of confirmed chlamydia cases is surprisingly high. According to the European Centre for Disease Prevention and Control, Denmark alongside Iceland, Norway, Sweden and the United Kingdom accounted for the largest number of confirmed chlamydia cases reported in 2019 by healthcare service providers in Europe.
A Personal Testimony
Over at least the past 12 years, the number of confirmed cases of chlamydia has been on a steady rise, and the struggle to break the curve appears far from over. In 2022, the number of positive cases hit a record high.
According to the latest data from the State Serum Institute (SSI), the total number of diagnosed cases jumped by 14% to more than 41,000 cases last year, rising for the second year in a row and continuing an upward trend that traces as far back as 2011. High testing rates in Denmark do serve as an explanation as for why the numbers are so high compared to other countries. However, it does not account for the high infection rate in general.
The rise in chlamydia cases is particularly noticeable amongst young people in Denmark. According to SSI, Danes between the ages of 15 and 29 make up the largest share of confirmed cases in 2022.
But why is that? Emma*, a 23-year-old history student from Aarhus, Denmark, contracted chlamydia last year from an unfaithful partner: “Since we were monogamous and in an exclusive relationship, I did not even think about the fact that I could have an STD at any point while we were together.”
Emma’s mother is a nurse and got alarmed when Emma one day complained about experiencing pain while using the bathroom. At first, they thought she had a UTI (urinary tract infection), but a doctor’s visit soon changed that. “I had to take a swab test for chlamydia and when I tested positive for the first time in my life, I just didn’t want to believe it”, she says. Emma got prescribed antibiotics and about a week later she was already back to her old self.
Emma’s attitude towards chlamydia changed, but not for the better: “I will say that the fear of getting chlamydia is gone in a way because the process of getting treatment for it was so incredibly easy and cheap.” Most women also do not experience heavy symptoms before testing positive, and Emma can relate to that. “In a way, I am actually more afraid of getting covid than chlamydia at the moment”, she admits.
Nonchalance among Danes
Emma speaks very openly about her experience with chlamydia: “I feel like this is a topic I talk a lot about with my friends. At this point, I know more people in my inner circle that have had it, than people that haven’t.” She believes there is less of a taboo behind STDs today, because of the rise in numbers. “I just don’t think people perceive it as a big health concern anymore, but rather something that is almost equal to getting a cold”, she laughs.
The high number of chlamydia cases also raises questions about the quality of sex education in Danish schools. “I did not have a full week dedicated to sex education like they do now, we just had some random classes about it”, Emma says. She also states that they did not cover much during those classes: “We just learned how to put a condom over a banana, but I don’t remember them ever explaining how the pill works, for example.” Emma hopes the curriculum has changed a lot since then because she did not even really know what chlamydia was until she got it last year:
“I do feel like learning about STDs more in-depth might resolve the major issue we are having.”
Even though her general attitude towards chlamydia as a health concern has not changed, Emma says she will try to be more careful about using protection with her sexual partners for more practical reasons: “I am currently not in a relationship, so I do try to make a point of using condoms every time I have a new partner. I honestly do not think the organisational stress behind getting an STD is worth it.”
*An alias was used in this testimony to keep the identity of the source anonymous
Sex Knowledge among Danes
Emma’s case represents a huge percentage of the Danish youth, as a recent study conducted by the Danish NGO Sex & Society found out. According to Majbrit Berlau, General Secretary of the organisation, many young people do not know how chlamydia is transmitted, and some of the young people indicated that they do not think about protection against chlamydia until after they have been infected.
Indeed, the survey shows surprisingly low numbers regarding the knowledge of young students between 18 and 25 about the routes of transmission and the consequences of infections with STDs. Only about 20% of young people assessed themselves as having a high level of knowledge about sexually transmitted diseases. However, about 40% said they were knowledgeable about contraception.
When asked, nearly half of the respondents were misinformed about the fact that chlamydia can be transmitted through oral sex and that STDs can be spread via surfaces. What’s more, a quarter of all respondents were inadequately informed about the health consequences of untreated chlamydia.
This is an alarming number for Danish youths, who are supposed to go through mandatory sexuality education from the young age of six onwards. Meanwhile, it can also serve as a first attempt to explain why Chlamydia cases are on the rise again. But there are other factors that play into the equation, such as the use of appropriate protection.
While the study found that there is general knowledge about which forms of contraception protect against STDs and which do not – like condoms and hormonal contraception – it also concluded that only half of the youth is to a (very) high degree informed about choosing the best form of contraception to match their lifestyle or needs, especially concerning parameters like individual sexual behaviour or side effects.
Condom Use and Risky Behaviours
To reduce the risk of getting an STD, a condom needs to be used (the right way) every single time you have sex. Despite the fact that this kind of information gets taught in school, Emma expressed a certain kind of nonchalance towards chlamydia, and that attitude is not only reserved for women.
According to a study published by the National Institutes of Health (NIH), only 62% of men used a condom when having a sexual debut with a new partner. Another study from Aalborg University shows that this behaviour is associated with alcohol consumption, and it is strongly rooted in Denmark’s party culture. The study also found that men, more often than not, only want to wear condoms to prevent unwanted pregnancies, rather than to keep themselves safe from getting an STD.
Studies show that there is also a strong connection between health-risk behaviours and non-condom use within the Danish population. Behaviours such as daily smoking and frequent binge drinking can for example lead to less condom use. It has also been proven that if the first sexual intercourse ever happened at a young age (meaning below 14 years), it could lead to more risk-taking behaviours. The reasoning behind that is that a longer sexual activity history leads to a more risk-taking lifestyle
Inside Denmark's Sex Ed
For young people, a better and broader knowledge of the different types of contraceptives is crucial to avoid risk-taking behaviour and decelerate the further spread of chlamydia, among other things. Despite Denmark being renowned for having a good sex education system, there seem to be huge gaps in certain areas of education about sexuality and health that still need to be filled. Given the fact, that over half of the respondents in the study cited earlier mentioned sex education as their primary source of information – closely followed by the internet and friends, education seems to play an important role in the information-gathering process of young people.
Sex Education has always had a solid position in the Danish education system – ever since its introduction in 1971. Though the topics taught have changed over time (and still do!), as a natural response to policy developments, changes in needs, and shifts in sexuality discourses in society, the main goal of Danish sexuality education has stayed the same: The curriculum wants to promote the students' awareness for the subjects of (sexual) health and wellbeing as well as their critical reflection on topics like gender, body, family and one’s own as well as other’s rights.
To achieve this, sex education starts at the age of six in primary school and continues up until 16 in lower secondary school. Additionally, Sex & Society also organises a so-called Sex Week every school year, where different topics are thoroughly discussed and reflected on.
Just recently, the Danish government introduced a new bill (Act 29 on Upper Secondary Education) to also implement compulsory sex education in upper secondary education after high school students demanded sex education to be included in their schools’ curriculum in nationwide strikes.
Government Reacts
The Act requires Danish schools to implement sex education to such an extent that it allows enough time for teaching as well as reflection about topics like consent, boundaries, contraception and sexually transmitted diseases. Other than that, the individual school managements are given a free hand, as there are no requirements as to how and to what extent the teaching is supposed to be carried out.
Including topics like contraception and STDs in the school’s curriculum seems to satisfy the urge for more comprehensive education at first glance. A closer look demonstrates a range of issues that remain unresolved despite the changes.
The revision of the Act budgeted expenses for 300,000 DKK for the development of inspirational material for teachers and school management that is “made to guide the teachers in how they can implement sex education into their own subjects”, the Ministry of Education and Children stated upon request.
“This is based on the assumption that the teachers should not have to teach a subject that is completely outside their professional knowledge.”
Yet, the teaching of sex education in school is frequently criticised for exactly that: the lack of competence of the educators.
As there are no funds allocated for further training of teachers, both students and educators fear they are not properly equipped to teach the topics in class and might therefore also not be confident enough to do so, Danish newspapers Avisen and Kristeligt Dagblad reported.
To counter the issue, students like Emma reach out to friends and families for help. “The way I schooled myself about STDs was through my mom, so I was lucky that she has always been very open about those kinds of topics growing up. Otherwise, I do not know where I would have gained that kind of knowledge from”, Emma admits.
A Call for Reform
These issues did not just emerge recently, but they have been on the agenda for quite some time. According to a study conducted by ALS in 2019, only a minority of educators (13 %) have completed voluntary courses in the teacher education programme, and more than half never even read the curriculum and guidance on the subject.
This is partly due to a lack of overall documentation of sex education progress in schools, which not only results in huge differences between municipalities but also an insufficient overview of the school’s practices. A significant proportion of the country’s schools therefore struggle to live up to the goals of sex education teaching.
In the study, Majbrit Berlau highlights the difficulties in achieving the targets for sex education competency and emphasises the necessity for drastic changes. A considerable proportion of educational institutions find it difficult to achieve these objectives and to cover essential subjects like gender and sexual diversity.
In the interview with Avisen, Isabella Skovhuus, a student from Ringkøbing-Skjern Youth Council, emphasises the importance of well-trained educators, asserting that a comprehensive curriculum should cover critical topics like boundaries, consent, LGBTQ+, and sexual understanding.
The High School Teachers' Association echoes the concerns, insisting on the necessity for further training and emphasising proper didactics rather than solely relying on digital teaching materials.
In response to these findings, Sex & Society proposes four key recommendations to address the deficiencies in Danish sex education:
A call for a restructured approach to Danish sex education emerges in the voices of students, educators, and associations. There is a clear need for change because ongoing conversations bring up issues with teacher credentials and the possible requirement for further training in the context that sex education is included in the curriculum. Denmark is at a turning point in its history, and for the sake of its young people's wellbeing, it is calling for a reevaluation of its position on sex education.
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