The Spanish HBSC team at the University of Seville, in collaboration with the Ministry of Health, has published a comprehensive report examining sexual health behaviours among Spanish adolescents aged 15 to 18 years. The report presents findings from the 2022 survey alongside trend analysis spanning two decades (2002-2022), providing crucial evidence for understanding how adolescent sexual health has evolved in Spain.
The publication reveals concerning developments in adolescent contraceptive use, particularly a significant 10-percentage-point decline in condom use between 2018 and 2022. Currently, 65.5% of sexually active adolescents report using condoms in their most recent sexual encounter, down from 83.8% in 2002. This represents the steepest single-wave decline observed across the study period and means that one in three sexually active adolescents are not using methods that protect against sexually transmitted infections.
The Spanish team surveyed 33,630 adolescents in 2022, including 16,424 aged 15-18 years. Of these older adolescents, 16,164 provided responses to questions about sexual behaviour. The analysis focuses specifically on the 34.8% who reported having engaged in sexual intercourse, allowing detailed examination of contraceptive practices, initiation patterns, and related health outcomes.
Key findings from the 2022 survey
Among adolescents aged 15 to 18 years, 34.8% report having engaged in sexual intercourse. This proportion has remained remarkably stable since 2006, fluctuating only between 33% and 36% across survey waves. However, patterns differ substantially by age group: whilst 20.7% of 15-16 year olds report sexual experience, this rises to 48.5% among 17-18 year olds.
Among sexually active adolescents, 13.2% initiated sexual activity at age 13 or younger. This early initiation peaked in 2010 at 23.9%, declined to 18.8% by 2018, and has remained relatively stable in 2022 at 19.8%. However, recent trends differ by gender: whilst rates among boys continued declining from 2018 to 2022, rates among girls increased from 15.1% to 19.3%, effectively eliminating the gender gap that had been present in previous survey waves.
Contraceptive practices reveal important patterns. In their most recent sexual encounter, 65.5% of sexually active adolescents used condoms, 15.9% used oral contraceptives, and 14.9% relied on withdrawal. Boys report higher condom use (70.6%) compared to girls (60.8%), a 10-percentage-point gap that represents the widest gender disparity observed in the study’s history. Oral contraceptive use, conversely, is higher among girls (19.6%) than boys (11.6%), reflecting the reality that contraceptive responsibility often falls disproportionately on young women.
Emergency contraception use remains substantial: 32.3% of sexually active girls report having used emergency contraception at least once in their lives, representing approximately 9% of all girls aged 15-18. This proportion increased sharply between 2010 and 2014, from 26.9% to 34.0%, and has since stabilised at around 32%.
Regarding pregnancy, 2.9% of sexually active girls aged 15-18 report having been pregnant at least once, representing 1.0% of all girls in this age group. Whilst this figure peaked at 5.8% in 2010 and has declined since, it remains a significant public health indicator requiring continued attention.
Widening inequalities
The report identifies persistent and, in some cases, widening inequalities across multiple dimensions. Girls demonstrate consistently less favourable outcomes in several areas: they report lower condom use, greater reliance on contraceptive pills and emergency contraception, higher rates of withdrawal method use, and consequently face pregnancy risks that boys do not experience directly.
Socioeconomic disparities are equally pronounced. Adolescents from families with low socioeconomic status show lower condom use (60.2% compared to 70.4% for high socioeconomic status), higher rates of early sexual initiation (17.6% initiated at age 13 or younger, compared to 11.2% for high socioeconomic status), greater use of the withdrawal method (17.8% compared to 12.1%), and higher pregnancy rates among girls (4.9% compared to 0.8% for high socioeconomic status).
Gender disparities have widened considerably in recent years. Between 2018 and 2022, condom use declined by 10.4 percentage points among girls (from 71.2% to 60.8%) compared to 8.9 percentage points among boys (from 79.5% to 70.6%). The percentage of girls initiating sex at younger ages increased, whilst rates among boys declined. Girls also show rising oral contraceptive use (from 16.8% in 2018 to 19.6% in 2022) whilst rates among boys have stabilised at around 11-12%.
Alarming trends in protective behaviours
Perhaps most concerning is the dramatic decline in methods that protect against both pregnancy and sexually transmitted infections. Between 2018 and 2022, the proportion of adolescents using condoms or the combination of condoms with oral contraceptives dropped from 75.4% to 64.8%. Over the full 20-year period, this protective behaviour has declined by 19 percentage points, from 83.8% in 2002.
When examining methods that prevent pregnancy (regardless of infection protection), use of reliable methods declined from 84.2% in 2018 to 74.0% in 2022. This means that one in four sexually active adolescents now uses unreliable pregnancy prevention methods (including no method or withdrawal), up from one in six just four years earlier.
The report emphasises that the 2022 decline represents the most dramatic single-wave drop in protective contraceptive use observed across the entire study period, raising urgent questions about sexual health education, contraceptive access, and adolescent health services in Spain.
Positive trends and areas of stability
Despite these concerning developments, some indicators show positive long-term trends. The pregnancy rate among sexually active girls has declined substantially from its 2010 peak of 5.8% to 2.9% in 2022, though this improvement predates the recent decline in condom use. Early sexual initiation rates, whilst having increased slightly in the most recent survey, remain well below the 2010 peak.
The proportion of adolescents engaging in sexual intercourse has remained stable since 2006, suggesting that changes in contraceptive use reflect shifts in behaviour among sexually active adolescents rather than changes in the size of this population.
Implications for policy and practice
The Spanish team’s comprehensive analysis provides crucial evidence for understanding adolescent sexual health needs and developing targeted interventions. The widening gender and socioeconomic disparities highlight the need for equity-focused approaches that address structural barriers to contraceptive access and use.
The dramatic recent decline in condom use, particularly among girls, suggests that current sexual health education and service provision may not be adequately meeting adolescent needs. The findings point to the importance of comprehensive sexuality education that addresses both pregnancy prevention and sexually transmitted infection protection, challenges gender norms around contraceptive responsibility, and ensures that all adolescents, regardless of family socioeconomic status, have access to confidential, youth-friendly sexual health services.
About the study
The Spanish HBSC study is conducted by the University of Seville through successive collaboration agreements with Spain’s Ministry of Health. Spain has participated continuously in HBSC since 1986 (with the exception of 1998) and surveys adolescents aged 11 to 18 years, extending beyond the standard HBSC age groups of 11, 13, and 15 years to include 12, 14, 16, and 17-18 year olds.
The 2022 survey achieved a sample of 33,630 adolescents using complex stratified cluster sampling designed to be representative of Spain’s school-enrolled adolescent population. Questions about sexual behaviour were administered only to adolescents aged 15 and above, following international HBSC protocols that have been maintained consistently since 2002, enabling robust trend analysis.
The full report, titled “Resultados del estudio HBSC-2022 en España sobre conducta sexual: Análisis de tendencias 2002-2006-2010-2014-2018-2022“, provides detailed breakdowns by sex, age group, and family socioeconomic status, offering valuable insights for policy development and health promotion interventions.
