Sexual health

Ladies and gentlemen, What does the government have to do with sex? I think most people’s immediate response to this question would be ‘Nothing at all. My sex life is a private matter and the government should mind its own business.’ No doubt most of you here today hold that view. And so do I – up to a point. There are exceptions to the rule, and in such cases, I believe the government should not look the other way but should intervene. For instance when a man of 51 takes a girl of 14 home and has sex with her. Or when a girl is pressurised by a group of boys she knows into having sex with them. Another example would be teenage pimps (known as ‘lover-boys’ in the Netherlands). A lover-boy ensnared Danielle, a 15-year-old girl who told her story to a journalist: ‘I was really crazy about Nick! He was so nice to me – gave me everything I wanted, perfume, new clothes, meals out – I was his one and only! Until he asked me to drive with him to Nijmegen with some friends of his. One of the friends hinted that he was in the mood for sex. Nick said to me, ‘Oh go on, just this once, do it for me.’ I felt terribly betrayed. I was raped in the car by that boy. Nick and the others just stood around smoking joints as if there was nothing wrong. Later on I had sex with other boys when Nick asked me to, sometimes for money. He thought it was time I started paying my way [...]’. In the Netherlands, the norm is that it is up to individuals to decide whether to have sex or not. It is part of individual autonomy – one’s right to self-determination. But where does that leave Danielle? Did the actions of Nick and his friends also fall under individual autonomy? And couldn’t Danielle simply have made it clear to them where her boundaries were? Today I want to talk about individual autonomy and about other values that are relevant to sexuality and relationships. And I also want to discuss the Dutch government’s role in these matters. First of all, I will consider the way our society has viewed sexuality over the past century. During that time, our attitudes to sex have changed completely. A revolution has taken place in our thinking. These days the Netherlands has an open and liberal image when it comes to sex. Most Dutch people have healthy sex lives. The Netherlands has a high rate of contraception and condom use and low abortion figures. Most people prefer sex to take place within an intimate relationship. Lecture State Secretary Bussemaker, Sexual health, 1 May 26 2009 But it’s not all positive, unfortunately. Take Danielle, for instance. Or take issues like female circumcision and the increase in Chlamydia infections among young people, which can affect fertility. These problems often affect not only individuals but also society as a whole, and I will discuss them in more detail in a moment. I shall also be looking at how the government’s basic premise for concerning itself with sexuality has also been revolutionised. In the past, it acted from the conviction that it knew what was best for people. Nowadays it seeks to encourage people to make up their own minds and think for themselves. But that, too, requires government action. The government has to act to make freedom and autonomy possible. The key questions are these: how far does individual sexual freedom go and where do you draw the line? And furthermore, when and how should the government intervene? Historical background At the end of the 19th century, the subject of sex was fraught with taboos, rules and injunctions. There was no such thing as homosexuality. In the sexual realm, women were subservient to men. The man was the one who got pleasure out of sex – and not only within marriage. The penalty for adultery was far more severe for wives than for husbands. Prostitutes, adulteresses and unmarried mothers were labelled as ‘immoral women’. Women rallied together and campaigned against this double standard. At the same time, various social groups (especially Christians) called for a strict moral code. In 1911, these moral crusaders won a temporary victory: indecent acts were made punishable by law. A ban on abortion was introduced and it became a criminal offence to promote contraception. In the Netherlands, the campaign for contraception was mainly led by the New Malthusian League (NMB), which held that birth control was the best way to deal with problems resulting from overpopulation. The League’s main focus was on information and education but it also gave practical assistance, for instance by making contraception available. Such assistance was limited to their own members, though, since the public sale or issue of contraceptives was outlawed in 1911 and remained illegal for some time after that. Within this conservative, moralistic climate, a Dutch association was set up in 1914 to combat venereal disease. This government-backed private initiative was prompted by a sharp increase in syphilis and gonorrhoea infections after 1908. The association’s main Lecture State Secretary Bussemaker, Sexual health, 2 May 26 2009 activity was to provide information, based on the prevailing – strongly normative – ideas about sexuality. In the 1930s, the NMB founded ‘sex and marriage advice bureaus’, which would later become the Rutgers’ family planning clinics. These clinics provided contraception and birth control services. In the period after the Second World War people sought to restore the status quo, not only in a material sense but also in terms of the family and male-female relationships. Traditional relationships and the ideal of the family enjoyed broad political support. Pre-marital sex was frowned upon and marriage automatically meant children. In 1946 the NMB became the Dutch Association for Sexual Reform (NVSH). Initially, the NVSH struggled amid the Catholic values and political climate of the time. Its work on contraception retained a semi-illegal aura until the very late 1950s, and there were even attacks on some of its local storage depots. Yet the success and the influence of the NVSH increased as time went on. The Sexual Revolution of the 1960s and 1970s completely overturned attitudes to sex. The tide of emancipation in these decades had a huge impact on sexuality and relationships. Sexual mores became much broader – suddenly, everything was permitted. Sex before and outside marriage, sex for its own sake and sexual desire were acceptable. Homosexuality was no longer taboo and gay liberation took off at great speed. The advent of the contraceptive pill in 1962 was instrumental in the rise of the permissive society. Other contraceptive devices such as the pessary, the coil (or IUD) and the condom also came into widespread use. This enabled sexuality and reproduction to be seen as separate issues, which was especially liberating for women. The sexual revolution gave many people a sense of being liberated from the constraints of gender stereotyping. For others, it raised new questions such as ‘what turns me on?’ and ‘how do sex, love and intimacy relate to each other?’. Yet others felt the process went much too fast, and they criticised what they perceived as debauchery and lack of self-control. This period saw the emergence of a new and open culture of sex education as an alternative to ‘the birds and the bees’. For instance, in 1958 the NVSH began convening teachers’ meetings on this subject and in 1967 published a report about sex education in schools. Lecture State Secretary Bussemaker, Sexual health, 3 May 26 2009 The government’s standpoint also changed. Whereas in the past, it had adopted a prohibitive and prescriptive approach, the reverse was true in the 1960s and 1970s. It no longer restricted sexual morality but followed the trend towards greater freedom and personal choice. For instance the ban on selling contraceptives was lifted in 1969. That same year, for the first time ever, the government made funding available for sex education. A debate on the legalisation of abortion was launched and the women’s movement, too, conducted a major family planning campaign. After a lengthy campaign, the ban on abortion was lifted in 1984. Meanwhile, the downside of sexuality came into focus, as well. And the family, it turned out, could be a dark, violent institution rather than a safe haven in a cruel world. Besides liberation, the sexual revolution also brought new rules – sex had to be fun and you could not really say ‘no’ to it. The women’s movement labelled sex as ‘personal and political’ and launched the debate about its negative aspects such as sexual abuse and rape within marriage. Yet this latter act was not designated a crime until 1991. It was also some time before the government treated sexual violence as a political theme. That was in 1984, when Hedy d’Ancona presented the first government paper on sexual violence against women and girls. From the 1960s onwards, there was a linear development towards greater sexual liberation and emancipation, but it came to an abrupt end with the discovery of HIV and the emergence of AIDS at the beginning of the 1980s. People were confronted with the negative side of free sex – it could actually kill. There was a new focus on sex education and it was given a different slant: there was more emphasis on safe sex and the discovery of HIV provided a context for sex education in schools. In 1990, under the Collective Preventive Public Health Act, the Municipal Health Services were made responsible for providing information about sexually transmitted infections (STIs) and HIV. Ladies and gentlemen, it is patently obvious from this short historical review that attitudes to sex have changed enormously. It is also evident that the government has always been involved with the subject. So the issue at stake now is not so much whether the government should intervene but how, when and in what way. Should it adopt a restrictive and moralising approach – like it did before the 1960s – or should it aim to facilitate and promote selfdetermination and emancipation? Should the government get directly involved, for instance by setting legal norms, or primarily by supporting professionals who make the actual Lecture State Secretary Bussemaker, Sexual health, 4 May 26 2009 decisions? Before going further into the subject, I will outline the values on which my own policy is based. Policy values The government never operates neutrally but from a set of specific values. My policy on sexual health, sexual relations and sexuality as such, is based on four principles: autonomy, self-reliance, mutual understanding and respect, and the right to effective care. Autonomy First of all autonomy, or self-determination. Sexuality and sexual experience are highly individual phenomena. What one person finds enjoyable is abhorrent to another. There is no general social framework that prescribes how people should treat each other and how they should experience sexuality. In the Dutch view, it is up to individuals to make their own choice and to indicate their preferences and their boundaries. The government should therefore be slow to pass moral judgements and should operate from the individual’s right to choose. For example, certain girls (especially Muslim girls) may see sexual abstinence as a form of emancipation: sexual desire is reserved for marriage. However, other girls have sex solely for enjoyment and for them, it is a form of emancipation, according to Kramer in the report ‘Identificatie met Nederland’, published by the Advisory Council on Government Policy. This is one of the great dividends of the previous century: sexual relations are now a matter for the individual, and not for the government, the Church, civil society or anybody else. Nevertheless, it is important to realise that not everyone is inherently capable of acting autonomously. The government has a role to play here, by creating the conditions under which people may develop their personal preferences. This is what the philosopher Isaiah Berlin called ‘positive freedom’, meaning that the government intervenes in the individual’s private life in order to facilitate their personal and social development. Autonomy simultaneously imposes boundaries on the government in the sense that it does not go into people’s bedrooms or interfere with individual sexual choices. This is ‘negative freedom’, freedom from state interference. In this context, government intervention is only admissible if people are incapable of deciding for themselves what they want to do in their Lecture State Secretary Bussemaker, Sexual health, 5 May 26 2009 bedrooms. After all, autonomy presupposes that people can make independent judgements about what they do and don’t want, and that they can express these preferences. Those who cannot do so because they do not have a fully developed independent capacity to judge, for instance children and mentally disabled people, are protected in their autonomy by the government. Sexual Self-reliance But even if you are considered to be capable of forming a judgement, being able to choose what you do and don’t want is not always as simple as it seems. To put it another way, does a girl act autonomously if she agrees to have sex with various boys because her friends think this would be normal? I think most of us would say ‘no – she is responding to peer pressure’. To be able to make autonomous decisions you must be able to stand up for yourself. So self-reliance is the second principle of my policy. You must be able to express your sexual choices and act accordingly. Or as the researcher Ine Vanwesenbeeck says: ‘If you can’t say a wholehearted ‘yes’ to sex, every ‘no’ is suspicious.’ And that ‘no’ is important, too. People must be able to indicate their boundaries and then act accordingly. They must be able to resist unwanted pressure to do things or have things done to them by others. That takes self-reliance. The saying ‘when a girl says no, she means no’, is still relevant in this day and age. Reciprocity and respect Autonomy and self-reliance alone are not enough to make a sexual relationship wellbalanced. Although sexuality has gradually become a hyper-individual experience, it is still generally experienced with another person rather than alone. That is why sexuality goes hand-in-hand with great vulnerability. And in this context, respect and reciprocity are closely connected. One person’s freedom ends at the point where it damages another person’s freedom. This is known as the ‘harm principle’. The individual’s right to self-determination is extremely important, but it is not unlimited. Autonomy is exercised in a social and relational context. That also means being responsible for the repercussions of your behaviour on the other person. A boy should for instance be aware that a girl could become pregnant if they don’t use a contraceptive. Someone having Lecture State Secretary Bussemaker, Sexual health, 6 May 26 2009 unsafe sex should tell their partner if they are HIV-infected. In terms of the harm principle, not to do so would be unacceptable behaviour. Effective care and assistance The last principle is the right to sex education and effective care and assistance. In the 1990s, sex education was identified worldwide as a human right, and a number of important UN conferences resulted in international agreements about sexual and reproductive health and rights. People can only enjoy their sexual and reproductive rights if they have learned how to handle sex, have access to information about sexuality and can develop sexually and relationally. It is important not only to have sex education but also access to good facilities such as lowthreshold access to contraception and treatment for sexually transmitted infections (STIs), or help in making a well-considered choice about an unwanted pregnancy. Ladies and gentlemen, The four principles I have just listed are not absolute, nor do they stand alone. They are closely connected, but they can also clash. For instance, absolute autonomy can lead to putting one’s own individual pleasure above everything else. That may conflict with respecting other people’s choices. Yet none of these four principles can exist in isolation: autonomy is only really effective if the individual is also self-reliant: in practice, saying what you do want is only possible when you can articulate what you don’t want – and can stick to your choice. Respect and effective care also go together: you can only demonstrate respect if you are aware of possible risks such as STIs, and have them diagnosed at an early stage. That is why accessible and high-quality care are vital. Challenges for the government We can use these principles to formulate core tasks for the government and set boundaries for them. Briefly, the tasks are to inform the public and to promote sex and relationship education, to promote effective care and to protect. These principles are central to the Lecture State Secretary Bussemaker, Sexual health, 7 May 26 2009 government’s policy; they do not stand in isolation but are the product of social or historical trends. In that sense, the government is reflecting the values that have developed within society. It does not prescribe these principles, it merely translates them into policy, and in doing so, it plays a variety of roles – that of legislator, information provider or enforcer of the law. Providing information and promoting sex and relationship education An important government task is to inform people – especially the young – in order to help them identify their own needs, desires and boundaries. Every year, about 200,000 young people become sexually active for the first time. They need to be aware of their own preferences and boundaries, show respect for others, and learn that sex can be wonderful, while also being aware of the possible risks involved. The government should also ensure that people know where to get information and help. And research shows that it’s sorely needed. A lot of young people are very ignorant about the facts of sex. For instance, one in three boys do not know that a girl can become pregnant if the boy does not ejaculate. Equally, many young people think that you can prevent sexually transmitted infections by washing yourself with extra care. A staggering 50% of boys think that the Pill can make girls infertile! Besides ignorance, there is also the problem of a lack of relational and sexual skills, or ‘sexual interaction competence’, to use the official terminology. Obviously, the task of providing information and teaching skills lies with parents: after all, they are their child’s primary educators. Research shows that close families have a positive influence on children’s sexual behaviour and sexual health. That is another incentive for parents to give them the right information. ‘Sex education means giving children a basis for a healthy relationship later on in life. Teaching them about their body, about the differences between boys and girls, and relational aspects, too. It is also important for children to learn early on about such matters as homosexuality,’ says sexologist Sanderijn van der Doef. Fortunately, many families do do this. I was pleased to read in the reports on parenting debates organised by the municipality of Rotterdam that sex education and learning to deal with one’s own and other people’s boundaries are seen as among the ten standard issues that fall under parenting. However not all parents are successful in teaching their children about sex. For instance in many Moroccan, Somali or Turkish families, talking openly about sex is taboo. And many poorly educated Dutch parents find it difficult to talk about sex without feeling embarrassed. Lecture State Secretary Bussemaker, Sexual health, 8 May 26 2009 This has consequences for the sex education of their children, who have to go elsewhere to find out what they want to know. School is an obvious place, but classroom discussions about sex cannot be taken for granted. Although schools have room in the curriculum for to sex education, it has never been made compulsory. So not every pupil necessarily gets satisfactory or adequate sex education and information. Some schools are very active while others do not know how to tackle the subject, or focus too much on the biological aspects and less on the relational aspects of sex. Or they consider that it has no place within their philosophical or religious beliefs. And yet school is an excellent platform for sex education because all children go to school. Sexual norms are certainly becoming more and more individual, but they are also becoming more dominated by a global culture that portrays sexuality in a very one-sided way. In the multicultural society, sexuality is also a minefield, according to the philosopher Appiah. Sexual norms may symbolise the degree to which individuals can hold onto their personal identity. It is unsettling when alternative standards are propagated by other cultural groups, i.e. if ‘outsiders’ have different norms. In the media, negative sexual phenomena are often linked to ethnic groups. In the Netherlands, the term ‘Breezer slut’ is associated with AfroCaribbean girls, and ‘lover boys’ with Moroccan boys. In these situations, it is important for the government to be supportive. For example, the Ministry of Health, Welfare and Sport commissions teaching materials which deal with the relational aspects of sex, such as the successful teaching pack ‘Long live love’ for pupils in pre-vocational secondary education. It revolves around the themes of resilience, communication and the development of personal norms. The government is also working on interventions to tackle gender stereotyping. Besides school, young people get a lot of their information from websites and other informal sources. My Ministry has recently subsidised a reliable website – www.sense.info – that provides information about sexuality, being in love, relationships and contraception. Disseminating information about sexual health is the responsibility of municipal authorities. I provide grants to organisations involved in promoting sexual health, for instance through research, knowledge transfer or by promoting expertise. That is the government’s way of encouraging private initiatives of this kind. Promoting effective care Lecture State Secretary Bussemaker, Sexual health, 9 May 26 2009 The second immediate task for the government is to promote effective care. And by that, I mean low-threshold, affordable facilities for everyone. For this purpose, the government has included contraception in the standard healthcare package and girls and women who have an unplanned pregnancy can count on effective care and – if they opt for it – safe abortion. To provide low-threshold care, special surgeries have been launched all over the country on my initiative. Young people can book an appointment at their municipal health services and ask questions about sex free of charge and anonymously. They are called ‘Sense’ surgeries. Thus, the government delegates actual care to professionals and does not intrude into the consulting room. A Sense appointment is a matter between the client and the professional counsellor. The government supports healthcare professionals in other ways, too. For instance, we are promoting and funding the detection and treatment of STIs among high-risk groups. Protection The government’s third and final core task is to provide shelter and protection for victims when things go wrong, and to punish offenders. When an individual goes so far in exercising their autonomy that they fail to respect another person’s boundaries, they cause harm. This will not be tolerated by the government, which can use existing legislation to prosecute, say, ‘lover boys’ or those who carry out female circumcision. The government sees itself as responsible for providing shelter for victims. That is why I am launching a major initiative to introduce a national network of shelters and support centres for victims of domestic violence, honour crimes and female circumcision. Finally, we as a government want to protect vulnerable groups, for instance by promoting gay liberation, supporting the National Partnership for Tackling Sexual Violence and campaigning to prevent the stigmatisation of people living with HIV. New dilemmas and challenges These three core tasks for the government are clear and straightforward. That’s probably a great relief for those who feared that the government wanted to ‘intervene in the bedroom’ Lecture State Secretary Bussemaker, Sexual health, 10 May 26 2009 and plunge us back into the sexual dark ages by issuing all kinds of moral injunctions. I hope that I have shown you that this is by no means the case. It would be all too easy to end my talk here, as if all sexual issues had been resolved in this country. But we face various new dilemmas and challenges to which the government must find solutions. Moral panic? An example is what the Dutch call ‘Breezer sex’ – young people providing sex in return for alcopops. It is regarded as the latest of many forms of sexual excess, though I would question its newness. Is sex gradually going off the rails in general or are we in the grip of moral panic, in which the occasional excess is posited as the norm? This question is difficult to answer. On the one hand everything seems to show that, as I mentioned earlier, the Dutch generally enjoy good sexual health. And the Netherlands also scores well in terms of gay liberation, for instance. ‘Breezer sex’ is new in that Breezers are new, but sex in return for goods or favours is as old as the hills. Whether this kind of behaviour is on the increase, I do not know. Research done in 2007 into transactional sex among teenagers does not reveal whether visits to sex parties and sex in return for money or other rewards have increased over the past ten years. However, the antiquity of certain undesirable practices should be no excuse to turn a blind eye to their most recent manifestations. The problem of teenage pimps requires a special approach, partly because it affects a specific subgroup of girls. My provisional conclusion is that we should beware of getting carried away by moral panic, while not shrinking from a close scrutiny of new problems or new manifestations of old problems. Whose autonomy? Another subject with which I am involved as State Secretary is the autonomy I mentioned earlier. Most people will probably agree that government policy should aim at autonomy and resilience. But the question is, for whom? Lecture State Secretary Bussemaker, Sexual health, 11 May 26 2009 The obvious answer, of course, is ‘girls’. Girls need to think about birth control and contraceptives and they need to stand up for themselves and say no. ‘In the world of education and social services, the girls are the ones who need to learn to express their wishes,’ says Monique Kremer. Boys also see this as the girl’s responsibility, as recent research shows. Boys and girls alike think that girls are responsible for setting boundaries, for themselves and for boys. But what are the implications for boys? Shouldn’t boys also learn to say no? After all autonomy is not just about expressing your own wishes or doing what you want. It is also about being able to exercise responsibility, which requires self-control. Some boys adopt a questionable attitude to this issue. Are their choices always the result of well-considered judgements and awareness of responsibility? Or do they stem from the notion that one should meet a socially accepted norm? Unfortunately, the socially accepted norm – as ever – reflects a double standard. Recent research shows that most young people – boys as well as girls, from Dutch as well as immigrant backgrounds – share the view that promiscuous boys are cool, but that promiscuous girls are whores. Girls who have sex are assumed to have made a conscious choice beforehand, whereas it is assumed that boys ‘just can’t help themselves’. Writing in the Dutch newspaper NRC on 22 April 2009, the philosopher Rob Wijnberg argued that sex education should not focus on girls being viewed as sex objects, but on the way in which the portrayal of boys in films and the media reduces them to their sexual desires. The government is already working on this issue. I have already referred to our planned interventions for combating gender stereotyping. The Ministry of Education is linking in with my policy aimed at making young people more resilient. And I have also made agreements with the Minister of Education that we will develop more interventions aimed at increasing boys’ resilience. I am interested in what motivates boys. What do they want? Is it really so cool to be ‘doing it’ with as many girls as possible? What are the real desires and needs of boys and can they be fulfilled in a way that respects others? Vulnerable groups Another challenge facing us as the government is the sexuality of vulnerable groups such as immigrants, the poorly educated, prostitutes and the disabled. Lecture State Secretary Bussemaker, Sexual health, 12 May 26 2009 Let me discuss two of these groups briefly. Certain sexual problems are more prominent among people of immigrant origin than among the indigenous population. For example, Surinamese and Antillean youngsters are more likely to get sexually transmitted infections. Teenage pregnancies and abortions are very common among Surinamese and Dutch Antillean girls and women from Africa and Central and South America. In addition, the selfassured, more liberal attitude of young immigrants to sex may run counter to the conservative, closed attitudes of older generations. The most extreme reaction to this is honour killing. This brings me to the second group: I am receiving signals from the field of sexual health that policy should focus more on people with mental or physical disabilities or chronic illnesses. For example, sexuality in the case of disabled children is an emotionally charged topic: it leaves parents very confused and prompts many questions from professionals working in this sector. The main issues include when and how to teach these children about sex, abuses within the care system, the best type of contraception, and early or delayed puberty. My plan is to inventarise the problems of this particular group – people with a mental or physical impairment or chronic illness – and what I propose to do for them. Sexually transmitted infections (STIs) The government is also concerned about the problem of STIs. Chlamydia infections among teenagers are on the increase. Young men who have sex with other men are increasingly opting for unprotected sex. Because good medication tends to mask HIV, they underestimate the chance of becoming infected. Professionals are warning of new problems in relation to sexually transmitted diseases and HIV, such as an increase in hepatitis B and C infections. How can we avert these undesirable developments and how far should the government be involved? We require obese candidates for IVF treatment to first tackle their obesity, otherwise the likelihood of success is too small. Should we similarly insist that before people receive treatment for STIs and HIV, they sign a contract that they will only practise safe sex? There are many possible objections to this approach. One is that it may deter people from getting treatment, and increase the risk of infection spreading further. Another is that it is impossible to check whether people have done what they pledged to do. And yet, we must confront the reality of these unsafe practices. Lecture State Secretary Bussemaker, Sexual health, 13 May 26 2009 Sexual coercion There are other areas, too, where we are seeing new or extremely persistent risks. I am concerned about the current figures for sexual coercion: at least 40% of women and 7% of men have at some time fallen victim to some form of sexual violence. This varies from sexual assault to rape. 18% of girls aged between 12 and 25 years are forced to have sex against their will. This is extremely serious and we as a society must not tolerate it. My policy therefore includes preventing and tackling sexual violence. And within the framework of my policy theme ‘Protected and self-reliant’, by intensifying care and assistance to the victims of violence in dependent relationships, I am also investing substantially in improving the services offered, especially to the victims of sexual violence. I am making extra funding available for this purpose. Ladies and gentlemen, this brings me to my conclusion. At the end of this year the Minister of Health, Welfare and Sport and I will jointly produce a detailed policy letter about sexual health. I can already tell you what its underlying principle will be: for many years, the government has been involved with morality issues and the sexual health of its citizens, and it will continue to do so in the future. It is the government’s duty to set clear boundaries in regard to practices that should not be tolerated in Dutch society. For instance, the violation of the basic principle that boys and girls should be treated as equals, the contention that homosexuality is not a sexual identity in its own right, and resorting to violence in dependent relationships. The government will also play a steering role in facilitating the freedom and autonomy of the individual. But at the same time the government must be careful not to intrude into the bedroom nor make pronouncements about what constitutes ‘good sex’. These are the parameters within which policy is being developed – a policy that is dynamic and responds to social trends. We are not a nanny state. It is our intention to promote freedom and autonomy for the citizens of this country, not to tell them what they may or may not do in the most intimate moments of their personal lives. Lecture State Secretary Bussemaker, Sexual health, 14 May 26 2009 Sources The following sources were consulted: • ‘Seks onder je 25e’, Soa Aids Nederland and Rutgers Nisso Groep, 2005 (research paper); • ‘Identificatie met Nederland’, Advisory Coucil on Government Policy (WRR), 2007; • ‘In de schaduw van de lust. Vijfentwintig jaar Rutgers Stichting (1969-1994)’, Lidy Schoon; • ‘Zwijgen is Zonde. Over seksuele en relationele vorming aan jongeren in multireligieuze en multiculturele groepen’, Barbara van Ginneken, Yuri Ohlrichs, Ineke van der Vlugt, Rutgers Nisso Groep, 2007; • Rapport ‘Doel(groep) bereikt – bevordering van de seksuele gezondheid tegen een culturele achtergrond’, Research voor Beleid, 2009; • ‘Seks en de seksen. Een geschiedenis van moderne omgangsvormen’, Cas Wouters, 2005; • ‘Seksuele gezondheid in Nederland 2006’, RNG-studies nr.9, edited by Floor Bakker and Ine Vanwesenbeeck, 2006; • ‘Vrouwenlexicon. Tweehonderd jaar emancipatie van A tot Z’, 1989; • ‘Seksualisering: “Je denkt dat het normaal is…”. Onderzoek naar de beleving van jongeren’, Hanneke Felten, Kristin Janssens, Luc Brants, Movisie, 2009; • Seksualisering: aandacht voor etniciteit. Een onderzoek naar verbanden met opvattingen en gedrag van jongeren’, Hanneke de Graaf, Corine van Egten, Saskia de Hoog, Willy van Berlo, Rutgers Nisso Groep/E-quality, 2009; • ‘Seksualisering. Reden tot zorg? Een verkennend onderzoek onder jongeren’, Hanneke de Graaf, Peter Nikken, Hanneke Felten, Kristin Janssens, Willy van Berlo, Rutgers Nisso Groep/Nederlands Jeugdinstituut/Movisie, 2008; • ‘Tienerseks. Vormen van instrumentele seks onder tieners’, Hanneke de Graaf, Mechtild Höing, Miriam Zaagsma, Ine Vanwesenbeeck (Rutgers Nisso Groep), commissioned by the Research and Documentation Centre (WODC) of the Ministry of Justice, 2007; • ‘Trends in seksualiteit in Nederland. Wat weten we anno 2008?’, Rutgers Nisso Groep, 2008; • Interviews were conducted with various professionals in the field. On behalf of the Platform Soa en Seksuele Gezondheid (Platform for Sexually Transmitted Diseases and Sexual Health), special thanks go to Monique Kremer (Advisory Council on Government Policy) and Ine Vanwesenbeeck (Rutgers Nisso Groep). Thanks are also due to Ton Coenen (STI AIDS Netherlands), Dianda Veldman (Rutgers Nisso Groep) and Onno de Zwart (Rotterdam Municipal Health Services); • Various websites and articles (in newspapers and other publications) were also consulted. Lecture State Secretary Bussemaker, Sexual health, 15 May 26 2009